# Granulosa cell tumor patients presenting with acute abdomen: a case series

## TL;DR

Granulosa cell tumors can present as acute abdomen in over 10% of cases, often requiring emergency surgery and leading to higher recurrence rates.

## Contribution

This study identifies acute abdomen as a significant and under-recognized presentation of adult-type granulosa cell tumors.

## Key findings

- 12.5% of adult-type granulosa cell tumor patients presented with acute abdomen.
- Patients with acute abdomen had more ruptured tumors and ovarian torsion requiring emergency surgery.
- These patients were younger, had higher blood loss, and more frequent recurrences.

## Abstract

•Acute abdomen was the first symptom in 12.5% of adult-type granulosa cell tumor patients.•Most patients with acute abdomen had a ruptured tumor or ovarian torsion requiring emergency surgery.•Granulosa cell tumor patients with acute abdomen were younger and had higher perioperative blood loss than others.•Awareness of granulosa cell tumor as a differential diagnosis in acute abdomen may improve surgical outcomes.

Acute abdomen was the first symptom in 12.5% of adult-type granulosa cell tumor patients.

Most patients with acute abdomen had a ruptured tumor or ovarian torsion requiring emergency surgery.

Granulosa cell tumor patients with acute abdomen were younger and had higher perioperative blood loss than others.

Awareness of granulosa cell tumor as a differential diagnosis in acute abdomen may improve surgical outcomes.

To highlight the unique clinical presentation of acute abdomen in granulosa cell tumor patients.

In a multicenter cohort study of adult-type granulosa cell tumors, women presenting with an acute abdomen at diagnosis were identified (Brink, 2025). After informed consent, clinical data were retrieved from patient records and collected in a Castor EDC database. Statistical analyses were performed to compare the subgroup of women with acute abdomen with the remainder of the adult type granulosa cell tumor cohort.

Twenty-six out of 208 (12.5%) patients had an acute abdomen as presenting symptom of an adult-type granulosa cell tumor. All patients underwent emergency abdominal surgery. In 16 (62%) patients, the tumor mass was found to be ruptured pre-operatively, and 7 (27%) patients had an ovarian torsion. Seventeen patients (65%) of this group developed recurrent disease. When compared with the rest of the adult-type granulosa cell tumor cohort, patients with an acute abdomen at diagnosis were younger, had significantly more perioperative blood loss, and more often developed a recurrence.

Adult-type granulosa cell tumors present with an acute abdomen in over 10% of the cases. In case of an ovarian mass or hemoperitoneum in women with an acute abdomen, a granulosa cell tumor should be considered in the differential diagnosis. Surgery can then be performed with a more oncological approach, striving to avoid spill and thus decrease the risk of recurrence.