Virilizing Juvenile Granulosa Cell Tumor in a Prepubertal Girl with Bilateral Inguinal Hernias: A Case Report.

BACKGROUND

Juvenile granulosa cell tumors usually cause estrogenic precocious puberty; virilization is rare.

CASE: After staged herniotomies for bilateral inguinal hernia, a 4-year-old girl was noted to have pubic hair, clitoromegaly, adult-type body odor, bilateral breast enlargement, a large pelvic mass, and vaginal bleeding. Gonadotropins were suppressed, while estradiol, testosterone, anti-Müllerian hormone, inhibin A, and CA 125 were elevated. Imaging showed a left adnexal mass with ascites. Left oophorectomy confirmed stage IA juvenile granulosa cell tumor. Sex steroids normalized within 7 days after surgical removal of tumor, and anti-Müllerian hormone declined.

CONCLUSION

Coexisting estrogenic and androgenic signs should prompt evaluation for juvenile granulosa cell tumors, particularly in children with a pelvic mass.