J Gynecol Oncol.  2011 Sep;22(3):188-195. 10.3802/jgo.2011.22.3.188.

Clinicopathologic characteristics of granulosa cell tumors of the ovary: a multicenter retrospective study

• Lee IH
• Choi CH
• Hong DG
• Song JY
• Kim YJ
• Kim KT
• Lee KW
• Park IS
• Bae DS
• Kim TJ

• KMID: 2055707
• DOI: http://doi.org/10.3802/jgo.2011.22.3.188

Abstract

OBJECTIVE
To evaluate the clinicopathologic characteristics and prognostic factors of ovarian granulosa cell tumors.
METHODS
Medical records of 113 patients presenting between January 1995 and December 2007 were retrospectively reviewed.
RESULTS
One-hundred two patients had adult type disease, with a mean age of 46.2 years (range, 18 to 83 years) and a mean follow-up period of 54.7 months (range, 1 to 155 months). The distribution of FIGO stages was 86 patients at stage I, 11 at stage II, and 5 at stage III. During follow-up, ten patients recurred at a mean time of 48 months (range, 4 to 109 months). Among them, three patients died after a mean of 57 months (range, 25 to 103 months). In recurrence analysis, advanced stage (p=0.032) and presence of residual disease (p=0.012) were statistically significant, and age<40 years, premenopause and positive washing cytology were marginally significant (p<0.1). In multivariate analysis, stage was the only factor associated with recurrence; adjuvant chemotherapy and fertility-sparing surgery were not statistically significant. Among 36 patients with fertility-sparing operations, eight patients had nine pregnancies and delivered seven babies. Eleven patients had juvenile type tumors; the mean age was 20.0 years (range, 8 to 45 years) and the mean follow-up period was 69.8 months (range, 20 to 156 months). The distribution of FIGO stage was nine patients at stage I and two at stage III. There were no recurrences or deaths reported. Four patients had seven pregnancies and delivered six babies.
CONCLUSION
Stage is the only factor associated with disease-free survival, and fertility-sparing surgery may be a treatment option for women with early-stage disease who want to retain fertility.

Keyword

Clinical study; Granulosa cell tumor; Ovary; Pregnancy; Recurrence

MeSH Terms

Adult
Chemotherapy, Adjuvant
Disease-Free Survival
Female
Fertility
Follow-Up Studies
Granulosa Cell Tumor
Granulosa Cells
Humans
Medical Records
Multivariate Analysis
Ovary
Pregnancy
Premenopause
Recurrence
Retrospective Studies

Reference

1. Rokitansky CV. Uber abnormalitiaten des corpus luteum. Allg Wien Med Z. 1859. 4:253–258.

2. Kent SW, McKay DG. Primary cancer of the ovary an analysis of 349 cases. Am J Obstet Gynecol. 1960. 80:430–438.

3. Schweppe KW, Beller FK. Clinical data of granulosa cell tumors. J Cancer Res Clin Oncol. 1982. 104:161–169.

4. Calaminus G, Wessalowski R, Harms D, Gobel U. Juvenile granulosa cell tumors of the ovary in children and adolescents: results from 33 patients registered in a prospective cooperative study. Gynecol Oncol. 1997. 65:447–452.

5. Malmstrom H, Hogberg T, Risberg B, Simonsen E. Granulosa cell tumors of the ovary: prognostic factors and outcome. Gynecol Oncol. 1994. 52:50–55.

6. McNatty KP, Makris A, DeGrazia C, Osathanondh R, Ryan KJ. The production of progesterone, androgens, and estrogens by granulosa cells, thecal tissue, and stromal tissue from human ovaries in vitro. J Clin Endocrinol Metab. 1979. 49:687–699.

7. Fox H, Agrawal K, Langley FA. A clinicopathologic study of 92 cases of granulosa cell tumor of the ovary with special reference to the factors influencing prognosis. Cancer. 1975. 35:231–241.

8. Pautier P, Lhomme C, Culine S, Duvillard P, Michel G, Bidart JM, et al. Adult granulosa-cell tumor of the ovary: a retrospective study of 45 cases. Int J Gynecol Cancer. 1997. 7:58–65.

9. Pankratz E, Boyes DA, White GW, Galliford BW, Fairey RN, Benedet JL. Granulosa cell tumors: a clinical review of 61 cases. Obstet Gynecol. 1978. 52:718–723.

10. Schwartz PE, Smith JP. Treatment of ovarian stromal tumors. Am J Obstet Gynecol. 1976. 125:402–411.

11. Chan JK, Zhang M, Kaleb V, Loizzi V, Benjamin J, Vasilev S, et al. Prognostic factors responsible for survival in sex cord stromal tumors of the ovary: a multivariate analysis. Gynecol Oncol. 2005. 96:204–209.

12. Zhang M, Cheung MK, Shin JY, Kapp DS, Husain A, Teng NN, et al. Prognostic factors responsible for survival in sex cord stromal tumors of the ovary: an analysis of 376 women. Gynecol Oncol. 2007. 104:396–400.

13. Ayhan A, Salman MC, Velipasaoglu M, Sakinci M, Yuce K. Prognostic factors in adult granulosa cell tumors of the ovary: a retrospective analysis of 80 cases. J Gynecol Oncol. 2009. 20:158–163.

14. Miller BE, Barron BA, Wan JY, Delmore JE, Silva EG, Gershenson DM. Prognostic factors in adult granulosa cell tumor of the ovary. Cancer. 1997. 79:1951–1955.

15. Bjorkholm E, Silfversward C. Prognostic factors in granulosa-cell tumors. Gynecol Oncol. 1981. 11:261–274.

16. Al-Badawi IA, Brasher PM, Ghatage P, Nation JG, Schepansky A, Stuart GC. Postoperative chemotherapy in advanced ovarian granulosa cell tumors. Int J Gynecol Cancer. 2002. 12:119–123.

17. Gershenson DM, Copeland LJ, Kavanagh JJ, Stringer CA, Saul PB, Wharton JT. Treatment of metastatic stromal tumors of the ovary with cisplatin, doxorubicin, and cyclophosphamide. Obstet Gynecol. 1987. 70:765–769.

18. Uygun K, Aydiner A, Saip P, Kocak Z, Basaran M, Dincer M, et al. Clinical parameters and treatment results in recurrent granulosa cell tumor of the ovary. Gynecol Oncol. 2003. 88:400–403.

19. Homesley HD, Bundy BN, Hurteau JA, Roth LM. Bleomycin, etoposide, and cisplatin combination therapy of ovarian granulosa cell tumors and other stromal malignancies: a Gynecologic Oncology Group study. Gynecol Oncol. 1999. 72:131–137.

20. Schumer ST, Cannistra SA. Granulosa cell tumor of the ovary. J Clin Oncol. 2003. 21:1180–1189.

21. Busby T, Anderson GW. Feminizing mesenchymomas of the ovary: includes 107 cases of granulosa-, granulosa-theca-cell, and theca-cell tumors. Am J Obstet Gynecol. 1954. 68:1391–1320.

22. Evans AT 3rd, Gaffey TA, Malkasian GD Jr, Annegers JF. Clinicopathologic review of 118 granulosa and 82 theca cell tumors. Obstet Gynecol. 1980. 55:231–238.

23. Norris HJ, Taylor HB. Prognosis of granulosa-theca tumors of the ovary. Cancer. 1968. 21:255–263.

24. Novak ER, Kutchmeshgi J, Mupas RS, Woodruff JD. Feminizing gonadal stromal tumors. Analysis of the granulosa-theca cell tumors of the Ovarian Tumor Registry. Obstet Gynecol. 1971. 38:701–713.

25. Colombo N, Parma G, Zanagnolo V, Insinga A. Management of ovarian stromal cell tumors. J Clin Oncol. 2007. 25:2944–2951.

26. Powell JL, Otis CN. Management of advanced juvenile granulosa cell tumor of the ovary. Gynecol Oncol. 1997. 64:282–284.

27. Schneider DT, Calaminus G, Wessalowski R, Pathmanathan R, Selle B, Sternschulte W, et al. Ovarian sex cord-stromal tumors in children and adolescents. J Clin Oncol. 2003. 21:2357–2363.