This 8 yo F presented to her PCP with vaginal bleeding and was diagnosed with precocious puberty. She presented to the ED with symptomatic anemia and had a pelvic US which revealed a left ovarian mass consistent with a hormone secreting granulosa cell tumor. Granulosa cell tumors are rare, but do secrete estrogen and this was the likely source of this patient’s precocious puberty. Granulosa cell tumors often appear as large multiloculated masses.

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