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    Acute Abdomen With Hemoperitoneum: A Rare Presentation Caused by The Rupture of Ovarian Granulosa Juvenile Cell Tumor

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    Granulosa juvenile cell tumors are rare neoplasms occur the most often before 20 years with a maximum of frequency between 0 and 10 years, in 44% of cases. These are rare tumors, less than 5% of ovarian tumors of the child and the teenager. 90% of these tumors are usually diagnosed at the stage 1 of the FIGO classification with a favourable prognosis. The presenting symptoms are usually nonspecific with abdominal pain or distension.

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    Acute Abdomen With Hemoperitoneum: A Rare Presentation Caused by The Rupture of Ovarian Granulosa Juvenile Cell Tumor

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    Scivision Publishers
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    Granulosa juvenile cell tumors are rare neoplasms occur the most often before 20 years with a maximum of frequency between 0 and 10 years, in 44% of cases. These are rare tumors, less than 5% of ovarian tumors of the child and the teenager. 90% of these tumors are usually diagnosed at the stage 1 of the FIGO classification with a favourable prognosis. The presenting symptoms are usually nonspecific with abdominal pain or distension.

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    Acute Abdomen with Hemoperitoneum: A Rare Presentation Caused by The Rupture of Ovarian Granulosa Juvenile Cell Tumor

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    Granulosa juvenile cell tumors are rare neoplasms occur the most often before 20 years with a maximum of frequency between 0 and 10 years, in 44% of cases. These are rare tumors, less than 5% of ovarian tumors of the child and the teenager. 90% of these tumors are usually diagnosed at the stage 1 of the FIGO classification with a favourable prognosis. The presenting symptoms are usually nonspecific with abdominal pain or distension.

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    3 views3 pages

    Acute Abdomen With Hemoperitoneum: A Rare Presentation Caused by The Rupture of Ovarian Granulosa Juvenile Cell Tumor

    Uploaded by

    Scivision Publishers
    Granulosa juvenile cell tumors are rare neoplasms occur the most often before 20 years with a maximum of frequency between 0 and 10 years, in 44% of cases. These are rare tumors, less than 5% of ovarian tumors of the child and the teenager. 90% of these tumors are usually diagnosed at the stage 1 of the FIGO classification with a favourable prognosis. The presenting symptoms are usually nonspecific with abdominal pain or distension.

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    of 3

    Case Report ISSN 2689-1093

    Research Article Surgical Research

    Acute Abdomen with Hemoperitoneum: A Rare Presentation Caused by


    The Rupture of Ovarian Granulosa Juvenile Cell Tumor
    Hamillour B*
    *
    Correspondence:
    HAMILLOUR Bochra, Public hospital establishment -Meghlaoui
    Public Hospital Establishment, Meghlaoui Brothers Hospital, Mila -Algeria.
    Department of Surgery, Mila, Algeria.
    Received: 29 May 2019; Accepted: 21 June 2019

    Citation: Hamillour B. Acute Abdomen with Hemoperitoneum: A Rare Presentation Caused by The Rupture of Ovarian Granulosa
    Juvenile Cell Tumor. Surg Res. 2019; 1(1): 1-3.

    ABSTRACT
    Granulosa juvenile cell tumors are rare neoplasms occur the most often before 20 years with a maximum of
    frequency between 0 and 10 years, in 44% of cases. These are rare tumors, less than 5% of ovarian tumors of the
    child and the teenager. 90% of these tumors are usually diagnosed at the stage 1 of the FIGO classification with a
    favourable prognosis. The presenting symptoms are usually nonspecific with abdominal pain or distension. Acute
    abdomen due to spontaneous rupture of (JGCT) is extremely rare clinical condition particularly in otherwise
    healthy subjects.

    We report a case of acute abdomen in a young girl due to spontaneous rupture of ovarian tumor. The patient was
    taken up for emergency; laparotomy drainage of hemoperitoneum and left salpingo-oophorectomy was done.

    Keywords temperature 38.2°C. Pelvic examination revealed nearly 15 cm


    Acute abdomen, Juvenile Granulosa Tumor, Ovarian Tumor, pelvic mass on the right adnexal region. Her hemoglobin count was
    Child, Surgery. 9 gr/dl. Hemostatic resuscitation has been used successfully in our
    patient. After obtaining stable vital signs, abdominal ultrasound
    Introduction and pelviabdominal tomography examination confirmed the mass
    Ovarian juvenile granulosa cells are rare; only 0.1% of all ovarian in the right adnexa measuring 1 3 × 1 2 × 8 cm without septations,
    tumors I infants. Their prognosis is predominantly favourable. and also revealed free fluid at Morisson’s space and the cul-de-sac
    Hemoperitoneum occurring as a result of spontaneous rupture of (Figure 1, Figure 2).
    the ovarian tumor is a rare complication that is potentially life-
    threatening in the immediate future.

    Observation
    A 12-year-old girl was brought to our emergency department
    with severe right lower abdominal pain. There was no history of
    abdominal trauma in the past, or any other chronic illness. The
    patient who was menarchic for two weeks she attained menarche
    12 days back with normal menstrual flow. She presented with
    tachycardia; hypotension; Glasgow coma scale 15, with abdominal
    distension for three months ago.

    Physical examination revealed abdominal tenderness and acute


    abdomen. Patient looked with normal weight, was dehydrated
    and pallor was present. Her vitals were pulse rate 120 bpm, blood
    pressure 90/60 mmHg, respiratory rate 28/min, SpO2 98%, and
    Surg Res, 2019 Volume 1 | Issue 1 | 1 of 3
    Figure 1: CT (axial view) revealed a large tumor in the entire abdomen
    and showed without septum in the cystic tumor.

    Figure 4: Laparotomy specimen showing right ovarian cystic mass.

    Postoperative recovery was uneventful and at follow up one year


    after surgery the patient was completely asymptomatic. Histology
    confirmed the diagnosis of ovarian juvenile granulosa cells cystic,
    Figure 2: CT (coronal view) of the abdomen and pelvis showing cystic evaluated as granulosa cell tumor at least stage 1, no chemotherapy
    mass and hemoperitoneum. was given.

    Because of the clinical findings and 1 gr/dl hemoglobin fall in Discussion


    three hours, an immediate exploratory laparotomy was performed. In 1855 Rokitansky presented a first description of juvenile
    ovarian granulosa tumor (JGCT). It has been established with
    During laparotomy large mass arising from right ovary was correlation of morphological aspect of cells tumor , close to that
    observed, 2700 cc of blood, ruptured and actively bleeding. of the granulosa cells of the ovarian follicle [1] They belong to
    Omentum, the left ovary, and the uterus were normal, and right the group of tumors (the mesenchyme and the sexual cord),
    salpingo-oopherectomy was performed in emergency conditions represent more than 70% of the malignant tumors of this group
    (Figure 3, Figure 4). and 5% of the ovarian cancers [1,2]. The incidence of this tumor is
    estimated at 1.3 per year per 100,000 females [1-3]. We distinguish
    two different anatomoclinical entities: the forms adults are more
    frequent, accounting for 95% of case; they occur during the peri-
    and postmenopausal period, with a frequency spike around 50 to
    55 years [2,3]. The juvenile form is much rarer representing 5% of
    these tumors; it occurs in women young people under 30 or pre-
    pubertal [3,4].

    The most common form is that of the adult, accounting for nearly
    95% of granulosa cell tumors. They are usually present in women
    over 40 years old in contrast, less than 5% of tumors are of the
    juvenile [1-3].

    Tumors of juvenile granulosa is rarely seen or isolated because


    it is often found in a syndromic setting in association with other
    pathological such as Olliers endochondromatosis, Maffucci
    syndrome and dysplastic abnormalities [5].

    Cellular and molecular alterations are involved in the development


    of JGCT, this hypothesis has been supported in the literature. On
    the light of chinieses study; Wen-Chung Wang and Yen-Chein Lai
    juvinil-type granulosa cell tumors are associated with FOXL2
    402C > G mutation. In addition to this unique FOXL2 mutation,
    they found DNA replication error and loss of heterozygosity. DNA
    mismatch repair system failure can be detected likely in these
    Figure 3: 2700 cc of blood, from cyst bleeding. patients [6].
    Surg Res, 2019 Volume 1 | Issue 1 | 2 of 3
    Symptoms are usually nonspecific with different clinical without any secondary sexual characteristics; we conclude that
    presentation such as chronic abdominal pain, an abdominal mass, it is very important to sensitize the population toward the early
    or distension. In rare cases symptoms related to hyperestrogenesim consultation in cases of young girls with an abdominal mass and
    in prepubertal age group, precocious puberty with breast pain abdomen. This is necessary to pick up ovarian tumors. Surgery
    development increased pubic hair, vaginal bleeding [1-4]. Acute is the mainstay of initial management for histological diagnosis,
    abdomen is a rare presentation of JGCT. Till now, very few cases appropriate staging, and debulkingat initial stages so that prompt
    have been reported [7-10]. therapy can be instituted and the prognosis can be improved in
    these patients.
    Occasionally, JGCT rupture causes abdominal pain and
    hemoperitoneum. It is usually associated with a mass on pelvic References
    examination which is subsequently confirmed with imagine 1. Lazrak. Granulosa-cell tumor of the ovary. International
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    1024.
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    alpha-subunit which can be elevate in 87 % showed a rise in chemotherapy in the management of patients with adult
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    3. S Ellouze, S krichen-Makni, K Trabelsi, et al. Granulosa-cell
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    Juvenil granulosa cell in a woman with Maffucci syndrome
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    the treatment of choice [4,7,8,10]. 8. Fox H, Agrawal K, Langley FA. A clinicopathologic study
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    Chemotherapy is reserved only for recidivism its principle is 10. Leder RR, Lane VM, Barrett DP. Ovariectomy as treatment
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    Postmenopausal Woman: A Case Report and Literature
    Conclusion Review. J Pathol Transl Med. 2018; 52: 344-348.
    In addition to its rarity in childhood, the presented case is of
    particular interest for having abdominal pain and distension only

    © 2019 Hamillour B. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License

    Surg Res, 2019 Volume 1 | Issue 1 | 3 of 3

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