title: A rare granulosa cell tumor presentation with virilization and cystic adnexal mass on three-dimensional ultrasound: a case report.
abstract: BACKGROUND
  Androgen-producing granulosa cell tumors (GCTs) are rare but should be suspected in patients presenting with rapid onset virilization and a large cystic adnexal mass. Preoperative diagnosis is difficult. By ultrasound, completely cystic, estrogen-producing GCTs are uncommon, while 39% of reported androgenic GCTs are completely cystic. We report a case of a GCT presenting with virilization and initially characterized on 3-dimensional (3-D) ultrasound.
  
  
  METHODS
  A 32-year-old woman, gravida 1 para 0010, presented with amenorrhea, rapid onset hirsutism, acne, a 15-lb (6,803 g) weight gain, and an 8.7-cm cystic adnexal mass. The mass was evaluated with 2-D ultrasound and characteristics were confirmed on 3-D ultrasound. No abnormal Doppler flow was noted. Initial laboratory values confirmed hyperandrogenemia. A laparoscopic right salpingo-oophorectomy was performed after thorough counseling, and pathology demonstrated an adult granulosa cell tumor. Postoperatively her androgen levels normalized and symptoms resolved within 6 weeks. She continues to pursue pregnancy.
  
  
  CONCLUSIONS
  Presentations of androgen-producing ovarian masses are rare; however, the possibility of an androgenic GCT should be considered in the presentation of a large, virilizing, cystic adnexal mass to facilitate appropriate counseling and management.
authors.forename: Staci
authors.initials: S
authors.lastname: Tanouye
authors.forename: Ravi
authors.initials: R
authors.lastname: Gada
authors.forename: Abimbola
authors.initials: A
authors.lastname: Famuyide
authors.forename: Charles
authors.initials: C
authors.lastname: Coddington
mesh_terms: D000152:Acne Vulgaris / Q000209:etiology; D000328:Adult; D000568:Amenorrhea / Q000209:etiology; D003687:Dehydroepiandrosterone / Q000097:blood*; D005187:Fallopian Tubes / Q000601:surgery; D005260:Female; D006106:Granulosa Cell Tumor / Q000000981:diagnostic imaging* / Q000601:surgery; D006628:Hirsutism / Q000209:etiology*; D006801:Humans; D021621:Imaging, Three-Dimensional; D010535:Laparoscopy; D010051:Ovarian Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D010052:Ovariectomy; D035583:Rare Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D013739:Testosterone / Q000097:blood*; D014463:Ultrasonography; D015430:Weight Gain
chemical_list: D013739:Testosterone; D003687:Dehydroepiandrosterone