DOI: https://doi.org/10.36347/sjmcr.2025.v13i09.009

Pages: 1991-1994

Background: Adult granulosa cell tumors (AGCTs) are rare ovarian neoplasms, representing 2–5% of malignant ovarian tumors. Their clinical presentation is often related to estrogenic activity, commonly causing postmenopausal bleeding and endometrial abnormalities. Preoperative diagnosis remains challenging due to nonspecific symptoms and inconclusive imaging. Case presentation: We report the case of a 56-year-old postmenopausal woman who presented with abundant vaginal bleeding. Pelvic MRI demonstrated significant endometrial thickening but no identifiable ovarian mass. She underwent total hysterectomy with bilateral salpingo-oophorectomy. Histopathological examination revealed atypical endometrial hyperplasia associated with an adult granulosa cell tumor of the left ovary, confirmed by immunohistochemistry. Postoperative staging, including imaging and tumor markers, showed no evidence of metastasis or recurrence. The case was discussed in a multidisciplinary tumor board, and a strategy of clinical and biological surveillance was adopted. Conclusion: This case illustrates the diagnostic difficulties of AGCTs when imaging findings are noncontributory. It emphasizes the central role of histopathology and immunohistochemistry in establishing a definitive diagnosis, the importance of multidisciplinary management, and the need for long-term follow-up given the risk of late recurrence.