GYNECOLOGIC ONCOLOGY Pregnancy concomitant with metastatic adult granulosa cell tumor R. Agarwal • G. Radhakrishnan • A. G. Radhika • J. Jain • S. Sharma • H. Srivastava Received: 24 March 2011 / Accepted: 15 June 2011 / Published online: 26 June 2011 Ó Springer-Verlag 2011 Abstract Introduction Metastatic adult granulosa cell tumor of the ovary is rarely encountered with pregnancy. Case report and results Primigravida (26 years) pre- sented at 20 weeks of gestation with acute abdomen and clinical evidence of supraclavicular lymphadenopathy and ascites. She was diagnosed of adult granulosa cell tumor (AGCT) of the right ovary following right salpingoophr- ectomy done 1 month prior to conception. Fine needle aspiration cytology of supraclavicular lymph node, revealed it to be a metastatic AGCT. Chemotherapy was given antepartum and she delivered a healthy preterm baby at 30 weeks. Subsequently, she had optimal debulking surgery following 6 cycles of cisplatin-based chemother- apy. Baby at 10 months of age was with normal milestones. Conclusions The case is an unusual presentation of metastatic adult granulosa cell tumor at child bearing age. Although rapidly progressing, successful prolongation of pregnancy till 30 weeks of gestation was possible with the judicious use of chemotherapy. Fetal and maternal out- comes were favorable. Keywords Granulosa cell tumor Á Pregnancy Á Chemotherapy Introduction The incidence of ovarian malignancies during pregnancy varies from 0.05 to 0.07 per 1,000 pregnancies. Only 10% of granulosa cell tumors (GCT) is present during preg- nancy, of which approximately 90% of GCT is at stage I at the time of diagnosis, with Juvenile variety being more common [1]. This case highlights an unusual type of metastatic adult granulosa cell tumor (AGCT) occurring in the third decade of life with progression to stage IV within 5 months of primary surgery. Metastatic adult granulosa cell tumor (AGCT) with successful pregnancy outcome with chemotherapy is previously unknown. Case report A 26-year-old primigravida presented in surgical emergency at 20-week period of gestation with complaints of acute pain abdomen and progressive distension of abdomen for the past 6 days. She had been married for 5 years and conceived after induction of ovulation. At the time of her infertility workup, as described in the case records carried by the patient 2 years back, she had been detected to have right tubo-ovarian mass suspected to be tubercular and was trea- ted with antitubercular therapy [4HREZ (isoniazid, rifam- picin, ethambutol, pyrazinamide) ? 2HR] for 6 months with no response. Subsequently, she underwent laparoscopy R. Agarwal Á G. Radhakrishnan Á A. G. Radhika Á H. Srivastava Department of Obstetrics and Gynaecology, UCMS and GTB Hospital, Delhi, India J. Jain Department of Oncology, Delhi State Cancer Institute, Delhi, India S. Sharma Department of Pathology, UCMS and GTB Hospital, Delhi, India R. Agarwal (&) 4/103, East End Apartments, Mayur Vihar Ph-I Extension, Delhi 110096, India e-mail: rachna_anila@yahoo.co.in 123 Arch Gynecol Obstet (2011) 284:743–747 DOI 10.1007/s00404-011-1958-y