GnRHa as A Treatment for Letrozole-Resistent Recurrent Adult Granulosa Cell Tumors:A Case Report and Literature Review

1. Abstract Ovarian Granulosa Cell Tumors (GCTs) are the most common type of ovarian sex cord-stromal tumor. They follow an indolent course and are characterized by a long natural history The optimal management of Recurrent GCT has never been determined by randomized trials ,Hormone therapy maybe an alternative here we report a case of Recurrent GCT treated with GnRHa and achieved clinical cure.A 46-year-old woman presented with third recurrence after primary treatment for adult granulosa cell tumor. She developed tumor progression and drug-induced nephritis after 6 cycles of TP chemotherapy for the second recurrence and failed to benefit from chemotherapy, after the third Optimal cytoreduction and tumor progression after Letrozole treatent for 6 months. we try to Experimental treatment with Diphereline achieved Good therapeutic effect. 2. Highlights • There is no optimal treatment for recurrent granulocell tumor. For this patient, we tried to use hormone therapy replace of chemotherapy and radiotherapy. • Considering the different mechanisms of action of Letrozole and GnRHa, we tried GnRHa treatment after letrozole resistance. • The literature reported that letrozole had the highest response rate, but this patient still benefited from GnRHa even after letrozole resistance, as we know, no similar case has been reported. 3. Introduction Granulosa cell tumors constitute less than 5% of all ovarian tumors. Unlike epithelial ovarian tumors, they occur in a younger age group, are usually detected in an early stage. They follow an indolent course and are characterized by a long natural history. Due to the chance of recurrence even years after apparent clinical cure of the primary tumor, lifelong follow up is recommended. About 25 % GCT develop recurrence and the median time to recur is usually 4–5 years [1]. Most recurrences are intraperitoneal and usually a complete debulking of the disease is feasible even in the recurrent setting. Postoperative chemotherapy (platinum based) is usually given after surgery more so in cases with widespread disease or after sub-optimal cytoreduction. Recurrent chemoresistant, progressive non-responding GCT or patients with high surgical risk are ideal candidates for targeted therapy [2]. During the last decade, our understanding of the molecular pathogenesis of AGCTs has significantly improved, whereas the developments of chemotherapeutic regimens and targeted therapies have remained modest. Here we report a case of Recurrent Adult Granulosa cell tumors, after three times of cytoreduction, we use letrozole as postoperative treatment for 6 mouths, Radiographic findings showed recurrence, and letrozole resistance was considered. We tried GnRHa treatment and achieved clinical cure. 4. Case Presentation The patient is a 46-year-old female with the third recurrence after primary treatment for adult granulosa cell tumor. 15 years ago, total abdominal hysterectomy, bilateral salpingo-oophorectomy