Liver metastasis of ovarian granulosa cell tumors: a case report and literature review

BACKGROUND: Granulosa cell tumors (GCT) are a distinct type of sex cord-stromal tumor with low-grade malignancy. It frequently recurs due to pelvic dissemination or direct spread, whereas liver metastasis rarely occurs. Here, we report a rare case of a GCT in which recurrence with liver metastasis occurred 14 years later. We also discuss the imaging findings, histological features, and therapeutic approaches, and conducted a review of similar reported cases. CASE PRESENTATION: A 61-year-old female with recurrent ovarian GCT presented with a hepatic mass measuring approximately 8 cm in diameter. After surgical resection, histopathological examination revealed tumor cells nuclei with characteristic longitudinal grooves, a key diagnostic feature of GCT. Additionally, eosinophilic, unstructured Call-Exner bodies were observed. Immunohistochemical staining confirmed positive immunoreactivity for inhibin α, CD99 and CD56 markers. Based on these findings, the tumor was diagnosed as a liver metastasis of an ovarian GCT. The patient remained recurrence-free for 7 years following hepatectomy. CONCLUSIONS: This case highlights the potential of ovarian GCT for late recurrence- even decades after primary treatment. A literature review revealed that, to date, only 21 cases of GCT with liver metastasis have been reported, with the interval between the diagnosis of the primary tumor and the development of liver metastasis ranging from 6 to 40 years. Close long-term follow-up is essential to detect recurrence early and optimize patient outcomes.