Abstract
BackgroundGranulosa cell tumor of the ovary is the most frequent sex cord stromal tumor and represents 2 to 5% of all primary ovarian cancers. Ovarian granulosa cell tumor is a malignant tumor with slow progression and in some cases this tumor is hormonally active. The recurrence of granulosa cell tumor often happens after 5 years.Case presentationWe describe two cases of postmenopausal women with adult-type granulosa cell tumors of the ovary. Patient 1 is a 49-year-old European woman with a recurrent tumor; patient 2 is a 55-year-old European woman without recurrence of tumor. Urinary steroid profiles of patient 1 were monitored during a 5-year period starting from before an operation (13 samples). In patient 2, the urinary steroid profiles were monitored during a 3-year period starting from after an operation (six samples). The 24-hour urinary samples were examined and the urinary concentration of 20 androgen, progesterone, and corticoid metabolites was quantitatively determined by gas chromatography-mass spectrometry with selected ion-monitoring mode.ConclusionsBased on these cases a correlation could be observed between increased levels of the urinary steroids and the recurrence of ovarian granulosa cell tumor; therefore, we concluded that a urinary steroid profile could be a more effective method to follow-up such patients compared to the traditional serum hormones determinations supplemented with conventional tumor markers.
Highlights
Based on these cases a correlation could be observed between increased levels of the urinary steroids and the recurrence of ovarian granulosa cell tumor; we concluded that a urinary steroid profile could be a more effective method to follow-up such patients compared to the traditional serum hormones determinations supplemented with conventional tumor markers
Six months after the OP the urinary concentrations of An, Et, 11OH-An, 16-OH-DHEA, Δ5-AT, PT, Δ5-PD, THE, THA, THB, THF, aTHF, α-CL and α-C were higher than the reference values
In sample 9 (2 years 11 months after OP and before epirubicin + cisplatin chemotherapy) the urinary concentrations of An, Et, DHEA, 11-OH-An, 16-OH-DHEA, Δ5-AT, PT, Δ5-PD, THE, aTHF, and α-CL were found to be higher than the reference values again
Summary
Our results suggest that the recurrence of GCT changes urinary steroid profiles, which was indicated by the differences between the urinary steroid levels of the two patients. To confirm that the presence of a GCT can be identified based on a urinary steroid profile, we plan to carry out further multicenter clinical trials. Abbreviations 11-OH-An: 11β-hydroxyandrosterone; 11-O-PT: 11-keto-pregnanetriol; 16-OHDHEA: 16-hydroxy-DHEA; A: Androstenediol; AFP: Alpha-fetoprotein; An: Androsterone; aTHB: Allo-tetrahydrocorticosterone; aTHF: Allotetrahydrocortisol; BEP: Bleomycin, etoposide, and cisplatin; CA125: Carbohydrate antigen 125; CA-15-3: Carbohydrate antigen 15–3; CA-199: Carbohydrate antigen 19–9; CAP I: Cyclophosphamide and doxorubicin; CEA: Carcinoembryonic antigen; CT: Computed tomography; DHEA: Dehydroepiandrosterone; E2: 17β-estradiol; Et: Etiocholanolone; FSH: Follicle-stimulating hormone; GC-MS: Gas chromatography-mass spectrometry; GCT: Granulosa cell tumor; LH: Luteinizing hormone; MRI: Magnetic resonance imaging; OP: Operation; P: Progesterone; PD: Pregnanediol; PT: Pregnanetriol; SIM: Selected ion-monitoring; T: Testosterone; THA: Tetrahydro-11-dehydrocorticosterone; THB: Tetrahydrocorticosterone; THE: Tetrahydrocortisone; THF: Tetrahydrocortisol; THS: Tetrahydro-11deoxycortisol; α-C: α-cortol; α-CL: α-cortolone; β-CL: β-cortolone; Δ5AT: Androstenetriol; Δ5-PD: Pregnenediol
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