Peritoneal washing cytology in an adult granulosa cell tumor: A case report and review of literature
A 30-year-old woman presented with menometrorrhagia and abdominal pain 6 years ago. She subsequently underwent left salpingo-oophorectomy (USO) for an adnexal mass, which was diagnosed as AGCT. Then, chemotherapy (Paclitaxel + Carboplatin) was prescribed on the basis of clinical records. In the follow-up, a hetero-echoic mass lesion measuring 6 × 4 cm with multicystic areas in the right adnexal region and multiple peritoneal and omental implants were seen on computed tomography (CT) scans. Then total abdominal hysterectomy with right USO, omentectomy, appendectomy and peritoneal washing were done.\nPeritoneal washing fluid was prepared using conventional methods. Cytology was hypercellular with both large and small overlapping cell clusters []. Tumor cells were round to oval, with hyperchromatic nuclei containing granular chromatin. Micronucleoli and cytoplasmic vacuoles were not observed. Characteristic Call-Exner bodies showing microfollicular structures with amorphous material and rare, coffee-bean-like nuclear grooves were seen []. Theca cells were not observed.\nGross examination of the right ovarian mass showed a tan and solid tumor with small cystic structures. Microscopically, the tumor was composed of granulosa cells arranged in the trabecular and microfollicular pattern []. Mild cytological atypia and 6 mitosis per 10 high power field (×400) were observed in the tumor, while there was no necrosis. Immunohistochemical stains exhibited that the tumor cells were strongly and diffusely cytoplasmic positive for inhibin and negative for epithelial membrane antigen (EMA) []. Both the cytological and histological findings were consistent with the diagnosis of AGCT. The histological examination of the implants in the peritoneal cavity and omentum also confirmed the diagnosis of AGCT.