Successful laparoscopic cytoreductive surgery for multiple (three) advanced recurrences of AGCT in a young woman. A case report

Introduction and importance: Debulking surgery is the main approach for recurrent adult granulosa cell tumors (AGCTs), but the effectiveness of laparoscopic extensive cytoreduction in advanced cases and its impact on quality of life (QoL) remains unclear. Case presentation: A 34-year-old woman, who had a right adnexectomy for AGCT in 2020, was referred with an 8-month history of a large left ovarian cyst and amenorrhea. Preoperative evaluations indicated a recurrence 18 months post-diagnosis. After discussing her career as a photo model, which required optimal aesthetic outcomes, we opted for total laparoscopic surgery, including radical type A hysterectomy, left salpingo-oophorectomy, pelvic peritonectomy, total mesorectal excision, total omentectomy, and pelvic and lumbo-aortic lymphadenectomy. Pathology confirmed stage 3C recurrent AGCT. After discussions, the patient declined adjuvant chemotherapy and received progestins with close follow-up. Fourteen months later, a positron emission tomography (PET) showed high metabolic activity in the left iliac fossa and right pelvis, confirmed by magnetic resonance as pelvic lymph node recurrence and small intestine involvement. She underwent laparoscopic cytoreductive surgery, including peritonectomy, lymph node metastases removal, and intestinal resection. She recovered with excellent aesthetic results and QoL. She completed six cycles of adjuvant cisplatin (80 mg/m2). Ten months later, following a suspected PET, a diagnostic/operative laparoscopy revealed a miliary peritoneal carcinosis, particularly in Morrison's space. Clinical discussion: Repeated laparoscopic extensive surgery for recurrent advanced AGCT yielded excellent aesthetic outcomes and effective cytoreduction. Conclusion: This case supports the safety and efficacy of minimally invasive techniques, emphasizing their role in preserving QoL and body image.