Case Of Granulosa Cell Tumor Research Articles

Tumor de células de la granulosa de tipo adulto. Un caso raro de tumor testicular. Presentación de un caso

Granulosa cell tumors (GCT) belong to the group of sex cord-gonadal stromal tumours. Two types can be differentiated: juvenile and adult. Adult testicular GCT are extremely rare with only a small number of published cases. Their biological behaviour is not completely clear with cases of distant metastasis appearing years after the initial diagnosis. Diagnosis is based on the cytological and architectural characteristics described in its ovarian counterpart, since both are morphologically indistinguishable. We present a further case of GCT of the adult type in a 23 year old man. We discuss the clinical behavior and immunophenotypical characteristics of this rare tumour.

Granulosa cells tumor in mules

Due to the current understanding of infertility and absence of ovarian activity in the female mule, scientificmaterial regarding their reproductive tract is lacking. Information regarding evaluation of the reproductivesystem, as well as diagnoses of ovarian neoplasms, is scarce for female mules. The purpose of this paperis to report the first case of granulosa cell tumor (GCT) in a female mule, characterized through histology,which suggests evidence of cyclicity. During the breeding season, within the Southern hemisphere, mules’ovaries were obtained from slaughterhouses. Notably, a pair ovarian rated was remarkable in size (16.5cm in diameter), weight (1.92 kg) as well as number of antral follicles. On sagittal section, the tissue wastrabecular and fluid filled. Histology revealed irregular cyst formations full of amphophilic fluid ranging incolor from pinkish to purple. The granulosa cells showed up in abnormal histology, featuring a granulosacell tumor. The contralateral ovary was evaluated, demonstrating anatomy, weight and granulosa cellsfrom normal. Therefore, we have described the first granulosa cells tumor report in a mule via gross andhistological features, which suggests evidence of cyclicity in female mules.

Granulosa Cell Tumors of the Ovary: Retrospective Analysis of 17 Cases

Background: Granulosa cell tumors (GCTs) are rare neoplasms with a relatively favorable prognosis. They are characterized by a prolonged history and a tendency to late recurrences. It is the most common type of sex cord-stromal tumors. Aims: To analyze, to report and to better understand the clinico-pathologic features and results of treatment, and prognostic factors of these tumors. Materials and Methods: A retrospective single-institutional review 17 cases of GCTs were treated in National Cancer Institute—Cairo University from January 2010 till December 2014. The clinical and pathological characteristics, treatment, and outcomes of patients with ovarian GCTs were analyzed. Results: Data from 17 patients were obtained. The median age was 54 years (range; 14 - 72). Abdominal pain was the most common presentation (64.7%). The mean tumor size was 14 cm (range; 7 - 23 cm). The majority of our patients were stage I (n = 11; 64.7%), while (n = 3; 17.6%) had stage III and (n = 2, 11.8%) were stage IV. Only one case (5.9%) had an unknown stage (explored outside NCI). The majority of cases were of adult type disease (n = 14) and low grade pathology (n = 10). In follow-up period (median = 42 months; ranging 9 - 60) three patients relapsed; the median overall survival time was not reached yet, however, the estimated 3-year survival was 72.5%. Conclusion: Granulosa cell tumors are rare neoplasms of the ovaries. They progress slowly and often are diagnosed in an early stage. Surgery is the main line of treatment. Prolonged post-therapeutic follow-up is necessary. Definition of proper prognostic factors is mandatory.

Profile of PAP smear cytology and its histopathological correlation at tertiary care center – A retrospective study

Objective: Cervical cancer is the second most common cancer in women worldwide after breast cancer, and in developing countries, the leading cause of death by cancer. It is one of the most preventable and curable of all cancers. Most women are never undergoing a cervical Pap smear screening. The Objective is to study the role of Pap smear in detecting premalignant and malignant lesions as well as nonneoplastic lesions of cervix and to determine the prevalence of various lesions. Methods: This retrospective study of 500 women with age group 18 to 90 years was carried out over a 2 years at cytology section of pathology department, M.P.Shah medical college, Jamnagar. This study had been divided into 2 groups. Group I included study of 400 women who attended gynaecological clinic at GGH hospital Jamnagar and Group II included study of 100 women who attended Pap smear screening camp at Air force hospital, Jamnagar. Pap smears were prepared and after fixation and staining, each smear was carefully examined. Results: In this study, Low-grade squamous intraepithelial lesions was the most common with 62 cases (12.4%) followed by High-grade squamous intraepithelial lesions with 25 cases (5%), then atypical squamous epithelial cells of undetermined significance 14 cases (2.8%), Squamous cell carcinoma 12 cases (2.4%), AGCUS 6 cases (1.2%), AGCUS probably neoplastic origin 1 case (0.2%) and other rare tumors- 1(0.2%) case of granulosa cell tumor and 1 case(0.2%) of clear cell carcinoma were seen. The average age of women for all the epithelial abnormalities was 49 years. Conclusion: Pap smear is a simple, cheap, safe and practical diagnostic tool for early detection of cervical cancer in high risk group population, so it should be established as a routine screening procedure. It also has a greater role in diagnosis of inflammatory lesions including the identification of causative organism, atrophic changes, changes of radiation therapy and some rare tumors. It is recommended that at least a single life-time pap screening cytology of uterine cervix of all the women aged 40 to 50 years.

Granulosa cell tumor of ovary: A clinicopathological study of four cases with brief review of literature.

Introduction:Adult granulosa cell tumor (GCT) is a rare ovarian malignancy having good prognosis in comparison with other epithelial tumors. The study aims to collect data of all granulosa cell tumors diagnosed in ESIC Medical College & PGIMSR, Rajajinagar, Bangalore over the last 3 years and to describe the patient profile, ultrasonographic and various histopathological features.Materials and Methods:A total of 4 granulosa cell tumors were diagnosed in ESIC Medical College & PGIMSR, Rajajinagar, Bangalore during the period from June 2010 to June 2013. The patient's age, clinical manifestations, radiological and histopathological findings were evaluated.Results:All 4 patients were diagnosed as adult granulosa cell tumor, three of four cases were in premenopausal age group and one case was in perimenopausal age. The clinical manifestations were menorrhagia and abdominal pain. Ultrasonographically, 2 cases of granulosa cell tumors were both solid and cystic and one case each was either solid or cystic. Histologically, variety of patterns like diffuse, trabecular, cords, spindle and clear cells were noted. Both Call-Exner bodies and nuclear grooves were observed in all cases. All four cases showed simple hyperplasia without atypia endometrial findings. Follow up on all patients revealed no evidence of recurrence.Conclusion:Granulosa cell tumor of the ovary is a rare ovarian entity. The important prognostic factor is staging of the tumor. Staging and histopathology helps in prediction of survival. Also diligent endometrial pathology has to be sorted to rule out endometrial carcinoma.

The Incidence of Endometrial Hyperplasia and Cancer in 1031 Patients With a Granulosa Cell Tumor of the Ovary

Concurrent presence of endometrial hyperplasia or cancer in patients with granulosa cell tumors (GCTs) is common, with reported incidences of 25.6% to 65.5%. Consequently, bilateral salpingo-oophorectomy and hysterectomy is usually recommended in patients with a GCT, but this remains debatable. Our aim was to evaluate the need for hysterectomy in patients with GCTs by studying the incidence of pathologically confirmed endometrial abnormalities at the time of diagnosis of GCT and during follow-up. All cases of GCT between 1991 and 2012 were evaluated for endometrial pathology using the Dutch nationwide network and registry of histopathology and cytopathology (PALGA). A total of 1031 cases of GCT were identified at a mean ± SD age of 55 ± 17 years. The incidence of GCTs in the period 1991-2012 was 0.61 per 100,000 women per year. Concurrent endometrial cancer at the time of diagnosis of GCT was found in 58 patients (5.9%) and endometrial hyperplasia in 251 patients (25.5%), including complex hyperplasia in 89 patients (9.1%) and simple hyperplasia in 162 patients (16.5%). Long-term follow-up of 490 patients (47.5%) without a hysterectomy showed that endometrial abnormalities were found in 10 patients (2.0%) of which 2 had endometrial cancer. Interestingly, 8 (80%) of the 10 patients with endometrial abnormalities had recurrent GCT at the time of diagnosis of endometrial hyperplasia or cancer. Our data suggest that after surgical removal of GCT, development of an endometrial abnormality, especially cancer, is very rare. Therefore, hysterectomy is not recommended in patients with a GCT without endometrial abnormalities at the time of diagnosis.

Granulosa Cell Tumor of the Ovary With High FDG Uptake

Granulosa cell tumor (GCT) of the ovary is a rare tumor accounting for 2%-5% of ovarian malignancies. Although the usefulness of 18F-FDG PET/CT is well demonstrated in the staging and follow-up of the great majority of ovarian cancers, GCTs are known to cause false-negative results on FDG PET because of very low FDG avidity. We present a case of a GCT in which an 18F-FDG PET/CT proved very useful in the detection of recurrence.

Review of seven cases of granulosa cell tumour of the equine ovary

This paper reviews the equine granulosa cell tumour (GCT) and describes the clinicopathological features, treatment and outcome in seven cases of GCT in mares. Mares were presented with unilateral ovarian...

Granulosa cell tumor of the ovary after long‐term use of tamoxifen and toremifene

The relation between the use of tamoxifen and gynecologic tumors has been documented. In this case, a 58-year-old postmenopausal woman had been treated with tamoxifen for 5 years followed by toremifene for 1.5 years due to the presence of stage II estrogen receptor-positive breast cancer. The patient was found to have a stage Ic granulosa cell tumor of the ovary despite undergoing annual gynecologic examinations. This report presents a case of granulosa cell tumor of the ovary after the long-term use of tamoxifen and toremifene.

Unusual Cause of a Massive Abdominal Cystic Tumor

Question: A 74-year-old Chinese woman presented to the gastroenterology unit with a 3-day history of abdominal distention. This was associated with intractable vomiting and an inability to tolerate food. There had been no bowel movement for the last 2 days. She had a history of total hysterectomy and bilateral salpingo-oopherectomy 19 years ago for ovarian granulosa theca cell tumor, but was otherwise healthy. Physical examination revealed a large, firm, immobile abdominal mass, with no hepatosplenomegaly. Computed tomography revealed a massive cystic lobulated and septated lesion measuring 21 cm in maximal diameter in the right peritoneal cavity (Figure A). Superiorly, it extended to the subhepatic space indenting the gallbladder. Laterally and anteriorly, it was inseparable from the anterior abdominal wall (Figure B). Blood investigations revealed anemia, with hemoglobin of 10.9 g/dL (normal, 11.7–14.7). Chest radiography was unremarkable. Tumor markers alpha-fetoprotein, CA19-9, CA12-5, CA15-3, and carcinoembryonic antigen levels were not elevated. The patient underwent resection of the tumor. Operative findings included a large, multiloculated, cystic tumor weighting 2.1 kg arising from the greater omentum, with no gross peritoneal disease. The tumor was removed, together with the greater omentum and the right-sided peritoneum. Figure C demonstrates hematoxylin and eosin-stained histologic section. What does the black arrow indicate? What is the diagnosis? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. The patient had recurrence of adult granulosa cell ovarian tumor (GCT). Figure C demonstrates oval tumor cells with fine chromatin, single small nucleoli and an occasional longitudinal groove (black arrow), which is a characteristic feature of GCT. Figure D demonstrates uniform cytoplasmic staining with S-100. Of GCTs, 50% are positive for S-100 protein. Figure E shows patchy membranous staining for inhibin (white arrows) in tumor cells. The tumor cells were negative for AE 1/3, calretinin, CD117, CD34, and desmin. Our case illustrates the importance of considering late recurrence of GCT as a cause for an abdominal cystic mass. Accounting for 70% of ovarian sex cord-stromal tumors,1Schumer S. Cannistra S. Granulosa cell tumor of the ovary.J Clin Oncol. 2003; 21: 1180-1189Crossref PubMed Scopus (481) Google Scholar GCTs mainly presents in peri- or postmenopausal women with a median age at presentation of 50 years.2Fox H. Agrawal K. Langley F.A. A clinicopathologic study of 92 cases of granulosa cell tumor of the ovary with special reference to the factors influencing prognosis.Cancer. 1975; 35: 231-241Crossref PubMed Scopus (260) Google Scholar Infertility and treatments for infertility have been suggested as risk factors for the disease.3Unkila-Kallio L. Tiitinen A. Wahlstrom T. et al.Reproductive features in women developing ovarian granulosa cell tumour at a fertile age.Hum Reprod. 2000; 15: 589-593Crossref PubMed Scopus (53) Google Scholar GCTs are known to recur many years after the disease, with the greatest reported time from primary presentation to recurrence being 37 years.4East N. Alobaid A. Goffin F. et al.Granulosa cell tumour: a recurrence 40 years after initial diagnosis.J Obstet Gynaecol Can. 2005; 27: 363-364Abstract Full Text PDF PubMed Scopus (39) Google Scholar Prognostic factors predicting early recurrence include fewer Call-Exner bodies and higher mitotic rates on pathologic examination, as well as more advanced stage and larger tumor size. However, none of these is a significant predictor of late recurrence.5Auranen A. Sundström J. Ijäs J. et al.Prognostic factors of ovarian granulosa cell tumor: a study of 35 patients and review of the literature.Int J Gynecol Cancer. 2007; 17: 1011-1018Crossref PubMed Scopus (54) Google Scholar A typical radiologic appearance of GCT recurrence is discrete round or lobulated masses. Because the patient had undergone total hysterectomy and bilateral oophorectomy, nongynecologic differential diagnoses with similar radiologic appearances should also be considered, including cystic mesothelioma and peritoneal carcinoma. However, cystic mesothelioma tends to occur in a younger age group, and peritoneal carcinoma tends to be characterized by omental caking and calcification. Pseudomyxoma peritonei is also a consideration, but it tends to cause multiple complex masses with scalloping of the liver. Operative resection of GCT recurrence remains the treatment of choice, but several other treatment options have been tried, with responses for radiotherapy, chemotherapy, gonadotrophin-releasing hormone agonists, and aromatase inhibitors. Because the patient was well, she declined any adjuvant therapy, and has been recurrence free 1 year after the surgery.

Review of seven cases of granulosa cell tumour of the equine ovary

This paper reviews the equine granulosa cell tumour (GCT) and describes the clinicopathological features, treatment and outcome in seven cases of GCT in mares. Mares were presented with unilateral ovarian...

Aspect en imagerie des tumeurs de la granulosa de l’ovaire : à propos de trois cas

Granulosa cell tumors of the ovary are rare, and included in the sex cord-stromal tumor category. They have a low malignancy potential and generally have a good prognosis. They are the most frequent hormone-secreting tumors of the ovary and may lead to suggestive clinical symptoms. Some biological markers (serum inhibin B and AMH) may be helpful for diagnosis, though their sensitivity is not perfect. Preoperative imaging diagnosis remains challenging due to the wide variability in morphology and lack of epidemiological data in the imaging literature (small patient populations). From a review of the clinical and MR imaging features of three cases of granulosa cell tumor of the adult and a review of the literature, we will describe a few imaging features that may suggest the correct diagnosis.

Two Atypical Cases of Granulosa Cell Tumours in Belgian Blue Heifers

This paper describes two atypical cases of granulosa cell tumours (GCTs) in Belgian Blue heifers. In the first case, an 18-month-old heifer died after ovariectomy, and a granulosa-theca cell tumour was diagnosed post-mortem. The second heifer (31 months of age) was near term and was successfully treated surgically for a malignant granulosa cell tumour. Unfortunately, no further reproductive data are available, as the heifer was sold for slaughter. This is the first report describing GCTs in Belgian Blue beef cattle.

Adult-type Granulosa Cell Tumor of Testis: Case Presentation

Testicular granulosa cell tumor of the adult type is a very rare tumor. Only 26 cases of this rare testicular tumor have been reported in the literature, 6 of which developed metastases. We report a case of granulosa cell tumor of adult type in a 47-years-old man. Within three-year follow-up period without any adjuvant therapy, no metastatic progression was observed. A adult-type testicular granulosa cell tumor is reported with reference to literature-based discussion.

Extraovarian granulosa cell tumor

Extraovarian granulosa cell tumor (GCT) is a very uncommon tumor, assumed to arise from the ectopic gonadal tissue along the embryonal route of the genital ridge. One such rare case of extraovarian GCT was encountered in a 58-year-old female who presented with a large intraabdominal lump. Computerized tomography revealed one large retroperitoneal mass measuring 15 cm x 16 cm and another mesenteric mass of 8 cm x 5 cm size. The patient had a history of hysterectomy with bilateral salpingooophorectomy 20 years ago for uterine leiomyoma. Ultrasonography-guided aspiration smears revealed cytological features suggestive of GCT. Histopathological examination of the excised masses showed features of adult-type GCT. Because metastatic epithelial tumors, particularly from the ovaries, may show identical morphology, immunostains for inhibin and epithelial membrane antigen (EMA) were performed. The tumor showed positivity for inhibin while EMA was negative thus confirming the diagnosis of GCT. As this patient had no previous history of GCT and was oophorectomized 20 years ago, the tumor was considered as extraovarian. A diagnosis of extraovarian GCT should be carried out after excluding any previous history of GCT of the ovary. Immunostains help to differentiate GCTs from other neoplasms.

Granulosa cell tumor arising in an ovary with mature teratoma

Granulosa cell tumor (GCT) with synchronous mature teratoma is extremely rare and only eight cases are documented in the literature. GCT is low-grade malignancy and need a close follow up for recurrences which may be late. We report a case of GCT and mature teratoma occurring synchronously in the same ovary in a perimenopausal woman.

Characteristics of recurrence in adult- type granulosa cell tumor

Granulosa cell tumor (GCT) of the ovary is a very rare neoplasm, which is characterized by an indolent clinical course. Thus, the clinical characteristics, optimal treatment, and follow-up protocols are not well established. The goal of this study is to evaluate clinical findings, prognostic factors, and recurrent features of GCT in Korean patients. Between 1987 and 2005, 42 cases of GCT were diagnosed in our institution. There were 35 cases showing adult-type GCT, which were available for evaluation. All charts were reviewed, and the clinical data along with treatment results were retrospectively studied. Statistical analyses were performed for risk factors of recurrence and disease-free survival. GCT accounted for 3% of all ovarian malignancies in our institution during the study period. The median age was 45 years (range, 24–68 years). Abdominal and hormone-related symptoms were the main causes of first presentation. There were eight cases of recurrence including two cases of disease-related deaths during the median follow-up period of 177 months (range, 8–212 months). Factors affecting the recurrence involved residual tumor and stage, but residual tumor was the only significant factor of recurrence in multivariate analysis. The median time to relapse was 75 months (range, 55–137 months), and the liver was the most common extra-pelvic metastatic site followed by the intestine. Continuous long-term follow-up with pelvic and whole-abdominal surveillance is absolutely required. Active management including complete tumorectomy is the most important treatment modality in both primary surgeries and recurrent cases.

Malignant advanced granulosa cell tumor of the adult testis: case report and review of the literature

Testicular granulosa cell tumors (GCTs) are very rare neoplasms. Although adult GCTs are thought to have a relatively indolent course, several reports have demonstrated the malignant potential of these lesions. In case of distant metastases, the overall survival is very short. To date, there is no well-established treatment for these tumors owing to poor results and very rapid progression. A 55-year-old male patient was diagnosed with a testicular GCT with distant lung metastases. He underwent surgical treatment with orchiectomy and adjuvant polychemotherapy (cisplantine, etoposide, and bleomycine) as well as metastasectomy of the right lung. We report the first case of a successfully treated testicular GCT with bipulmonary metastases at initial diagnosis. Thirty-nine months after treatment, the patient is alive with no evidence of disease. We subsequently reviewed all reported cases of an adult GCT in the published literature (25 published cases). This review will summarize all reported cases and discuss treatment options. The current case suggests that a combination of varying treatment modalities could be a promising and reasonable way to manage malignant advanced GCT of the adult testis.

Characteristics of recurrence in adult-type granulosa cell tumor

Granulosa cell tumor (GCT) of the ovary is a very rare neoplasm, which is characterized by an indolent clinical course. Thus, the clinical characteristics, optimal treatment, and follow-up protocols are not well established. The goal of this study is to evaluate clinical findings, prognostic factors, and recurrent features of GCT in Korean patients. Between 1987 and 2005, 42 cases of GCT were diagnosed in our institution. There were 35 cases showing adult-type GCT, which were available for evaluation. All charts were reviewed, and the clinical data along with treatment results were retrospectively studied. Statistical analyses were performed for risk factors of recurrence and disease-free survival. GCT accounted for 3% of all ovarian malignancies in our institution during the study period. The median age was 45 years (range, 24-68 years). Abdominal and hormone-related symptoms were the main causes of first presentation. There were eight cases of recurrence including two cases of disease-related deaths during the median follow-up period of 177 months (range, 8-212 months). Factors affecting the recurrence involved residual tumor and stage, but residual tumor was the only significant factor of recurrence in multivariate analysis. The median time to relapse was 75 months (range, 55-137 months), and the liver was the most common extra-pelvic metastatic site followed by the intestine. Continuous long-term follow-up with pelvic and whole-abdominal surveillance is absolutely required. Active management including complete tumorectomy is the most important treatment modality in both primary surgeries and recurrent cases.

Testicular granulosa cell tumor of adult type: A new case and a review of the literature

Testicular granulosa cell tumor of the adult type is a very rare tumor, and, to date and our knowledge, only 23 cases of this rare testicular tumor have been reported in the literature, 5 of which developed metastases. We report a case of granulosa cell tumor of adult type in a 45-year-old man with a 15-year history of a painless increasing right testicular volume who underwent radical orchiectomy. The patient is disease-free after a 2-year follow-up, without any adjuvant therapy. Our case and a review of the literature indicate that this type of tumor is a rare, slow-growing neoplasm. Because distant metastases may occur late in the clinical course, long-term follow-up of these patients is recommended.