Ovarian granulosa cell tumors: a retrospective study of 27 cases and a review of the literature

Abstract

BackgroundGranulosa tumors were described for the first time in 1855 by Rokitansky. These tumors are malignancies with a relatively favorable prognosis. They are characterized by a prolonged natural history and a tendency to late recurrences. The aim of this study is to investigate the epidemiological and pathological characteristics of granulosa cell tumors and to investigate the prognosis factor for recurrences.MethodsThe clinical data of patients who were treated in the period from January 2003 to December 2010 at the National Institute of Oncology in Rabat, Morocco for adult granulosa cell tumors of the ovary were investigated retrospectively. Data for age, clinical manifestation, imaging, diagnosis and treatment of the patients were reviewed and analyzed. Post-operative histology was obtained for all patients.ResultsTwenty-seven cases were retrieved. The median patient age was 53 years. The most common clinical manifestations at diagnosis were abdominal pain and vaginal bleeding. Mean tumor size was 14 cm.The majority of patients had stage I (63%, n = 17), while (18,5%, n = 5) had stage III, (7.4%, n = 2) had stage IV, and (11%, n = 3) of patients had an unknown stage.In the follow-up period (median = 63.44 months), five (18.51%) patients relapsed. The median time to relapse was 41.8 months, (range: 18 to 62 months).ConclusionsGranulosa cell tumor of the ovary is an uncommon neoplasm. The adult form progresses slowly and often is diagnosed in an early stage of disease. Surgery is indicated. A prolonged post-therapeutic follow-up is necessary because of the risk of recurrences, late and exceptional for the adult form.

Single tertiary care centre experience of ovarian granulosa cell tumour in Chennai, India: a retrospective analysis

“…6 The serum tumor markers are inhibin, estradiol and anti mullerian hormone. 7 The Serum CA125 is not associated with tumor progression. 7 Mutation in FOXL2 gene has been identified in 97% of adult granulosa cell tumor and 10 percentage of juvenile granulosa cell tumor.…”

“…However, late relapse often occurs due to an indolent disease course, and the prognosis of advanced disease is poor, with a 5-year survival rate of 0% to 20%, comparable to that for epithelial ovarian cancer. 4 Prognostic factors for Granulosa Cell tumours have been reported previously and include age, tumor size, tumor rupture, tumor stage, bilaterality, postoperative residual tumour status and high mitotic index (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). However, prognostic factors for Granulosa Cell tumour and it's recurrent nature remain unclear, due to rarity and indolent course of the disease.…”

Juvenile granulosa cell tumour: a rare clinical entity

“…They are characterized by a prolonged natural history and a tendency to late recurrences. 2 Kalfa et al identified a mutation FOXL2 (transcription factor gene) in the majority of GCTs, particularly in adult form. This FOXL2 could be the next target for use in treatment.…”

MANAGEMENT OF ENDOCRINE DISEASE: Hyperandrogenism after menopause

“…Postmenopausal bleeding, hirsutism, and often virilization are the main clinical manifestations, whereas malignant transformation has been reported in very few cases (59). Primary granulosa cell tumors account for 2-3% of all ovarian tumors and are mostly found during the sixth decade of life (67). Although the majority are diagnosed at an early stage (stage I) and thus exhibit a good prognosis, late recurrences and dissemination necessitating systemic chemotherapy may occur.…”

“…Although the majority are diagnosed at an early stage (stage I) and thus exhibit a good prognosis, late recurrences and dissemination necessitating systemic chemotherapy may occur. Granulosa cell tumors mainly secrete estrogens leading to postmenopausal bleeding, endometrial hyperplasia, and endometrial carcinoma; however, w10% may secrete androgens and cause virilization (67,68). In addition to estradiol and testosterone, inhibin and anti-Müllerian hormone can be used as specific tumor markers for granulosa and Sertoli cell ovarian tumors (69,70).…”