Background: Adult granulosa cell tumors (AGCTs) are rare, low-grade malignant ovarian neoplasms of sex cord-stromal origin. They are characterized by an indolent clinical course but possess a significant propensity for late recurrence. Early detection and appropriate intervention are crucial, particularly in resource-limited settings where advanced diagnostic tools and standard chemotherapeutic agents are often constrained.
Case presentation: A 35-year-old nulliparous woman presented with a two-month history of progressive abdominal pain, swelling, and vomiting. Initial imaging suggested a malignant teratoma. Exploratory laparotomy revealed a ruptured left ovarian mass measuring 8×15 cm. Histopathological examination confirmed an adult granulosa cell tumor, staged as FIGO IC2 due to preoperative capsule rupture. Three years post-surgery, she presented with recurrent abdominal swelling. Clinical assessment and imaging confirmed a right ovarian recurrence accompanied by severe ascites. Following emergency surgical debulking, systemic therapy was indicated. Due to the unavailability of Bleomycin in the local setting, a pragmatic chemotherapy regimen of Cisplatin and Etoposide (EP) was initiated. The patient completed six cycles with a favorable clinical response, characterized by the complete resolution of ascites and significant symptomatic improvement.
Conclusion: This case highlights the diagnostic and therapeutic challenges associated with managing recurrent AGCTs in resource-limited environments. It emphasizes the necessity of maintaining a high index of clinical suspicion for recurrence, the critical role of timely surgical debulking, and the pragmatic application of available chemotherapy regimens, such as the EP doublet, when standard protocols are inaccessible.