Synchronous Granulosa Cell Tumor and Endometrial Pathologies: A Descriptive Case Series

Background: Granulosa cell tumors (GCTs) are rare ovarian sex cord–stromal neoplasms characterized by estrogen secretion, which can result in prolonged endometrial stimulation. This hormonal activity increases the risk of synchronous endometrial and uterine pathology, particularly in women presenting with abnormal uterine bleeding. Failure to recognize concurrent uterine disease may lead to diagnostic delay or suboptimal surgical management. Case Presentation: This descriptive case series includes five women aged 44–62 years who presented with abnormal uterine bleeding, postmenopausal bleeding, or abdominal pain. Pelvic imaging in all patients revealed adnexal masses suspicious for ovarian pathology. All patients underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. Histopathological examination confirmed adult-type granulosa cell tumors in all cases, with coexisting uterine and endometrial pathologies including endometrioid adenocarcinoma, disordered proliferative endometrium, adenomyosis, leiomyoma, and chronic cervicitis. Results: Synchronous uterine or endometrial pathology was identified in all five patients. One patient had FIGO stage IB endometrioid endometrial carcinoma, while the remaining cases demonstrated benign but clinically significant uterine conditions. Postoperative recovery was uneventful in all patients. The findings underscore the diagnostic value of comprehensive uterine evaluation in patients with suspected ovarian granulosa cell tumors. Conclusion: Granulosa cell tumors may coexist with significant uterine and endometrial pathology due to estrogen excess. This case series highlights the importance of routine endometrial assessment in women with suspected GCTs, particularly those presenting with abnormal uterine bleeding, to ensure accurate diagnosis and optimal surgical planning. Larger prospective studies are required to better define the prevalence and clinical implications of synchronous pathology. Keywords: Abnormal Uterine Bleeding, Endometrial Pathology, Estrogen-Secreting Ovarian Tumor, Granulosa Cell Tumor, Synchronous Gynecologic Disease.