title: A recurrent granulosa cell tumor of the ovary 25 years after the initial diagnosis: A case report.
abstract: BACKGROUND
  Granulosa cell tumors (GCTs) are rare functional sex-cord-stromal ovarian neoplasms characterized by low malignancy potential and late relapse, which rarely metastasize to the liver.
  
  
  METHODS
  A 43-year-old female, who had undergone surgery to treat a GCT of the left ovary in 1976, complained of abdominal distention in May 2001. Imaging studies demonstrated masses in the right lobe of the liver, together with massive ascites. The patient's bloody ascites showed no cytological evidence of malignancy. A diagnostic laparoscopy was performed, and the biopsy specimen was histologically proven to be a recurrent granulosa cell tumor. The patient was successfully treated surgery followed by systemic chemotherapy. Her postoperative course was uneventful and systemic chemotherapy was repeated due to the suspicion of a recurrence in the pelvic cavity.
  
  
  CONCLUSIONS
  GCTs which are rare malignant tumors of the ovary, tend to be associated with late recurrence. Although most recurrences occur within 10 years after the initial diagnosis, there are occasional reports of recurrences after 10 years have been. We experienced the rare case of a patient who relapsed 25 years after the initial diagnosis.
  
  
  CONCLUSIONS
  The long natural history of this disease highlights the importance of extended follow up for GCT patients. In addition, aggressive therapy including surgery and chemotherapy may contribute to a patient's long-term prognosis.
authors.affiliation: Department of Transplantation and Digestive Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 8528501, Japan. Electronic address: ffujita-ngs@umin.ac.jp.
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Fujita
authors.affiliation: Department of Transplantation and Digestive Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 8528501, Japan. Electronic address: sueguchi@nagasaki-u.ac.jp.
authors.forename: Susumu
authors.initials: S
authors.lastname: Eguchi
authors.affiliation: Department of Transplantation and Digestive Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 8528501, Japan. Electronic address: takapon@nagasaki-u.ac.jp.
authors.forename: Mitsuhisa
authors.initials: M
authors.lastname: Takatsuki
authors.affiliation: Department of Transplantation and Digestive Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 8528501, Japan. Electronic address: bakehasky@eagle.ocn.ne.jp.
authors.forename: Kazuma
authors.initials: K
authors.lastname: Kobayashi
authors.affiliation: Department of Transplantation and Digestive Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 8528501, Japan. Electronic address: kkanetaka@kce.biglobe.ne.jp.
authors.forename: Kengo
authors.initials: K
authors.lastname: Kanetaka
authors.affiliation: Department of Pathology, National Hospital Organization Nagasaki Medical Center, Ohmura 8560835, Japan. Electronic address: itohm@nmc.hosp.go.jp.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ito
authors.affiliation: Department of Pathology, Nagasaki University Hospital, Nagasaki 8528501, Japan. Electronic address: abek@nagasaki-u.ac.jp.
authors.forename: Kuniko
authors.initials: K
authors.lastname: Abe
authors.affiliation: Department of Transplantation and Digestive Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 8528501, Japan. Electronic address: tkuroki-gi@umin.ac.jp.
authors.forename: Tamotsu
authors.initials: T
authors.lastname: Kuroki
keywords: Diagnostic laparoscopy; Granulosa cell tumor; Metastatic liver tumor; Recurrence