Gulshan Ara Saeed, Naushin Farooq.
Precocious Pseudopuberty due to Juvenile Granulosa Cell Tumor.
J Coll Physicians Surg Pak Jan ;13(5):287-8.

A case of precocious puberty occurring in a young girl is presented. Vaginal bleeding and secondary sexual characteristics had occurred at 7 years of age associated with an abdominal mass. These findings were due to a functional juvenile granulosa cell tumor in the right ovary. Right adenectomy was performed. Histopathology was confirmatory.

Case Report: A 7-year-old girl was brought to the OPD of Federal Government Services Hospital, Islamabad, with the complaints of continuous vague pain in the lower abdomen along with a slowly enlarging tender mass for the last 6 months. Irregular episodes of vaginal spotting were occurring since last 2 months with onset of secondary sexual characteristics. Her two other sisters were normal. Abdominal examination revealed a well-defined tender mass arising from the pelvis, extending towards umbilicus and more towards right side of abdomen. Ultrasonography revealed anteverted uterus of adult size with a 8 mm thick endometrial lining. Right adnexa revealed a 17x12cm size solid-cum-cystic mass with multiple septas. Left ovary was normal. No ascites was visualized. X-rays for bone age corresponded with chronological age. Hormonal assays results were LH:0.01mIU/ml, FSH:0.01mIU/ml, prolactin:8.2ngm/ml, estrogen:527.7pgm/ml, testosterone:3.5nmol/l, and progesterone:1.3ngm/ml. A diagnosis of functional right ovarian tumor was made which was predominantly estrogen secreting. Consent was taken for exploratory laparotomy and right salpingo-oophorectomy. Laparotomy findings revealed normal uterus left ovary and fallopian tube. A 17x12 cm size solid tumor with cystic areas and no necrosis was arising from the right ovary involving the right tube. No other pelvic mass or adhesions visualized. A right salpingo-oophorectomy was performed and the tumor was removed en-masse. Tumor and peritoneal washings were sent for histopathology and cytology. Patient had a smooth recovery with an un-eventful postoperative period. Tumor histopathology report showed juvenile granulosa cell tumor of ovary with negative peritoneal washings.

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