Combined ovarian granulosa cell tumor and mucinous tumor: Collision tumor or heterologous differentiation?

摘要

We read with interest the reports by McKenna et al. (1) and Subrahmanya et al. (2) of combined adult granulosa cell tumor (AGCT) and mucinous cystadenoma in which they argue that such tumors represent heterologous mucinous differentiation within an AGCT. However, personal analysis of a similar case suggests that such combined tumors may also represent a collision tumor as proposed previously by other authors (3,4).A 50-year-old woman who had a hysterectomy 5 years earlier for menorrhagia presented with a 2-year history of progressive abdominal distension and discomfort. Clinical examination revealed a pelvic mass, and subsequent investigations showed an elevated serum cancer antigen 125 of 404units/mL. Serum carcinoembryonic antigen and cancer antigen 19.9 were within the normal range. A computed tomography scan showed a partly solid, partly cystic, left-sided ovarian mass measuring 20 cm in diameter. There were no ascites, and the right ovary, appendix, and large bowel appeared normal. Laparotomy revealed a smooth-surfaced solid and cystic left ovarian tumor adherent to the sigmoid colon, but the right adnexa, large bowel, and appendix were otherwise normal.