Unusual radiologic imaging in juvenile granulosa cell tumor with precocious puberty - A unilocular cyst

Sep 21, 2026

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Juvenile granulosa cell tumor (JGCT) is a rare ovarian sex cord-stromal malignancy and is frequently associated with precocious puberty. A 2-year-2-month-old girl was evaluated for suspected ovarian cancer, dysfunctional uterine bleeding, and early pubertal development. Ultrasound showed a solitary anechoic cystic pelvic lesion, while MRI demonstrated solid components along the cyst wall. IHC confirmed JGCT. Imaging overlaps with adult granulosa cell tumors, so histopathology and IHC remain mandatory despite suggestive imaging features.

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Case report

Background

Case report

Radiology Ca s e Reports 19 (2024) 4283 – 4288 Available online [at](at www.sciencedirect.com)[ www.sciencedirect.com](at www.sciencedirect.com) journal [homepage:](homepage: www.elsevier.com/locate/radcr)[ www.elsevier.com/locate/radcr](homepage: www.elsevier.com/locate/radcr) | Case Report
Unusual radiologic imaging in juvenile granulosa cell tumor with precocious puberty: A unilocular cyst ✩
Nurmilia Afriliani, MDa,b, Tri Wulanhandarini, MDa,b,∗
a Department of Radiology, Faculty of Medicine-Universitas Airlangga, Surabaya, Indonesia b Department of Radiology, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia | | | | --- | --- | --- | | a r t i c l e i n f o | | a b s t r a c t | | Article history:
Received 30 April 2024 Revised 25 June 2024 Accepted 28 June 2024 | | Juvenile Granulosa Cell Tumor (JGCT) represents 5% of all granulosa cell cancers. Precocious puberty is a frequent feature of this tumor. A 2-year and 2-month-old girl was referred with a diagnosis of suspected ovarian cancer, dysfunctional uterine bleeding, and precocious puberty. Radiologic examination revealed the following: Abdominal ultrasonography showed a solitary anechoic cystic lesion in the pelvic cavity. MRI confirmed the existence of solid components on its walls. JGCT was then confirmed using immunohistochemistry (IHC) markers. JGCT, along with adult granulosa cell tumors (AGCT) are subgroups of granulosa cell tumors (GCTs), which are part of pure sex cord tumors. The 2 forms share imaging findings due to their comparable gross appearance. GCTs require diagnostic imaging tests to distinguish them from other ovarian tumors. Two ultrasound patterns can be identified GCTs, and MRI showed that GCTs are more heterogeneous than other sex-cord stromal tumors (OSCs) . In our case, the imaging characteristics for juvenile granulosa cell tumors were nonspecific and these tumors cannot be reliably distinguished from other ovarian neoplasms based on imaging alone. Although GCTs have imaging characteristics that can help to distinguish them from other tumors, confirmation by histopathology and IHC is still mandatory, especially in cases with nonspecific radiological features.
© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.
This is an open access article under the CC BY-NC-ND license
([http://creativecommons.org/licenses/by-nc-nd/4.0/](http://creativecommons.org/licenses/by-nc-nd/4.0/)) | | Keywords:
Juvenile granulosa cell tumor Precocious puberty Ovarian tumor | | | Background Precocious puberty refers to the manifestation of secondary sexual characteristics before the age of 8 in girls and 9 in boys. The signs of puberty experienced by a girl are characterized by the development of breasts (thelarche), while in boys the development of the testicles in both volume and length. Precocious puberty is classified into 2 types: central and peripheral. Peripheral precocious puberty can be due to 2 types of etiolo- ✩ Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. ∗ Corresponding author. E-mail [addresses:](addresses: nurmilia.afriliani-2018@fk.unair.ac.id)[ nurmilia.afriliani-2018@fk.unair.ac.id](addresses: nurmilia.afriliani-2018@fk.unair.ac.id) (N. Afriliani), [ilmiahndaridr@gmail.com](ilmiahndaridr@gmail.com) (T. Wulanhandarini). [https://doi.org/10.1016/j.radcr.2024.06.072](https://doi.org/10.1016/j.radcr.2024.06.072) 1930-0433/© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington. This is an open access article under the CC BY-NC-ND license ([http://creativecommons.org/licenses/by-nc-nd/4.0/](http://creativecommons.org/licenses/by-nc-nd/4.0/)) gies: acquired or hereditary conditions, and functional tumors or cysts are among the acquired causes [1] . Granulosa cell tumors, part of ovarian sex

FAQs

What clinical presentation prompted evaluation in the reported juvenile granulosa cell tumor case?

The patient presented with vaginal bleeding and progressive abdominal enlargement, together with precocious pubertal changes. She was referred for suspected ovarian cancer and dysfunctional uterine bleeding.

What imaging findings were described before immunohistochemistry confirmation?

Ultrasound showed a solitary anechoic cystic lesion in the pelvic cavity, and MRI confirmed solid components on the cyst wall. The imaging features were noted as nonspecific in this case.

Why are histopathology and immunohistochemistry considered essential for diagnosis?

Radiologic characteristics can overlap with other ovarian tumors, making reliable differentiation impossible with imaging alone. Definitive diagnosis requires histopathology and IHC confirmation.

Sep 21, 2026

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