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Joyce F. Liu, MD, MPH
Joyce F. Liu, MD, MPH
Posted: Monday, May 12, 2025
In a case study published in the International Journal of Surgery Case Reports, repeated laparoscopic extensive surgery for a recurrent adult granulosa cell tumor (AGCT) achieved effective cytoreduction with reportedly minimal aesthetic impact. Antonio Macciò, MD, of the University of Cagliari, Monserrato, Italy, and colleagues emphasized the role of such minimally invasive surgical techniques in preserving quality of life and body image in patients with this rare ovarian cancer.
A 34-year-old woman who previously underwent right adnexectomy for AGCT presented with an 8-month history of a large left ovarian cyst and amenorrhea. Preoperative evaluations indicated a recurrence 18 months after the initial diagnosis. Prioritizing aesthetic outcomes, tThe patient requested total laparoscopic surgery, which included radical type A hysterectomy, left salpingo-oophorectomy, pelvic peritonectomy, total mesorectal excision, total omentectomy, and pelvic and lumbo-aortic lymphadenectomy. Pathologic analyses confirmed stage IIIC recurrent AGCT. The patient declined adjuvant chemotherapy and received progestins with close follow-up.
After 14 months, a PET scan revealed high metabolic activity in the left iliac fossa and right pelvis; an MRI confirmed pelvic lymph node recurrence and small intestine involvement. The patient underwent laparoscopic cytoreductive surgery, including peritonectomy, removal of lymph node metastases, and intestinal resection. According to the investigators, she recovered with “excellent” aesthetic results and quality of life. The patient completed six cycles of adjuvant cisplatin (80 mg/m2).
Ten months after her secondary cytoreductive surgery, a PET/CT revealed suspected abdominal hypermetabolic areas. A tertiary laparoscopic surgery showed a miliariform peritoneal carcinomatosis; a peritonectomy was performed. Six months later, based on a PET/CT, there was no significant hypermetabolic activity. The investigators noted that, currently, the patient is healthy with “excellent” quality of life, has stable sexual function, and continues progestin treatment.
“[This] personalized treatment approach [replacing] open surgery and traditional postoperative chemotherapy with multiple laparoscopic procedures...offers new insights for similar cases,” the investigators concluded. “However, due to limitations in patient data, the clinical implications of the report require further investigation.”
Disclosure: The study authors reported no conflicts of interest.
International Journal of Surgery Case Reports
