(12) Adolescent Hyperandrogenism: Consider The Sinister Cause. A Case Report Of A Juvenile Granulosa Cell Tumour.

Background: We present the case of a 14 year old girl, referred to the Paediatric and Adolescent Gynaecology service for the assessment and management of hyperandrogenism. Ultrasound Pelvis revealed a 13cm adnexal cyst. The patient underwent a right salpingo-oophorectomy. Histology confirmed a juvenile granulosa cell tumour.

This case underscores the importance of consideration of a broad differential diagnosis in the assessment of hyperandrogenism, including malignancy.

Case: Our patient presented with a history of incongruent pubertal development; Tanner Stage 1 breast development, in the setting of significant hirsutism, affecting the face, chest, lower abdomen, and inner thigh. US and MRI Pelvis were carried out, and showed a large adnexal cyst, measuring 11.4 x 4 x 7.4cm. Chest x-ray and adrenal US were both carried out and were normal. Testosterone was moderately elevated at 2.7nmol/L (0.22-1.7). Karyotype was 46XX. This patient’s case was discussed pre-operatively at a Gynaecology Oncology MDT

Comments: The differential diagnosis for hyperandrogenism in the adolescent patient includes Polycystic Ovarian Syndrome, late-onset Congenital Adrenal Hyperplasia, and androgen-secreting tumours of the ovary or adrenal gland.

Surgical findings were of an approximately 20cm right ovarian cyst with a solid component, and the patient underwent a right-salpingoophorectomy, complicated by intra-operative spillage of cyst contents. Histology revealed a juvenile granulosa cell tumour. She then had staging, including a CT TAP and completion surgery, including lymph node sampling, omentectomy, and appendicectomy. This confirmed a FIGO Stage 1C1 malignancy, and the patient received three cycles of Carboplatin Paclitaxal adjuvant chemotherapy.

This case highlights the importance of considering malignancy in the differential diagnosis of an adolescent patient presenting with hyperandrogenism.