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

Objective: To highlight the unique clinical presentation of acute abdomen in granulosa cell tumor patients. Methods: 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. Results: 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. Conclusions: 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.