BRIEF REPORT Cytomorphology and Clinicopathologic Correlation of the Recurrent and Metastatic Adult Granulosa Cell Tumor of the Ovary: A Retrospective Review Aparna Harbhajanka,* Pincas Bitterman, Vijaya B. Reddy, Ji-Weon Park, and Paolo Gattuso Granulosa cell tumors (GCT) of the ovary are low grade tumor with a potential ability of late pelvic recurrences and distant metastases. However, there is sparse literature on the cytopatho- logic features of metastatic granulosa cell tumors (MGCT). Between 2000 and 2014, eight cases of MGCT were diagnosed by FNA. Clinical, cytologic, and histopathologic features were reviewed. The age ranged from 34 to 84 years. Metastases were found in abdominal wall (4 cases), pelvic mass (1 case), liver (2 cases), and lung (1 case). The time to metastasis ranged from 1 to 14 years. All cases were hypercellular, with both large and small overlapping cell clusters and individual cells. The cytolog- ic features included: naked nuclei (8/8 cases), Call-Exner bodies (2/8 cases), and prominent metachromatic stroma (3/8 cases). Moderate cytoplasm (4/8 cases) to scant delicate cytoplasm (4/8 cases) was seen. Cytoplasmic vacuoles were also noted (6/8 cases). N/C ratios were high although lower than small round cell tumors like lymphoma. Prominent, central nucleoli were also present (6/8 cases) as well as nuclear grooves (2/8 cases). Cell block was available in 3/8 cases and all were positive for inhibin immunostain. Histologic examination of the metastatic tissue confirmed MGCT. The important cytologic features of GCT like uniformity of tumor cells, nuclear grooves and Call- Exner bodies are occasionally present in MGCT. Prominent nucleoli and many naked nuclei were frequent. Therefore, the accurate interpretation of cytologic findings of MGCT requires cytohistologic correlation and inhibin positivity to avoid unnec- essary surgical interventions for diagnostic purposes. The possi- bility of late recurrence of GCT should be kept in mind. Diagn. Cytopathol. 2016;00:000–000. V C 2016 Wiley Periodicals, Inc. Key Words: metastatic adult granulosa cell tumor; cytology; fine needle aspiration Granulosa cell tumor (GCT) is a rare ovarian sex cord- stromal tumor. It develops from granulosa cells, which produce estradiol. GCT constitute 1% to 2% of all ovari- an neoplasms but are the most common malignant neo- plasms among the sex cord–stromal tumors and occur in women aged 50 to 55 years. 1 The adult granulosa cell tumors (AGCT) most commonly presents with abnormal uterine bleeding (63.9%) and abdominal pain (45.4%). 2 These tumors are regarded as malignancies, although of a low-grade type. Patients with GCT require long-term clin- ical follow-up because of the known, yet unpredictable, recurring or metastasizing behavior many years after a disease-free interval even in those with Stage I or Stage II tumor at diagnosis. 3,4 Cytological features of AGCT such as Call-Exner bod- ies and the presence of nuclear grooves are well described in the literature by the author from our institute. 5 The previous study focused on cytological features of primary GCT of ovary while the present study focused on FNA of metastatic or recurrent GCT of ovary at various sites. There are relatively few case reports in the literature Acknowledgment of sources of support, conflicts of interest and dis- claimer – none. Department of Pathology, Rush University Medical Center, Chicago, Illinois *Correspondence to: Aparna Harbhajanka, 1548 west Harrison street, apt 2B, Chicago, IL 60607. E-mail: aparna_medi@yahoo.com or aparna_harbhajanka@rush.edu Received 20 May 2016; Revised 23 June 2016; Accepted 5 July 2016 DOI: 10.1002/dc.23535 Published online 00 Month 2016 in Wiley Online Library (wileyonli- nelibrary.com). V C 2016 WILEY PERIODICALS, INC. Diagnostic Cytopathology, Vol. 00, No 00 1