Retrospective Analysis of 32 Cases of Ovarian Granulosa Cell Tumours

Abstract

Introduction Granulosa cell tumour (GCT) comprises 2-5% of ovarian malignancies. They are hormonally active tumours and may present with menstrual complaints, abdominal distension or infertility. Prognosis is generally favourable because of the early stage at diagnosis and less aggressive behaviour. Materials and Methods Medical records of 32 cases presenting from January 2008 to December 2014 were retrospectively analysed for the patient characteristics, tumour characteristics and the treatment received. ResultsThe mean age was 42.75 ± 10.25 years (range: 22 to 70 years). The most common presenting symptom was abdominal distension (50.00%) followed by menstrual complaints. The mean tumour diameter was 15.24 cm (range: 4-25 cm). Endometrial pathology was found in 4 patients (12.50%), and all had simple hyperplasia without atypia. Twenty-four patients underwent primary staging surgery; one patient underwent interval debulking surgery after neo-adjuvant chemotherapy. Seven patients had undergone surgery elsewhere of which 4 underwent re-staging and three were given chemotherapy. All patients had the final histopathology of adult granulosa cell tumour except one patient with juvenile granulosa cell tumour. Most patients had stage I disease (81.25%). Post-operative chemotherapy was administered to 22 patients. The most commonly used regimen was paclitaxel and carboplatin. The overall 5-year survival rate was 90%. The mean overall survival was 36.95 ± 34.08 months (range: 0.50 to 112.00 months). Two patients had recurrence at 38 and 44 months, respectively. Conclusion GCT of the ovary is a rare tumour with a tendency for late relapse. Survival is generally excellent as majority of the patients present in early stages.

Fertility-Sparing Surgery for Ovarian Cancer

“…Two important characteristics of granulosa cell tumors affect FSS: bilaterality is only observed in between 2% and 8% of cases [ 118 , 119 , 120 , 121 , 122 ]; and these tumors are often associated with endometrial disorders (hyperplasia or cancers). Therefore, while random biopsies of the contralateral ovary (if macroscopically normal) are not necessary, uterine curettage should be systematically performed.…”

“…The most frequent subtypes of SCSTs are granulosa cell, Sertoli-Leydig cell, and thecal cell tumors. Publications of FSS outcomes in women with SCSTs are scarce and mainly consist of case reports or short series [111][112][113][114][115][116][117][118][119][120][121][122].…”

Oncological Prognosis and Fertility Outcomes of Different Surgical Extents for Malignant Ovarian Sex-Cord Stromal Tumors: A Narrative Review

“…The residual tumor may be associated with an increased risk of death, 5 but some studies suggest that after accounting for stage and age at diagnosis in a study of GCT, this finding was no longer relevant in multivariate analysis. 3 , 26 , 67 Another study did not find any impact on the survival of postoperative residual disease. 85 Cyst rupture is a strong predictive factor for recurrence.…”

“…Moreover, 12.50–26.2% of the GCT patients had simple hyperplasia. 25 , 67 Approximately 5% of AGCT patients had complex hyperplasia with or without atypia, and 1–25.5% had adenocarcinoma. 25 , 68 , 69 Therefore, all fertility preservation patients with GCT should have a thorough endometrial evaluation, especially in patients older than 40 years old and with symptoms like abnormal uterine bleeding.…”

“… 25 , 68 , 69 Therefore, all fertility preservation patients with GCT should have a thorough endometrial evaluation, especially in patients older than 40 years old and with symptoms like abnormal uterine bleeding. 67 , 68 …”