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Bin Naeem S, Imran M, Abbas M, Majeed MA, Jamil MA, Samreen M, Siddiqui N. Story of 20 Years of Triumph: A Case Report of Two Patients With Stage IV Granulosa Cell Tumor of the Ovary. Cureus 2024; 16:e57615. [PMID: 38707031 PMCID: PMC11069410 DOI: 10.7759/cureus.57615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 05/07/2024] Open
Abstract
Ovarian granulosa cell tumors (GCTs) are rare neoplasms with a unique incidence pattern peaking in postmenopausal women. This case report presents two instances of stage 4 recurrent adult GCTs with a prolonged 20-year follow-up. Patient 1, diagnosed at 54 years, experienced multiple recurrences managed through surgery, hormonal therapy, and chemotherapy, culminating in hepatocellular carcinoma. Patient 2, diagnosed at 67 years, underwent various treatments, including surgery, chemotherapy, and hormonal therapy, demonstrating disease stability. Despite the generally favorable prognosis, these cases highlight the challenges of managing recurrent GCTs, emphasizing the need for tailored therapeutic approaches.
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Affiliation(s)
- Sameen Bin Naeem
- Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Maryam Imran
- Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Mansoor Abbas
- Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | | | - Muhammad Ahsan Jamil
- Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Mahnoor Samreen
- Radiology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Neelam Siddiqui
- Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
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Tokalioglu AA, Oktar O, Sahin M, Ozturk C, Erdogan O, Yildirim HEK, Ucar Y, Kilic F, Ersak B, Yalcin N, Ozmen F, Alci A, Bas S, Gorgulu G, Selcuk I, Ucar G, Kocak O, Cakir C, Kilic C, Comert GK, Ureyen I, Toptas T, Narin MA, Tasci T, Taskin S, Boran N, Ozdal B, Sanci M, Uncu D, Korkmaz V, Tekin OM, Ustun Y, Ortac F, Turan T. Defining the relationship between ovarian adult granulosa cell tumors and synchronous endometrial pathology: Does ovarian tumor size correlate with endometrial cancer? J Obstet Gynaecol Res 2024; 50:655-662. [PMID: 38304973 DOI: 10.1111/jog.15896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 01/17/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVE The main feature of adult granulosa cell tumors (AGCT) is their capacity to secrete hormones, with nearly all of them capable of synthesizing oestradiol. The primary goal of this study is to identify synchronized endometrial pathologies, particularly endometrial cancer, in AGCT patients who had undergone a hysterectomy. MATERIALS AND METHODS The study cohort comprised retrospectively of 316 AGCT patients from 10 tertiary gynecological oncology centers. AGCT surgery consisted of bilateral salpingo-oophorectomy, hysterectomy, peritoneal cytology, omentectomy, and the excision of any suspicious lesion. The median tumor size value was used to define the relationship between tumor size and endometrial cancer. The relationship between each value and endometrial cancer was evaluated. RESULTS Endometrial intraepithelial neoplasia, or hyperplasia with complex atypia, was detected in 7.3% of patients, and endometrial cancer in 3.1% of patients. Age, menopausal status, tumor size, International Federation of Gynecology and Obstetrics stage, ascites, and CA-125 level were not statistically significant factors to predict endometrial cancer. There was no endometrial cancer under the age of 40, and 97.8% of women diagnosed with endometrial hyperplasia were over the age of 40. During the menopausal period, the endometrial cancer risk was 4.5%. Developing endometrial cancer increased to 12.1% from 3.2% when the size of the tumor was >150 mm in menopausal patients (p = 0.036). CONCLUSION Endometrial hyperplasia, or cancer, occurs in approximately 30% of AGCT patients. Patients diagnosed with AGCT, especially those older than 40 years, should be evaluated for endometrial pathologies. There may be a relationship between tumor size and endometrial cancer, especially in menopausal patients.
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Affiliation(s)
- Abdurrahman Alp Tokalioglu
- Department of Gynecologic Oncology, Ankara Bilkent City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Okan Oktar
- Department of Gynecologic Oncology, Ankara Etlik City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Mustafa Sahin
- Department of Gynecologic Oncology, Ankara Bilkent City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Cagatayhan Ozturk
- Department of Gynecologic Oncology, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Ozgur Erdogan
- Department of Gynecologic Oncology, Tepecik Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Izmir, Turkey
| | - Hande Esra Koca Yildirim
- Department of Gynecologic Oncology, Ankara Etlik City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Yesim Ucar
- Department of Gynecologic Oncology, Ankara Bilkent City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Fatih Kilic
- Department of Gynecologic Oncology, Ankara Bilkent City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Burak Ersak
- Department of Gynecologic Oncology, Ankara Etlik City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Necim Yalcin
- Department of Gynecologic Oncology, Antalya Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Antalya, Turkey
| | - Fatma Ozmen
- Department of Gynecologic Oncology, Adana City Hospital, Faculty of Medicine, University of Health Sciences, Adana, Turkey
| | - Aysun Alci
- Department of Gynecologic Oncology, Antalya Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Antalya, Turkey
| | - Sevda Bas
- Department of Gynecologic Oncology, Adana City Hospital, Faculty of Medicine, University of Health Sciences, Adana, Turkey
| | - Goksen Gorgulu
- Department of Gynecologic Oncology, Tepecik Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Izmir, Turkey
| | - Ilker Selcuk
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Gokhan Ucar
- Department of Medical Oncology, Ankara Bilkent City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Ozgur Kocak
- Department of Gynecologic Oncology, Hitit University, Faculty of Medicine, Corum, Turkey
| | - Caner Cakir
- Department of Gynecologic Oncology, Ankara Etlik City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Cigdem Kilic
- Department of Gynecologic Oncology, Hitit University, Faculty of Medicine, Corum, Turkey
| | - Gunsu Kimyon Comert
- Department of Gynecologic Oncology, Ankara Bilkent City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Isin Ureyen
- Department of Gynecologic Oncology, Antalya Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Antalya, Turkey
| | - Tayfun Toptas
- Department of Gynecologic Oncology, Antalya Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Antalya, Turkey
| | - Mehmet Ali Narin
- Department of Gynecologic Oncology, Adana City Hospital, Faculty of Medicine, University of Health Sciences, Adana, Turkey
| | - Tolga Tasci
- Department of Gynecologic Oncology, Bahcesehir University, Faculty of Medicine, Istanbul, Turkey
| | - Salih Taskin
- Department of Gynecologic Oncology, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Nurettin Boran
- Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Bulent Ozdal
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Muzaffer Sanci
- Department of Gynecologic Oncology, Tepecik Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Izmir, Turkey
| | - Dogan Uncu
- Department of Medical Oncology, Ankara Bilkent City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Vakkas Korkmaz
- Department of Gynecologic Oncology, Ankara Etlik City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Ozlem Moraloglu Tekin
- Department of Obstetrics and Gynecology, Ankara City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Yaprak Ustun
- Department of Obstetrics and Gynecology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Fırat Ortac
- Department of Gynecologic Oncology, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Taner Turan
- Department of Gynecologic Oncology, Ankara Bilkent City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
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Zhang Y, Zhang Z, Ding X, Zhang K, Dai Y, Cheng W, Luo C. Identification of prognostic factors and construction of nomogram to predict cancer-specific survival for patients with ovarian granulosa cell tumors. Cancer Rep (Hoboken) 2024; 7:e2046. [PMID: 38507268 PMCID: PMC10953832 DOI: 10.1002/cnr2.2046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 02/26/2024] [Accepted: 03/05/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Ovarian granulosa cell tumors (OGCTs) feature low incidence, indolent growth and late recurrence. Treatment for recurrent OGCTs is challenging. METHODS The present study was designed to explore the prognostic factors and establish a nomogram to predict cancer-specific survival (CSS) for OGCTs patients. Enrolled in the study were 1459 eligible patients in the Surveillance, Epidemiology, and End Results (SEER) database, who were randomized to the training (n = 1021) or testing set (n = 438) at a ratio of 7:3. Univariate and multivariate Cox regression analyses were employed to screen the prognostic factors. The predictors were determined by using the Least absolute shrinkage and selection operator (LASSO) regression analysis. The model was constructed via the Cox proportional hazards risk regression analysis. The performance and clinical value of the nomograms was assessed with C-index, calibration plots, and decision curve analysis. RESULTS Age, pTNM stage, tumor size, surgery of the primary tumor, surgery of regional lymph nodes (LNs), residual disease after surgery, and chemotherapy were considered as significant predictive factors for CSS in OGCTs patients. After screening, the prognostic factors except surgery of regional LNs and chemotherapy were employed to build the nomogram. With desirable discrimination and calibration, the nomogram was more powerful in predicting CSS than the American Joint Committee on Cancer staging system in clinical use. CONCLUSION This novel prognostic nomogram, which comprises a stationary nomogram and a web-based calculator, offers convenience for clinicians in personalized decision-making including optimal treatment plans and prognosis assessments for OGCTs patients.
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Affiliation(s)
- Yue Zhang
- Department of GynecologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Zhen Zhang
- Department of GynecologySuqian First HospitalSuqianChina
| | - Xinyao Ding
- Department of GynecologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Keyi Zhang
- Department of GynecologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Youren Dai
- Department of GynecologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Wenjun Cheng
- Department of GynecologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Chengyan Luo
- Department of GynecologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
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Bin Naeem S, Baloch NU, Jhatial MA, Abbas M, Fasih S, Masood Sheikh R, Hamdani SAM, Siddiqui N. Clinicopathological Features and Outcomes of Granulosa Cell Tumor of the Ovaries - A Retrospective Study. Cureus 2023; 15:e38892. [PMID: 37303438 PMCID: PMC10257470 DOI: 10.7759/cureus.38892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 06/13/2023] Open
Abstract
Background Granulosa cell tumor (GCT) is rare among all ovarian cancers. Its overall prognosis is favorable; however, the presence of extra-ovarian disease is associated with worse clinical outcomes. We report a retrospective analysis of granulosa cell tumors to evaluate the clinicopathological features and their outcomes. Methods This retrospective study included 54 adult patients aged 13 years and older. After data extraction and scrutiny, only those patients who were treated and followed up later at our institute were included in this study. Results Fifty-four patients were evaluated in this study, with a median age of 38.5 years. Most of the patients had dysfunctional uterine bleeding and abdominal pain (40.7%, n=22). The majority (n=26, 48%) underwent completion surgery as per ovarian protocol; however, 16.7% (n=09) patients underwent simple total abdominal hysterectomy with a bilateral salpingo-oophorectomy (TAH+BSO), debulking surgery in 3.7% (n=2), unilateral salpingo-oophorectomy in 20.4% (n=11) and fertility-sparing surgery in 11.1% (n=06) of the patients. Pathological stage I-A was found in 59.3%(n=32), I-C in 25.9% (n=14), II-A in 1.9% (n=1), III-A in 1.9% (n=1), III-C in 9.3% (n=5) and IV-B in 1.9% (n=1) of the population. Eleven (20.3%) patients relapsed during their course of treatment. Out of these 11 patients, three went into remission, two still have active disease, and six patients died. Conclusion Post-menopausal patients, more advanced disease at presentation, capsular rupture, presence of ascites, omental involvement, peritoneal spread, and residual disease after surgical resection were the main contributing factors towards poorer outcomes affecting disease-free survival. Overall median disease-free survival was 60 months for all the stage groups, while the overall survival was 62 months.
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Affiliation(s)
- Sameen Bin Naeem
- Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Naqib U Baloch
- Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Mussadique A Jhatial
- Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Mansoor Abbas
- Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Samir Fasih
- Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Rizwan Masood Sheikh
- Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Syed Abdul M Hamdani
- Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Neelam Siddiqui
- Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
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Sonkusare A, Dixit P, Karmarkar PJ, Thombare D. Fertility Sparing Surgery in Young Woman With Granulosa Cell Tumor Followed by a Successful Pregnancy. Cureus 2023; 15:e35359. [PMID: 36974246 PMCID: PMC10039671 DOI: 10.7759/cureus.35359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 02/25/2023] Open
Abstract
An uncommon form of cancer known as a granulosa cell tumor (GCT) arises from ovarian sex cord cells that produce estrogen. The goal of conservative surgery in cancer is to retain organ functions while avoiding severe excision wherever possible. In oncologic gynecological surgery, fertility-sparing surgery (FSS) is a technique that tries to preserve the uterus and ovarian tissue. A 26-year-old woman with nulligravida presented with the main complaints of pain in the right iliac fossa for 10 to 15 days and fullness in the abdomen for one month, along with a change in appetite and noticeable weight loss. The Magnetic Resonance Imaging (MRI) revealed a large, well-defined, multiloculated, solid cystic mass with altered signal intensity. On exploratory laparotomy, an intraoperatively left ovarian cystic mass was seen. The ovarian mass was histopathologically diagnosed as a sex cord tumor of the ovary, with characteristics compatible with adult GCT. Disregarding the follow-up advice on discharge four months later, the patient conceived spontaneously and gave birth to a male child via emergency lower segment cesarean section. In GCTs that have not spread beyond the ovary or in people who have had relapses of the disease, FSS created the groundwork for conception and appeared safe. In the lack of any compelling supporting evidence, the line of care of terminal surgery should always be thoroughly discussed with the patient and advised for women after their families are complete.
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Zhuang Y, Yang H. The Prognostic Significance of Adjuvant Chemotherapy in Adult Ovarian Granulosa Cell Tumors: A Systematic Review and Meta-analysis. Cancer Control 2023; 30:10732748231215165. [PMID: 37957122 PMCID: PMC10644757 DOI: 10.1177/10732748231215165] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 10/01/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
INTRODUCTION This study aimed to evaluate the oncological and prognostic significance of adjuvant chemotherapy (CT) in patients with adult granulosa cell tumors of the ovary (AOGCT). METHODS We searched the Chinese National Knowledge Infrastructure, Clinical Trials, Wanfang Database, Web of Science, Cochrane Library, and MEDLINE electronic databases for articles published up to May 2023. Reference lists of the enrolled studies, Google Scholar, and scientific meeting reports were also manually searched. RESULTS We enrolled 5641 patients with AOGCT from 33 eligible studies, including 1674 (29.7%) and 3967 (70.3%) patients in the CT and non-CT groups, respectively. Based on the cumulative results, adjuvant CT did not affect the risk of recurrence or progression (R/P) (odds ratio [OR]: 1.67, 95% confidence interval [CI]: 1.01-2.78, I2 = 63%, P = .05) and 5-year overall survival (OR: .86, 95% CI: .70-1.04, I2 = 0%, P = .12) of patients with AOGCT. However, adjuvant CT might reduce the 5-year disease-free survival (OR: 2.90, 95% CI: 1.19-7.08, I2 = 55%, P = .02). Sub-group analysis revealed that adjuvant CT did not affect the risk of R/P in patients with early-stage AOGCT (OR: .78, 95% CI: .43-1.43, I2 = 2%, P = .43) and advanced or recurrent AOGCT (OR: .78, 95% CI: .43-1.43, I2 = 2%, P = .43). CONCLUSION This meta-analysis suggests that patients with AOGCT might not benefit from adjuvant CT, even those with advanced or recurrent disease. The results should be interpreted with caution because of the inherent limitations of retrospective studies.
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Affiliation(s)
- Yuan Zhuang
- Department of Gynecology, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
| | - Hua Yang
- Department of Gynecology, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
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Fischer AK, Schömig-Markiefka B, Heydt C, Ratiu D, Mallmann P, Meinel J, Büttner R, Schmidt D, Quaas A. Incidental FOXL2 mutated adult granulosa cell tumour of the ovary with thecoma-like foci. Virchows Arch 2022:10.1007/s00428-022-03452-y. [DOI: 10.1007/s00428-022-03452-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/25/2022] [Accepted: 11/02/2022] [Indexed: 11/19/2022]
Abstract
Abstract
We report on the incidental finding of a FOXL2 mutated adult granulosa cell tumour of the ovary with thecoma-like foci, a rare entity recently described by Jennifer N. Stall and Robert H. Young in a series of sixteen cases in 2019, displaying features differing from conventional adult granulosa cell tumour. Our aim is to specify the morphologic and molecular particularities of this presumably underrecognized finding, with a short presentation of the typical clinical context. Awareness of this rare and challenging neoplasm with indeterminate clinical course is crucial in routine diagnostics.
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Alhusaini H, Elshenawy MA, Badran A, Elshentenawy A, Mohieldin A, Mostafa Gad A, Omar A, Shaheen A, Elhassan T, Soudy H. Adult-Type Ovarian Granulosa Cell Tumour: Treatment Outcomes From a Single-Institution Experience. Cureus 2022; 14:e31045. [DOI: 10.7759/cureus.31045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2022] [Indexed: 11/07/2022] Open
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Abstract
PURPOSE OF REVIEW Sex cord-stromal tumours (SCSTs) are rare ovarian cancers. As in the literature, only small case series or case reports are published, gathering solid evidence about their management is challenging. Surgery plays a pivotal role, and accurate staging is one of the most important prognostic factors. This review focuses on the current evidence for surgical staging in the management of SCSTs. RECENT FINDINGS Staging procedures have been inferred by epithelial ovarian cancers; however, they are often only partially performed, and most SCSTs therefore end up incompletely staged, raising the issue of the need for restaging or further treatments. In addition, some parts of the staging procedure have been questioned over the years, and lymphadenectomy is now considered unnecessary for SCSTs.The generally favourable prognosis of SCSTs, the introduction of minimally invasive surgery and fertility-sparing approaches is empowering the question of which staging procedures are beneficial for these patients. We reviewed the role of each staging procedure proposed by the guidelines in light of new scientific updates. SUMMARY Surgical staging should always be performed. It includes peritoneal samplings (peritoneal washing, multiple peritoneal biopsies, omental biopsy and biopsy of any suspicious area), whereas lymphadenectomy could be omitted. Laparoscopy may be considered a feasible approach.
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Zhuang Y, Zhang S, Liu Y, Yang H. Can adjuvant chemotherapy improve the prognosis of adult ovarian granulosa cell tumors?: A narrative review. Medicine (Baltimore) 2022; 101:e29062. [PMID: 35356927 PMCID: PMC10513366 DOI: 10.1097/md.0000000000029062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 02/24/2022] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Adult granulosa cell tumors (aGCTs) are rare ovarian neoplasms with a relatively favorable prognosis. They follow an indolent course, characterized by a prolonged natural history and a tendency to late recurrences, Around a quarter of patients develop recurrence and More than 70% of women with recurrence die from their disease, The percentage of patients received chemotherapy increases over time, whether adjuvant chemotherapy improve the prognosis of aGCTs is equivocal? The purpose of this review is to summarize the previously published evidence to evaluate whether adjuvant chemotherapy improve the prognosis of aGCTs to provide guidance for clinical practice. EMBASE, PubMed, Web of Science, WanFang Data and Chinese National Knowledge Infrastructure are searched up to December 2020, used the search strategy of ovar* and granulosa cell* and (tumor* or tumour* or malignan* or cancer* or carcinom* or neoplasm*) and chemotherapy. The screening process was conducted strictly based on inclusion and exclusion criteria. Clinical studies based on human including randomized controlled trial, quasi-randomised controlled trials, nonrandomised trials cohort study and case control study were included without restriction of time. The percentage of patients received chemotherapy increases over time, but the benefit of adjuvant chemotherapy is lack of high-grade evidence of prospective study, based on the current retrospective studies, we still do not have the evidence to confirm the survival benefit of adjuvant chemotherapy in early stage, advanced stage or recurrent aGCT with no residual tumor, but for inoperable disseminated disease or disease with suboptimal cytoreduction, adjuvant chemotherapy maybe an Optable options. Multinational prospective randomised controlled trials are urgently needed to validate the role of adjuvant chemotherapy. Further research on molecular mechanisms and developing novel targeted medicines may improve the survival of aGCTs.
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Affiliation(s)
- Yuan Zhuang
- Department of Gynecology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China,Sun Yat-sen University, Zhuhai, China
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Kim YS, Lee JH. A case report of ovarian granulosa cell tumor in patient with polycystic ovarian syndrome. Medicine (Baltimore) 2021; 100:e28261. [PMID: 34918698 PMCID: PMC10545264 DOI: 10.1097/md.0000000000028261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 11/25/2021] [Indexed: 10/19/2022] Open
Abstract
RATIONALE Granulosa cell tumors (GCTs) account for less than 2% of all ovarian malignancies and are the second most common ovarian sex cord stromal tumors after fibroma/thecomas.GCTs occur most frequently in postmenopausal women with a peak age of 50 to 55, are usually diagnosed in their early stages, and have a good prognosis. GCTs usually present with features of hyperestrogenism, with an average size is 10 to 15 cm. PATIENT CONCERNS A 31-year-old nulligravida diagnosed with polycystic ovarian syndrome (PCOS) 10 years prior, had a 20-mm mass in her right ovary found on ultrasonography 2 years ago. She had been taking dienogest 2 mg for 2 years for a misdiagnosed endometrioma, but over a 2-year course, the mass increased to 50 mm. DIAGNOSES An ultrasound scan revealed a 47 × 37-mm round solid mass in the right ovary with a spongiform appearance and little vascularity. The pathologic findings showed an adult-type granulosa cell tumor with necrosis and hemorrhage. The tissue stained positive for inhibin-α, Wilms' tumor-1, CD56, and negative for cytokeratin 7. INTERVENTIONS We finally performed right salpingo-oophorectomy, endometrial biopsy, peritoneal biopsy, and partial omentectomy. The pathological findings were adult-type granulosa cell tumor. The International Federation of Gynecology and Obstetrics staging was IA. The patient did not require additional treatment. OUTCOMES Surprisingly, her normal menstruation returned 2 weeks after the operation, and she had a normal pregnancy and parturition. The patient had been followed-up regularly for 3 years following the surgery. The patient has not experienced any complications and has remained disease-free. LESSONS GCTs should be considered in the differential diagnosis if a female patient with PCOS and amenorrhea shows a unilateral small solid mass. They are extremely rare malignant ovarian tumors that must be differentiated from other benign ovarian tumors, especially endometriomas and dermoid cysts. It was difficult for us to suspect a granulosa cell tumor because the patient already had PCOS symptoms such as mild hirsutism and amenorrhea. This case highlights the importance of physicians being aware of and suspicious for GCTs in similar cases, along with knowing their characteristics in considering possible differential diagnoses.
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Affiliation(s)
- Yun S. Kim
- Department of Obstetrics and Gynecology, Soonchunhyang University College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Ji H. Lee
- Department of Pathology, Soonchunhyang University College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
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Prognostic predictors in recurrent adult granulosa cell tumors of the ovary: a systematic review and meta-analysis. Arch Gynecol Obstet 2021; 306:315-321. [PMID: 34799743 DOI: 10.1007/s00404-021-06305-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 10/18/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Ovarian adult granulosa cell tumours are low-grade malignant sex cord-stromal neoplasm with a low recurrence rate. Prognostic factors for recurrence include tumor stage, tumor rupture in Stage I neoplasms and the presence of residual tumors after surgery. However, in recurrent tumors, prognostic factors for overall survival (OS) are lacking. In the present paper, we conducted a systematic meta-analysis with the aim to assess prognostic factors for OS in patients with recurrent GCT. METHODS Electronic databases were searched for all studies assessing prognostic factors in recurrent adult granulosa cell tumor of the ovary. Student T test, Fisher's exact test and Kaplan-Meier survival analysis with long-rank test were used to assess differences among groups; a p value < 0.05 was considered significant. RESULTS Eleven studies analyzing 102 recurrent tumors were included in the systematic review. Tumor stage and localization of recurrent tumors were significantly associated with OS on Kaplan-Meier analysis; Cox regression analysis showed a HR of 0.879 for the stage II, of 3.052 for the stage III, and of 2.734 for stage IV tumor was significantly associated with OS (p = 0.037); observed HRs for abdominal and thoracic locations were of 2.405 and of 4.024, respectively. CONCLUSIONS In conclusion, the present article emphasizes the prognostic significance of tumor stage > II and extrapelvic anatomic sites of recurrences in patients with recurrent granuolase cell tumors of the ovary.
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Sp B, J P, Mp K, Im R. Long-term effect of repeated deslorelin acetate treatment in bitches for reproduction control. Theriogenology 2021; 173:73-82. [PMID: 34339906 DOI: 10.1016/j.theriogenology.2021.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 11/17/2022]
Abstract
Long-acting gonadotropin-releasing hormone (GnRH) analogs, which are approved for male dogs and ferrets, have been used off-label to suppress estrus in bitches predisposed to the side effects of spaying. Health data from the past 12 years were evaluated from bitches without progestogen pretreatment that received deslorelin acetate (DA) to suppress estrus for the first time before the age of 4.5 years. The study population included 32 client-owned bitches repeatedly treated with either 4.7 mg or 9.4 mg DA implants for a period of 5.3 ± 3.4 years (range 0.5-11.3 years). Follow-up information concerning immediate side effects of DA occurring within five months after the first DA treatment (n = 23) as well as long-term side effects of sustained gonadal suppression occurring after five months up to three years (n = 2), three years up to five years (n = 2) or more than five years (n = 8) were assessed through a questionnaire. Treatment was considered successful if no major side effects requiring medical treatment occurred, which applied to 26 out of 32 (81 %) bitches. In the six remaining bitches, the following major side effects led to treatment discontinuation: persistent urinary incontinence (n = 1), reoccurring induced heat (n = 1), uterine disease (n = 3) and/or ovarian tumor (n = 3). The bitches recovered completely after surgical spaying and/or DA implant removal. Minor side effects that did not require therapy or affect animal welfare included body weight changes (n = 18), subtle behavioral changes (n = 13), induced heat (n = 12), coat changes (n = 11), pseudocyesis (n = 6), transient urinary incontinence (n = 4), and/or temporary thickening of the uterine wall with little anechogenic content (n = 2). To examine a possible causal relationship between adverse side effects and DA treatment, further studies should compare the frequency of pathologies between groups of GnRH-treated, intact and spayed bitches of similar breeds and ages. Nevertheless, DA application before the age of 4.5 years may be a means of postponing surgical spaying for several years in breeds at high risk for developing urinary incontinence. Before DA is used in bitches, owners should be fully informed regarding possible side effects.
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Affiliation(s)
- Brändli Sp
- Clinic of Reproductive Medicine, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057, Zurich, Switzerland
| | - Palm J
- Clinic of Reproductive Medicine, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057, Zurich, Switzerland
| | - Kowalewski Mp
- Institute of Veterinary Anatomy, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057, Zurich, Switzerland
| | - Reichler Im
- Clinic of Reproductive Medicine, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057, Zurich, Switzerland.
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Abstract
RATIONALE Ovarian microcystic stromal tumor is a relatively rare tumor type, which is characterized by morphology with microcyst structure, solid cellular areas, and hyalinized fibrous stroma. The most reported tumors were stage I with good prognosis. PATIENT CONCERNS We report a case of a 33-year-old woman with primary ovarian microcystic stromal tumor with significant bizarre nuclei. We describe the clinical, histopathological, and immunohistochemical findings and review the English literatures. So far, as we know, the patient presented here is a rare case of ovarian microcystic stromal tumor with prominent bizarre nuclei accounting for about 50% of the tumor cells. DIAGNOSES She was diagnosed with ovarian microcystic stromal tumor with significant bizarre nuclei. INTERVENTIONS The right ovarian tumor was resected laparoscopically on October 19, 2018. OUTCOMES Up to now, the patient is free of disease at 19 months of follow-up. LESSONS This is a rare case of ovarian microcystic stromal tumor with obvious bizarre nuclei. This report will contribute to expand the morphological spectrum of ovarian microcystic stromal tumor.
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Affiliation(s)
- Ying He
- Department of Pathology, West China Second Hospital of Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan, China
| | - Lian Xu
- Department of Pathology, West China Second Hospital of Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan, China
| | - Min Feng
- Department of Pathology, West China Second Hospital of Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan, China
| | - Wei Wang
- Department of Pathology, West China Second Hospital of Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan, China
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Kayastha S, Chitrathara K, Sigdel B, Sanam P, Anupama S, Remi A, Augustine T, Peter BC. Adult Granulosa Cell Tumor of Ovary: Clinical Study of 10 Cases. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2020. [DOI: 10.1007/s40944-019-0343-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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16
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Peiretti M, Candotti G, Fais ML, Ricciardi E, Colombo N, Zanagnolo V, Bruni S, Aletti G, Maggioni A. Comparison between laparoscopy and laparotomy in the surgical re-staging of granulosa cell tumors of the ovary. Gynecol Oncol 2020; 157:85-88. [PMID: 31954531 DOI: 10.1016/j.ygyno.2019.12.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 12/02/2019] [Accepted: 12/25/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To evaluate the role of laparoscopic (LPS) and laparotomic (LPT) re-staging in patients with incompletely surgically staged ovarian granulosa cell tumors (OGCT). METHODS We conducted a medical chart retrospective analysis of all patients with sex cord stromal tumors (SCSTs) who were managed in our division between March 1994 and March 2017. After a complete review of surgical and pathological notes, patients with incomplete staging were restaged according to the FIGO guidelines. Statistical analysis was conducted using Statistical Package version 20.0 for Windows (SPSS, Inc., Chicago, Illinois). RESULTS Out of a total of 170 patients SCSTs, 84 patients (49,5%) received primary surgery that included a hysterectomy; 86 patients (50,5%) underwent fertility-sparing surgery. Eighty-one patients (48%) with diagnosis of OGCT were incompletely surgically staged at another institution. We evaluated our results in terms of laparoscopic approach (56 patients) and open treatment (25 patients). Among the IA patient's group, 1 was upstaged to IIB stage and 2 to IIIB; among patients with IC stage, 1 was upstaged to IIA, 2 to IIB and 1 to IIIB stage. Adjuvant chemotherapy was given to the upstaged patients with final stage IIB-IIIC. No statistically significant difference between laparoscopy and open-surgery was detected in terms of upstaged patients after second surgery (p = 0,36). CONCLUSION According to our series, laparoscopic restaging compared to the open approach seems to be a feasible and efficient technique to complete surgical staging in patients with GCTs incorrectly staged. Surgical restaging seems to upstage a considerable number of OGCT, mainly in the initial stage IC group of patients. However, the impact of restaging on final outcome and survival remains to be demonstrated.
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Affiliation(s)
- M Peiretti
- Department of Surgical Sciences, Division of Gynecology and Obstetrics, University of Cagliari, Italy.
| | - G Candotti
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - M L Fais
- Department of Surgical Sciences, Division of Gynecology and Obstetrics, University of Cagliari, Italy
| | - E Ricciardi
- Department of "Gynäkologie & Gynäkologische Onkologie", Kliniken Essen-Mitte, Essen, Germany
| | - N Colombo
- Division of Gynecologic Oncology, European Institute of Oncology, Milan, Italy
| | - V Zanagnolo
- Division of Gynecologic Oncology, European Institute of Oncology, Milan, Italy
| | - S Bruni
- Division of Gynecologic Oncology, European Institute of Oncology, Milan, Italy
| | - G Aletti
- Division of Gynecologic Oncology, European Institute of Oncology, Milan, Italy
| | - A Maggioni
- Division of Gynecologic Oncology, European Institute of Oncology, Milan, Italy
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Other Primary Malignancies Among Women With Adult-Type Ovarian Granulosa Cell Tumors. Int J Gynecol Cancer 2019; 28:1529-1534. [PMID: 30036228 DOI: 10.1097/igc.0000000000001333] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine the incidence of new primary malignancies after adult-type granulosa cell tumor (AGCT) and the incidence of AGCT after breast and uterine cancer using nationwide population-based registry data. METHODS We used the Finnish Cancer Registry to identify all patients diagnosed with AGCT in 1968 to 2013 (n = 986). The number of subsequent primary malignancies among women with AGCT and the number of AGCTs in women with previous breast or uterine cancer were compared with the expected number of cases and expressed as standardized incidence ratios (SIRs). RESULTS There were 122 cases of subsequent cancers diagnosed at least 6 months after the primary diagnosis of AGCT (SIR, 1.09; 95% confidence interval [CI], 0.91-1.3). In particular, the observed number of cancers of the soft tissue (SIR, 4.13; 95% CI, 1.33-12.8), thyroid (SIR, 3.42; 95% CI, 1.54-7.62), and leukemia (SIR, 2.67; 95% CI, 0.98-5.82) exceeded the number of expected cases. The SIR for breast cancers after AGCT was 1.26 (95% CI, 0.92-1.73), and the SIR for AGCT after breast cancer was 1.59 (95% CI, 1.04-2.29). The risk for subsequent AGCT was more than 2-fold in breast cancer patients younger than 50 years, and over 15 years after primary diagnosis. CONCLUSIONS There is an increased risk for thyroid and soft tissue cancer as well as leukemia after AGCT, which may be associated with late effects of carcinogenic treatments and possibly shared risk factors. After breast cancer, the risk for AGCT was higher, which may indicate a shared hormonal etiology.
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Makhija A, Patel BM, Kenkre MA, Desai AD, Patel SM, Mankad MH, Parekh CD. Retrospective Analysis of 32 Cases of Ovarian Granulosa Cell Tumours. J Obstet Gynaecol India 2019; 70:50-56. [PMID: 32030006 DOI: 10.1007/s13224-019-01203-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 01/21/2019] [Indexed: 10/26/2022] Open
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. Results The 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.
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Affiliation(s)
- Amrita Makhija
- Department of Gynecological Oncology, Gujarat Cancer and Research Institute, Ahmedabad, 380016 India
| | - Bijal M Patel
- Department of Gynecological Oncology, Gujarat Cancer and Research Institute, Ahmedabad, 380016 India
| | - Mangirish A Kenkre
- Department of Gynecological Oncology, Gujarat Cancer and Research Institute, Ahmedabad, 380016 India
| | - Ava D Desai
- Department of Gynecological Oncology, Gujarat Cancer and Research Institute, Ahmedabad, 380016 India
| | - Shilpa M Patel
- Department of Gynecological Oncology, Gujarat Cancer and Research Institute, Ahmedabad, 380016 India
| | - Meeta H Mankad
- Department of Gynecological Oncology, Gujarat Cancer and Research Institute, Ahmedabad, 380016 India
| | - Chetana D Parekh
- Department of Gynecological Oncology, Gujarat Cancer and Research Institute, Ahmedabad, 380016 India
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Erkılınç S, Taylan E, Karataşlı V, Uzaldı İ, Karadeniz T, Gökçü M, Sancı M. Does lymphadenectomy effect postoperative surgical morbidity and survival in patients with adult granulosa cell tumor of ovary? J Obstet Gynaecol Res 2019; 45:1019-1025. [PMID: 30761709 DOI: 10.1111/jog.13928] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 01/03/2019] [Indexed: 11/30/2022]
Abstract
AIM To evaluate the effect of lymphadenectomy on surgical morbidity and survival in adult granulosa cell tumor (AGCT) of the ovary. METHODS Patients who underwent surgical treatment for AGCT between January 1993 and January 2016 were identified. Data were collected for patient age, menopausal status, surgical staging, lymphadenectomy, postoperative complications (anemia, wound infection, incisional hernia), length of hospital stay, follow-up duration, site and time for recurrence, management of recurrence and vital status. Histopathological records were also evaluated for number of cellular mitosis. RESULTS Lymphadenectomy (pelvic-paraaortic) was performed in 53 (53%) of 98 patients. Decrease in postoperative hemoglobin level and increased wound infection and longer hospital stay were significantly higher in lymphadenectomy group (P = 0.003, 0.043 and <0.001, respectively). Tumor stage (HR 95% CI 14.9 [2.43-92.8]) and number of mitoses >5 (HR 95% CI 14.9 [2.43-92.8]) were significantly associated with recurrence (P = <0.001 and 0.02, respectively). Tumor stage was the only prognostic factor for predicting overall survival (HR 95% CI 8.47 [2.17-33.2]). Lymphadenectomy showed no effect on disease-free survival and overall survival both in multivariate Cox regression analyses (P = 0.46 and 0.69, respectively). Disease-free survival and overall survival were similar in lymphadenectomy and no lymphadenectomy groups (Log Rank P = 0.382, 0.741, respectively). CONCLUSION Lymphadenectomy had no improved effect on survival and had negative effect on surgical morbidity in patients with AGCT.
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Affiliation(s)
- Selçuk Erkılınç
- Division of Gynecologic Oncology, University of Medical Sciences Tepecik Education and Research Hospital, Izmir, Turkey
| | - Enes Taylan
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Volkan Karataşlı
- Division of Gynecologic Oncology, University of Medical Sciences Tepecik Education and Research Hospital, Izmir, Turkey
| | - İpek Uzaldı
- Division of Gynecologic Oncology, University of Medical Sciences Tepecik Education and Research Hospital, Izmir, Turkey
| | - Tuğba Karadeniz
- Division of Pathology, University of Medical Sciences Tepecik Education and Research Hospital, Izmir, Turkey
| | - Mehmet Gökçü
- Division of Gynecologic Oncology, University of Medical Sciences Tepecik Education and Research Hospital, Izmir, Turkey
| | - Muzaffer Sancı
- Division of Gynecologic Oncology, University of Medical Sciences Tepecik Education and Research Hospital, Izmir, Turkey
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Ghalleb M, Bouzaiene H, Sghaier S, Bouaziz H, Hechiche M, Hassouna JB, Rahal K. Fertility sparing surgery for ovarian sex cord stromal tumors: a nine case series. Pan Afr Med J 2018; 31:221. [PMID: 31447979 PMCID: PMC6691291 DOI: 10.11604/pamj.2018.31.221.15531] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 07/01/2018] [Indexed: 12/23/2022] Open
Abstract
Ovarian Sex Cord Stromal Tumors (SCST) are a rare disease carrying a good prognosis. They generally affect young women; therefore fertility preservation is a critical issue. Fertility Sparing Surgery (FSS) showed promising results in both oncologic safety and fertility preservation. A retrospective case series involving 9 patients diagnosed with SCST and treated with fertility sparing surgery at our institution was conducted between January 2000 and May 2015. The median age was 24 years old (10 to 39). The main clinical manifestation was pelvic pain seen in seven patients. Five patients complained about menstrual cycle disorders. The nine patients went through fertility sparing surgery; seven had conservative staging and the other two had a unilateral salpingo-oophorectomy. Three patients out of nine had a pelvic unilateral lymphadenectomy. Two patients received adjuvant chemotherapy. Only two patients presented locoregional recurrence that occurred respectively after 7 and 192 months. The treatment combined chemotherapy and surgery based on mass resection. One patient achieved a natural pregnancy after the treatment. FSS seems to be a suitable approach for SCST. However, more case series and meta-analysis should be conducted.
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Affiliation(s)
- Montassar Ghalleb
- Surgical Oncology Department, Institut Salah Azaiez de Cancérologie, Tunis, Tunisie.,Faculté de Médicine Tunis El Manar, Tunis, Tunisia
| | - Hatem Bouzaiene
- Surgical Oncology Department, Institut Salah Azaiez de Cancérologie, Tunis, Tunisie.,Faculté de Médicine Tunis El Manar, Tunis, Tunisia
| | - Sarah Sghaier
- Surgical Oncology Department, Institut Salah Azaiez de Cancérologie, Tunis, Tunisie.,Faculté de Médicine Tunis El Manar, Tunis, Tunisia
| | - Hanen Bouaziz
- Surgical Oncology Department, Institut Salah Azaiez de Cancérologie, Tunis, Tunisie.,Faculté de Médicine Tunis El Manar, Tunis, Tunisia
| | - Monia Hechiche
- Surgical Oncology Department, Institut Salah Azaiez de Cancérologie, Tunis, Tunisie.,Faculté de Médicine Tunis El Manar, Tunis, Tunisia
| | - Jamel Ben Hassouna
- Surgical Oncology Department, Institut Salah Azaiez de Cancérologie, Tunis, Tunisie.,Faculté de Médicine Tunis El Manar, Tunis, Tunisia
| | - Khaled Rahal
- Surgical Oncology Department, Institut Salah Azaiez de Cancérologie, Tunis, Tunisie.,Faculté de Médicine Tunis El Manar, Tunis, Tunisia
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Wang D, Cao D, Jia C, Huang H, Yang J, Wu M, Pan L, Shen K, Xiang Y. Analysis of oncologic and reproductive outcomes after fertility-sparing surgery in apparent stage I adult ovarian granulosa cell tumors. Gynecol Oncol 2018; 151:275-281. [DOI: 10.1016/j.ygyno.2018.09.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 08/30/2018] [Accepted: 09/04/2018] [Indexed: 10/28/2022]
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Adult Granulosa Cell Tumors of the Ovary: A Retrospective Study of 36 FIGO Stage I Cases with Emphasis on Prognostic Pathohistological Features. Anal Cell Pathol (Amst) 2018; 2018:9148124. [PMID: 30186737 PMCID: PMC6116457 DOI: 10.1155/2018/9148124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 07/31/2018] [Indexed: 11/18/2022] Open
Abstract
Objective Adult granulosa cell tumors (AGCTs) represent 2%-5% of all ovarian malignancies. The aim of this study was to analyze clinical and pathohistological parameters and their impact on recurrence, overall, and disease-free survival in FIGO stage I AGCT patients. Methods The tumor specimens analyzed in this retrospective study were obtained from a total of 36 patients with diagnosis of ovarian AGCT surgically treated at the Department of Gynecology, Rijeka University Hospital Centre, between 1994 and 2012. Clinical, pathological, and follow-up data were collected. Results The mean age at diagnosis was 54.5 years with a range of 24-84. The majority of the patients, 30 (83%), were in FIGO stage IA, 3 (8%) in stage IC1, 1 (3%) in stage IC2, and 2 (6%) in stage IC3. During follow-up period (median 117.5 months, range 26-276), recurrence occurred in 4 patients (12%) with 2 deaths of the disease recorded. In univariate analysis, the 5-year survival rates were significantly shorter in patients with FIGO substage IC (p = 0.019), with positive LVSI (p = 0.022), with presence of necrosis (p = 0.040), and with hemorrhage (p = 0.017). In univariate analysis, the 5-year disease-free survival rates were significantly shorter in patients treated with fertility surgery (p = 0.004), with diffuse growth pattern (p = 0.012), with moderate and severe nuclear atypia (p = 0.032), and with presence of hemorrhage (p = 0.022). FIGO substage IC proved to be independent predictor for recurrence (OR = 16.87, p = 0.015, and OR = 23.49, p = 0.023, resp.) and disease-free survival (p = 0.0002; HR 20.84, p = 0.02) at the uni- and multivariate analyses. Conclusions FIGO substage IC is predictive of recurrence and disease-free survival in patients with early-stage AGCTs. LVSI, presence of necrosis and hemorrhage, diffuse growth pattern, and nuclear atypia in AGCTs seem to be associated with overall and disease-free survival, so these pathological features should be taken into consideration when managing patients with AGCT.
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KMT2D/MLL2 inactivation is associated with recurrence in adult-type granulosa cell tumors of the ovary. Nat Commun 2018; 9:2496. [PMID: 29950560 PMCID: PMC6021426 DOI: 10.1038/s41467-018-04950-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 06/06/2018] [Indexed: 12/18/2022] Open
Abstract
Adult-type granulosa cell tumors of the ovary (aGCTs) are rare gynecologic malignancies that exhibit a high frequency of somatic FOXL2 c.C402G (p.Cys134Trp) mutation. Treatment of relapsed aGCT remains a significant clinical challenge. Here we show, using whole-exome and cancer gene panel sequencing of 79 aGCTs from two independent cohorts, that truncating mutation of the histone lysine methyltransferase gene KMT2D (also known as MLL2) is a recurrent somatic event in aGCT. Mono-allelic KMT2D-truncating mutations are more frequent in recurrent (10/44, 23%) compared with primary (1/35, 3%) aGCTs (p = 0.02, two-sided Fisher's exact test). IHC detects additional non-KMT2D-mutated aGCTs with loss of nuclear KMT2D expression, suggesting that non-genetic KMT2D inactivation may occur in this tumor type. These findings identify KMT2D inactivation as a novel driver event in aGCTs and suggest that mutation of this gene may increase the risk of disease recurrence.
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Yang AD, Curtin J, Muggia F. Ovarian adult-type granulosa cell tumor: focusing on endocrine-based therapies. INTERNATIONAL JOURNAL OF ENDOCRINE ONCOLOGY 2018. [DOI: 10.2217/ije-2017-0021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Adult-type granulosa cell tumors (GCTs), although rare, are the most commonly diagnosed neoplasms arising in the endocrine-active ovarian stroma. They are characterized by excessive production of estrogens, antimullerian hormone and inhibins. In 2009, a specific mutation in FOXL2 was identified to be pathognomonic of GCTs. How dysregulation of this transcription factor, resulting in upregulation of aromatase, leads to unchecked proliferation, and progression to a malignancy, remains unclear. The key pathological and clinical feature of GCTs that affects their usually favorable outcomes is a diagnosis of greater than Stage 1 disease at presentation. Chemotherapy is given as adjuvant upon an advanced stage diagnosis; however, its effect on survival upon recurrence is modest. On the other hand, aromatase inhibitors also lead to tumor regression and are suitable for long-term maintenance.
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Affiliation(s)
- Annie D Yang
- NYU School of Medicine & Divisions of Medical Oncology & Gynecologic Oncology of the Perlmutter Cancer Center at NYU Langone Health, New York, NY 10016, USA
| | - John Curtin
- NYU School of Medicine & Divisions of Medical Oncology & Gynecologic Oncology of the Perlmutter Cancer Center at NYU Langone Health, New York, NY 10016, USA
| | - Franco Muggia
- NYU School of Medicine & Divisions of Medical Oncology & Gynecologic Oncology of the Perlmutter Cancer Center at NYU Langone Health, New York, NY 10016, USA
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Wang J, Li J, Chen R, Lu X. Contribution of lymph node staging method and prognostic factors in malignant ovarian sex cord-stromal tumors: A world wide database analysis. Eur J Surg Oncol 2018; 44:1054-1061. [PMID: 29705285 DOI: 10.1016/j.ejso.2018.03.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 03/20/2018] [Accepted: 03/29/2018] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To investigate the clinicopathologic prognostic factors in patients with malignant sex cord-stromal tumors (SCSTs) with lymph node dissection, and at the same time, to evaluate the influence of the log odds of positive lymph nodes (LODDS) on their survival. METHODS Patients diagnosed with malignant SCSTs who underwent lymph node dissection were extracted from the 1988-2013 Surveillance, Epidemiology, and End Results (SEER) database. Overall survival (OS) and cancer-specific survival (CSS) were estimated by Kaplan-Meier curves. The Cox proportional hazards regression model was used to identify independent predictors of survival. RESULTS 576 patients with malignant SCSTs and with lymphadenectomy were identified, including 468 (81.3%) patients with granulosa cell tumors (GCTs) and 80 (13.9%) patients with Sertoli-Leydig cell tumors (SLCTs). 399 (69.3%) patients and 118 (20.5%) patients were in the LODDS < -1 group and -1 ≤ LODDS < -0.5 group, respectively. The 10-year OS rate was 80.9% and CSS was 87.2% in the LODDS < -0.5 group, whereas the survival rates for other groups were 68.5% and 73.3%. On multivariate analysis, age 50 years or less (p < 0.001), tumor size of 10 cm or less (p < 0.001), early-stage disease (p < 0.001), and GCT histology (p ≤ 0.001) were the significant prognostic factors for improved survival. LODDS < -0.5 was associated with a favorable prognosis (OS: p = 0.051; CSS:P = 0.055). CONCLUSIONS Younger age, smaller tumor size, early stage, and GCT histologic type are independent prognostic factors for improved survival in patients with malignant SCST with lymphadenectomy. Stratified LODDS could be regarded as an effective value to assess the lymph node status, and to predict the survival status of patients.
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Affiliation(s)
- Jieyu Wang
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200032, China; Shanghai Key Laboratory of Female Reproductive Endocrine-Related Disease of Fudan University, Shanghai, 200011, China
| | - Jun Li
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200032, China
| | - Ruifang Chen
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200032, China
| | - Xin Lu
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200032, China; Shanghai Key Laboratory of Female Reproductive Endocrine-Related Disease of Fudan University, Shanghai, 200011, China.
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Granulosa Cell Tumor of the Ovary: A Retrospective Study of 31 Cases and a Review of the Literature. Int J Surg Oncol 2018; 2018:4547892. [PMID: 29796312 PMCID: PMC5896205 DOI: 10.1155/2018/4547892] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 06/18/2017] [Accepted: 09/13/2017] [Indexed: 12/11/2022] Open
Abstract
Background Adult granulosa cell tumors (AGCTs) are the most common sex cord-stromal tumors. Unlike epithelial ovarian tumors, they occur in young women and are usually detected at an early stage. The aim of this study was to report the clinical and pathological characteristics of AGCT patients and to identify the prognostic factors. Methods All cases of AGCTs, treated at Salah Azaïz Institute between 1995 and 2010, were retrospectively included. Kaplan-Meier's statistical method was used to assess the relapse-free survival and the overall survival. Results The final cohort included 31 patients with AGCT. The mean age was 53 years (35–73 years). Patients mainly presented with abdominal mass and/or pain (61%, n = 19). Mean tumor size was 20 cm. The majority of patients had a stage I disease (61%, n = 19). Two among 3 patients with stage IV disease had liver metastasis. Mitotic index was low in 45% of cases (n = 14). Surgical treatment was optimal in almost all cases (90%, n = 28). The median follow-up time was 14 years (1–184 months). Ten patients relapsed (32%) with a median RFS of 8.4 years (6.8–9.9 years). Mean overall survival was 13 years (11–15 years). Stage I disease and low-to-intermediate mitotic index were associated with a better prognosis in univariate analysis (resp., p = 0.05 and p = 0.02) but were not independent prognostic factors. Conclusion GCTs have a long natural history with common late relapses. Hence, long active follow-up is recommended. In Tunisian patients, hepatic metastases were more frequent than occidental series. The prognosis remains good and initial staging at diagnosis is an important prognostic factor.
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Wang D, Xiang Y, Wu M, Shen K, Yang J, Huang H, Ren T. Clinicopathological characteristics and prognosis of adult ovarian granulosa cell tumor: a single-institution experience in China. Onco Targets Ther 2018; 11:1315-1322. [PMID: 29563810 PMCID: PMC5846745 DOI: 10.2147/ott.s155473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objectives We aimed to demonstrate the clinical characteristics and risk factors associated with recurrence of adult granulosa cell tumor (AGCT), as well as the pregnancy and long-term outcomes among patients in a single institution in China. Patients and methods We reviewed 141 patients with AGCT in Peking Union Medical College Hospital between January 1983 and September 2015. Results The mean patient age was 45.1 years (16–78 years), and the mean tumor size was 8.8 cm (1–40 cm). The most common symptom was irregular menstruation (31.9%, n=45). The disease distribution was stage I in 136 patients, stage II in three patients, and stage III in two patients. Eighty-seven patients (61.7%) underwent radical surgery, while 54 (38.3%) underwent fertility-sparing surgery, of whom five subsequently had a total of five pregnancies. Fifty-two patients underwent pelvic and/or paraaortic lymphadenectomy, and none of them showed lymph node metastasis. The median follow-up period was 72.7 months (8.9–344 months). Twenty-six patients (18.4%) developed recurrence during the study period, with a median time to recurrence of 68 months (7–312 months). Initial stage (stage IC vs IA) and nonstaging surgery were independent risk factors for recurrence in both univariate and multivariate analyses for stage I AGCT patients. Conclusion Tumor stage is an independent risk factor for recurrence in patients with AGCT. Staging surgery is recommended for patients with AGCT, though lymphadenectomy may be omitted. Complete tumor resection is important for patient survival in patients with AGCT recurrence. Long-term follow-up is required, even in early-stage AGCT patients.
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Affiliation(s)
- Dan Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Yang Xiang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Ming Wu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Keng Shen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Jiaxin Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Huifang Huang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Tong Ren
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
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Bergamini A, Ferrandina G, Candiani M, Cormio G, Giorda G, Lauria R, Perrone AM, Scarfone G, Breda E, Savarese A, Frigerio L, Gadducci A, Mascilini F, Maneschi F, Cassani C, Marchetti C, Cecere SC, Biglia N, De Giorgi U, Raspagliesi F, Lorusso D, Mangili G. Laparoscopic surgery in the treatment of stage I adult granulosa cells tumors of the ovary: Results from the MITO-9 study. Eur J Surg Oncol 2018; 44:766-770. [PMID: 29576462 DOI: 10.1016/j.ejso.2018.03.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/16/2018] [Accepted: 03/05/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Surgery represents the mainstay of treatment of stage I adult type granulosa cell tumors of the ovary (AGCTs). Because of the rarity and indolent course of the disease, no prospective trials are available. Open surgery has long been considered the traditional approach; oncological safety of laparoscopy is only supported by small series or case reports. The aim of this study was to compare the oncological outcomes between laparoscopic and open surgery in stage I AGCTs treated within the MITO (Multicenter Italian Trials in Ovarian cancer) Group. METHODS Data from patients with stage I AGCTs were retrospectively collected. Clinicopathological features were evaluated for association with relapse and death. Survival curves were calculated using the Kaplan-Meier method and compared with the log-rank test. The role of clinicopathological variables as prognostic factors for survival was evaluated using Cox's regression model. RESULTS 223 patients were identified. Stage 1A, 1B and 1C were 61.5%, 1.3% and 29.6% respectively. 7.6% were apparently stage I. Surgical approach was laparoscopic for 93 patients (41.7%) and open for 130 (58.3%). 5-years DFS was 84% and 82%, 10-years DFS was 68% and 64% for the laparoscopic and open-group (p = 0.6).5-years OS was 100% and 99%, 10 years OS was 98% and 97% for the laparoscopic and open-surgery group (p = 0.8). At multivariate analyses stage IC, incomplete staging, site of primary surgery retained significant prognostic value. CONCLUSION The present study suggests that surgical route does not affect the oncological safety of patients with stage I AGCTs, with comparable outcomes between laparoscopic and open approach.
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Affiliation(s)
- A Bergamini
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Milan, Italy.
| | - G Ferrandina
- Department of Obstetrics and Gynecology, Gynecology Oncology Unit, Catholic University of Sacred Heart of Rome, Italy
| | - M Candiani
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Milan, Italy
| | - G Cormio
- Department of Biomedical Science and Human Oncology, University of Bari, Bari I, Bari, Italy; Gynecologic Oncology Unit, IRCCS National Cancer Institute "Giovanni Paolo II" Bari, Italy
| | - G Giorda
- Gynecological Oncology Unit, Centro di Riferimento Oncologico - National Cancer Institute, Aviano, Italy
| | - R Lauria
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Napoli, Italy
| | - A M Perrone
- Department of Gynecology Oncology, Institute of Obstetrics and Gynecology, S. Orsola Hospital, Bologna, Italy
| | - G Scarfone
- Department of Obstetrics, Gynecology and Neonatology, IRCCS Fondazione Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - E Breda
- Medical Oncology Unit Ospedale S Giovanni Calibita Fatebenefratelli, Rome, Italy
| | - A Savarese
- Division of Medical Oncology 1, Regina Elena Cancer Institute, Rome, Italy
| | - L Frigerio
- Department of Obstetrics & Gynaecology, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - A Gadducci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - F Mascilini
- Department of Obstetrics and Gynecology, Gynecology Oncology Unit, Catholic University of Sacred Heart of Rome, Italy
| | - F Maneschi
- Gynecology and Obstetric Unit, AO San Giovanni Addolorata, Rome, Italy
| | - C Cassani
- Department of Obstetrics and Gynaecology Fondazione IRCCS Policlinico San Matteo-University of Pavia, Pavia, Italy
| | - C Marchetti
- Department of Gynecological-Obstetrical and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - S C Cecere
- Division of Medical Oncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy
| | - N Biglia
- Obstetrics and Gynaecology Unit, Umberto I Hospital, Department of Surgical Sciences, School of Medicine, University of Turin, Turin, Italy
| | - U De Giorgi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Italy
| | - F Raspagliesi
- Gynecologic Oncology Unit, IRCCS National Cancer Institute Foundation, Milan, Italy
| | - D Lorusso
- Gynecologic Oncology Unit, IRCCS National Cancer Institute Foundation, Milan, Italy
| | - G Mangili
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Milan, Italy
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Cheng H, Peng J, Yang Z, Zhang G. Prognostic significance of lymphadenectomyin malignant ovarian sex cord stromal tumor: A retrospective cohort study and meta-analysis. Gynecol Oncol 2017; 148:91-96. [PMID: 29107349 DOI: 10.1016/j.ygyno.2017.10.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 10/14/2017] [Accepted: 10/18/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To evaluate the prognostic significance of lymphadenectomy in malignant ovarian sex cord stromal tumor (SCST). METHODS The medical records of patients with malignant ovarian SCST who underwent primary surgery from April 2005 to December 2016 were retrospectively reviewed in the Department of Obstetrics and Gynecology of Qilu Hospital. A meta-analysis was performed by searching the PubMed and Embase database up to July 20, 2017. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by STATA statistical software version 19.0. RESULTS Seventy-two patients with malignant SCST were identified in our institution. The mean age of the patients was 44.3years (range, 8-80years). Among the 72 patients, 69.4% had granulosa cell tumors (GCTs, n=50); 47.2% (n=34) underwent lymphadenectomy, and 52.8% (n=38) did not undergo the surgery. None of the lymph nodes had pathologically confirmed metastasis. No significant differences in overall survival of the patients with SCST or GCT were noted based on patient age, tumor size, surgery extent, or administration of cytotoxic chemotherapy, except tumor stage (P=0.010 in SCTs and 0.029 in GCTs, respectively). Lymphadenectomy showed no statistically significant difference in overall survival of patients with SCST or GCT (P=0.734 and 0.079, respectively). In our meta-analysis, a total of 179 studies were identified through a search strategy, and 13 studies were included eventually; 3223 cases were identified, including those from our institution. The random-effects model was used because of moderate heterogeneity (I2=43.8%, P=0.040). The estimated pooled OR was 0.87 (95% CI, 0.57-1.31), indicating that lymphadenectomy has no statistical significance in improving overall survival in SCSTs (Z=0.68, P=0.496). CONCLUSIONS Tumor stage is the most important prognostic factor affecting SCST overall survival. There is no significant effect of lymphadenectomy in improving the overall survival of SCSTs. Lymphadenectomy is not recommended in initial staging surgery of SCST due to the extremely low lymph node metastasis rate.
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Affiliation(s)
- Hongyan Cheng
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji'nan, Shandong 250012, PR China; Qilu Medical School, Shandong University, Ji'nan, Shandong 250012, PR China
| | - Jin Peng
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji'nan, Shandong 250012, PR China
| | - Zhaojie Yang
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji'nan, Shandong 250012, PR China; Qilu Medical School, Shandong University, Ji'nan, Shandong 250012, PR China
| | - Guiyu Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji'nan, Shandong 250012, PR China; Qilu Medical School, Shandong University, Ji'nan, Shandong 250012, PR China.
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Safety of Fertility-Sparing Surgery for Premenopausal Women With Sex Cord-Stromal Tumors Confined to the Ovary. Int J Gynecol Cancer 2017; 27:1826-1832. [DOI: 10.1097/igc.0000000000001110] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectiveThe aim of this retrospective population-based study was to investigate the oncologic safety of fertility-sparing surgery (FSS) for premenopausal women with malignant sex cord-stromal tumors (SCSTs) confined to the ovary.MethodsA cohort of women aged 18 to 49 years and diagnosed with a stage I malignant SCST between 1984 and 2013 was drawn from the National Cancer Institute's Surveillance, Epidemiology, and End Results database. Based on site-specific surgery codes, women who had FSS, defined as unilateral oophorectomy/tumor resection without hysterectomy, and definite surgery were identified. Cancer-specific survival and overall survival were evaluated after generation of Kaplan-Meier curves, whereas comparisons between the 2 groups were made with the log-rank test.ResultsA total of 255 women who met the inclusion criteria were identified; 161 (63.1%) underwent FSS whereas 94 (36.9%) had definitive surgery (bilateral salpingo-oophorectomy and hysterectomy). Median follow-up was 104 months. Cancer-specific survival (P= 0.015) but not overall survival (P= 0.76) was superior for women who had definite surgery.ConclusionsIn this retrospective population-based cohort of premenopausal women with SCSTs confined to the ovary, FSS was associated only with a worse long-term cancer-specific survival compared with definitive surgery. Women undergoing FSS for early stage SCSTs should be extensively counseled and closely monitored.
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31
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Färkkilä A, McConechy MK, Yang W, Talhouk A, Ng Y, Lum A, Morin RD, Bushell K, Riska A, McAlpine JN, Gilks CB, Unkila-Kallio L, Anttonen M, Huntsman DG. FOXL2 402C>G Mutation Can Be Identified in the Circulating Tumor DNA of Patients with Adult-Type Granulosa Cell Tumor. J Mol Diagn 2017; 19:126-136. [DOI: 10.1016/j.jmoldx.2016.08.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 08/23/2016] [Accepted: 08/25/2016] [Indexed: 12/12/2022] Open
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Roles of human epididymis protein 4, carbohydrate antigen 125, inhibin B and anti-Müllerian hormone in the differential diagnosis and follow-up of ovarian granulosa cell tumors. Gynecol Oncol 2017; 144:83-89. [DOI: 10.1016/j.ygyno.2016.11.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/07/2016] [Accepted: 11/11/2016] [Indexed: 12/12/2022]
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Bús D, Buzogány M, Nagy G, Vajda G. Rare virilizing granulosa cell tumor in an adolescent. Mol Clin Oncol 2016; 6:88-90. [PMID: 28123736 DOI: 10.3892/mco.2016.1084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 09/14/2016] [Indexed: 11/05/2022] Open
Abstract
Hormone-producing malignancies are rare in children or adolescent patients: Only 0.1% of all ovarian tumors and 4-5% of granulosa cell tumors occur in the sexually non-active ages. Granulosa cell tumors (GCTs) are sex cord-stromal tumors of the ovary, representing 7-8% of all ovarian neoplasms. A total of 95% of all GCTs are adult-type, and only 5% are diagnosed as juvenile-type GCT. A majority of children with juvenile-type GCT present with isosexual precocious pseudopuberty due to excessive estrogen production, although virilizing, testosterone-producing, juvenile-type GCTs are rare, occurring only in 2-3% of cases. The present case study reports on a case of a virilizing, juvenile-type GCT in a 14-year-old girl, along with a review of the literature.
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Affiliation(s)
- Dorottya Bús
- Department of Obstetrics and Gynecology, Zala County Hospital, 8900 Zalaegerszeg, Hungary
| | - Mária Buzogány
- Department of Neonatology and Pediatrics, Zala County Hospital, 8900 Zalaegerszeg, Hungary
| | - Gyöngyi Nagy
- Department of Radiology, Zala County Hospital, 8900 Zalaegerszeg, Hungary
| | - György Vajda
- Department of Obstetrics and Gynecology, Zala County Hospital, 8900 Zalaegerszeg, Hungary
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34
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Bryk S, Färkkilä A, Bützow R, Leminen A, Tapper J, Heikinheimo M, Unkila-Kallio L, Riska A. Characteristics and outcome of recurrence in molecularly defined adult-type ovarian granulosa cell tumors. Gynecol Oncol 2016; 143:571-577. [PMID: 27729108 DOI: 10.1016/j.ygyno.2016.10.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 09/28/2016] [Accepted: 10/01/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Adult-type ovarian granulosa cell tumors (AGCTs) have an unpredictable tendency to relapse. In a carefully validated patient cohort, we evaluated the prognostic factors related to AGCT recurrence. METHODS We identified all patients diagnosed with AGCT during 1956-2014 in Helsinki University Hospital, with a minimum follow-up of one year (n=240). After a histological review supplemented with FOXL2 (402C-G) mutation status analysis, we analyzed the clinical data for association with relapse. RESULTS The final cohort included 164 (68%) molecularly defined AGCTs (MD-AGCTs). The majority of the women were postmenopausal (63%), and 92% of tumors were stage I. The median follow-up time was 15.5years. Fifty-two (32%) patients developed tumor recurrence, of whom 55% had successive recurrences. Multiple-site recurrences were common, and nearly half of the recurrences were asymptomatic. The median time to the first relapse was 7.4years, and 75% of relapses occurred within ten years after primary diagnosis. The median disease-free survival was 11.3years. Premenopausal status at initial diagnosis, FIGO stage Ic versus Ia, and tumor rupture associated with relapse. However, tumor rupture was the only independent predictive factor. Of the relapsed patients, 48% died of AGCT in a median time of 15.3years. CONCLUSION Tumor rupture is the strongest predictive factor for recurrence, and these patients might benefit from a more aggressive initial treatment approach. AGCT requires active follow up for 10 to 15years after primary diagnosis, since recurrences may develop late, asymptomatically and in multiple anatomical locations.
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Affiliation(s)
- Saara Bryk
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Finland; Children's Hospital, University of Helsinki and Helsinki University Hospital, Finland.
| | - Anniina Färkkilä
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Finland; Children's Hospital, University of Helsinki and Helsinki University Hospital, Finland
| | - Ralf Bützow
- Pathology and HUSLAB, University of Helsinki and Helsinki University Hospital, Finland
| | - Arto Leminen
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Finland
| | - Johanna Tapper
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Finland
| | - Markku Heikinheimo
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Finland; Department of Pediatrics, Washington University School of Medicine, St Louis Children's Hospital, St Louis, MO, United States
| | - Leila Unkila-Kallio
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Finland
| | - Annika Riska
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Finland
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35
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Hua G, He C, Lv X, Fan L, Wang C, Remmenga SW, Rodabaugh KJ, Yang L, Lele SM, Yang P, Karpf AR, Davis JS, Wang C. The four and a half LIM domains 2 (FHL2) regulates ovarian granulosa cell tumor progression via controlling AKT1 transcription. Cell Death Dis 2016; 7:e2297. [PMID: 27415427 PMCID: PMC4973349 DOI: 10.1038/cddis.2016.207] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 05/04/2016] [Accepted: 05/24/2016] [Indexed: 12/14/2022]
Abstract
The four and a half LIM domains 2 (FHL2) has been shown to play important roles in the regulation of cell proliferation, survival, adhesion, motility and signal transduction in a cell type and tissue-dependent manner. However, the function of FHL2 in ovarian physiology and pathology is unclear. The aim of this study was to determine the role and functional mechanism of FHL2 in the progression of ovarian granulosa cell tumors (GCTs). Immunohistochemical analysis indicated that FHL2 was overexpressed in GCT tissues. Cellular localization of FHL2 in GCT cells was cell cycle dependent. Knockdown of FHL2 suppressed GCT cell growth, reduced cell viability and inhibited cell migration. Consistently, ectopic expression of FHL2 in GCT cells with very low endogenous FHL2 promoted cell growth, improved cell viability and enhance cell migration. Importantly, overexpression of FHL2 promoted GCT progression in vivo. Mechanistic studies indicated that FHL2 regulates AKT1 gene expression in vitro and in vivo. Knockdown of FHL2 or AKT1 in GCT cell lines induced very similar phenotypes. Ectopic expression of constitutively active AKT1 rescued FHL2 knockdown-induced arrest of GCT cell growth and reduction of GCT cell viability, suggesting that FHL2 regulates GCT cell growth and viability through controlling AKT1 expression. Finally, co-immunoprecipitation and chromatin immunoprecipitation analyses indicated that FHL2 functions as a co-activator of NFκB and AP-1 to regulate AKT1 gene transcription. In conclusion, results from the present study indicate that FHL2 exerts its oncogenic action in GCT cells via controlling AKT1 gene expression. FHL2 is a promising target for the development of novel drugs against ovarian granulosa cell tumor.
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Affiliation(s)
- G Hua
- Olson Center for Women's Health, Department of Obstetrics/Gynecology, University of Nebraska Medical Center, Omaha, NE 68198, USA.,Key Lab of Agricultural Animal Genetics, Breeding and Reproduction of Ministry of Education, College of Animal Science and Technology, Huazhong Agricultural University, Wuhan, Hubei province 430070, China
| | - C He
- Olson Center for Women's Health, Department of Obstetrics/Gynecology, University of Nebraska Medical Center, Omaha, NE 68198, USA.,Key Lab of Agricultural Animal Genetics, Breeding and Reproduction of Ministry of Education, College of Animal Science and Technology, Huazhong Agricultural University, Wuhan, Hubei province 430070, China
| | - X Lv
- Olson Center for Women's Health, Department of Obstetrics/Gynecology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - L Fan
- Key Lab of Agricultural Animal Genetics, Breeding and Reproduction of Ministry of Education, College of Animal Science and Technology, Huazhong Agricultural University, Wuhan, Hubei province 430070, China
| | - C Wang
- Key Lab of Agricultural Animal Genetics, Breeding and Reproduction of Ministry of Education, College of Animal Science and Technology, Huazhong Agricultural University, Wuhan, Hubei province 430070, China
| | - S W Remmenga
- Olson Center for Women's Health, Department of Obstetrics/Gynecology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - K J Rodabaugh
- Olson Center for Women's Health, Department of Obstetrics/Gynecology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - L Yang
- Key Lab of Agricultural Animal Genetics, Breeding and Reproduction of Ministry of Education, College of Animal Science and Technology, Huazhong Agricultural University, Wuhan, Hubei province 430070, China
| | - S M Lele
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - P Yang
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - A R Karpf
- Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - J S Davis
- Olson Center for Women's Health, Department of Obstetrics/Gynecology, University of Nebraska Medical Center, Omaha, NE 68198, USA.,Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE 68198, USA.,Omaha Veterans Affairs Medical Center, Omaha, NE 68105, USA
| | - C Wang
- Olson Center for Women's Health, Department of Obstetrics/Gynecology, University of Nebraska Medical Center, Omaha, NE 68198, USA.,Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE 68198, USA
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Thomakos N, Biliatis I, Koutroumpa I, Sotiropoulou M, Bamias A, Liontos M, Vlachos G, Rodolakis A. Prognostic factors for recurrence in early stage adult granulosa cell tumor of the ovary. Arch Gynecol Obstet 2016; 294:1031-1036. [PMID: 27324782 DOI: 10.1007/s00404-016-4135-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 06/07/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Adult granulosa cell tumors (AGCTs) account for less than 5 % of all ovarian malignancies, whereas the majority (95 %) occurs after the age of 30 (adult-type) and present at an early stage. Aim of this study is to identify clinical and pathological risk factors for recurrence in early stage AGCTs. METHODS Retrospective review of patients with AGCT of the ovary, treated surgically at our institution from 1996 to 2011. Clinical, pathological and follow-up data were collected. Systematic analysis was performed to determine variables for predicting recurrence. RESULTS In total, 43 patients were identified. The mean age at diagnosis was 54.3 years and 65.1 % of them were postmenopausal. All patients underwent surgical staging and intraoperative rupture of the tumor occurred in four of them (9.3 %). The majority of the cases were staged as IA (72.1 %) while 10 (23.3 %) were staged as IC and only two patients as IIB. Mitotic index was 4 or more in 34.9 % of the patients and nuclear atypia was moderate to high in 60.5 %. During follow-up period (mean 9.2 years), recurrence occurred in three patients (7 %) with no deaths recorded so far. The cumulative recurrence free rate for the first 2 years was 97.6 % (SE = 2.4 %), for 5 years 94.9 % (SE = 3.5 %) and for 10 years 91.0 % (SE = 5.1 %).Tumor size, stage and mitotic index proved to be independent predictors for recurrence at the multivariate analysis. CONCLUSIONS Recurrence in early stage AGCT seems to be associated with stage, tumor size and mitotic index. All the above should be taken into consideration when tailored postoperative management is planned.
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Affiliation(s)
- Nikolaos Thomakos
- 1st Department of Obstetrics and Gynaecology, Division of Gynaecological Oncology, University of Athens, "Alexandra" Hospital, 80, Vas. Sophias Ave, 11528, Athens, Greece.
| | - Ioannis Biliatis
- 1st Department of Obstetrics and Gynaecology, Division of Gynaecological Oncology, University of Athens, "Alexandra" Hospital, 80, Vas. Sophias Ave, 11528, Athens, Greece
| | - Ioanna Koutroumpa
- 1st Department of Obstetrics and Gynaecology, Division of Gynaecological Oncology, University of Athens, "Alexandra" Hospital, 80, Vas. Sophias Ave, 11528, Athens, Greece
| | | | - Aris Bamias
- Department of Clinical Therapeutics, University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Michalis Liontos
- Department of Clinical Therapeutics, University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Georgios Vlachos
- 1st Department of Obstetrics and Gynaecology, Division of Gynaecological Oncology, University of Athens, "Alexandra" Hospital, 80, Vas. Sophias Ave, 11528, Athens, Greece
| | - Alexandros Rodolakis
- 1st Department of Obstetrics and Gynaecology, Division of Gynaecological Oncology, University of Athens, "Alexandra" Hospital, 80, Vas. Sophias Ave, 11528, Athens, Greece
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Bryk S, Pukkala E, Martinsen JI, Unkila-Kallio L, Tryggvadottir L, Sparén P, Kjaerheim K, Weiderpass E, Riska A. Incidence and occupational variation of ovarian granulosa cell tumours in Finland, Iceland, Norway and Sweden during 1953-2012: a longitudinal cohort study. BJOG 2016; 124:143-149. [PMID: 26924812 DOI: 10.1111/1471-0528.13949] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine the incidence and occupational variation of granulosa cell tumours (GCTs) in Finland, Iceland, Norway and Sweden over a 60-year period, 1953-2012. DESIGN A longitudinal cohort study. SETTING AND POPULATION Finland, Iceland, Norway and Sweden and a total of 249 million women over a 60-year period (1953-2012). The NOCCA (Nordic Occupational Cancer Study) included 6.4 million women with 776 incident GCT cases diagnosed until the end of follow up. METHODS Incidence rates were calculated from the national cancer registries and compared using quasi-Poisson regression models. Occupation-specific standardised incidence ratios (SIRs) were calculated from the Nordic Occupational Cancer (NOCCA) database. MAIN OUTCOME MEASURES Incidence rates and standardised incidence ratios. RESULTS The age-adjusted (World Standard) incidence rates remained quite constant: about 0.6-0.8 per 100 000 for most of the study period. The age-specific incidence was highest at 50-64 years of age. There were no occupations with significantly increased risk of GCT. Major changes in the use of oral contraceptives, postmenopausal hormonal therapy, fertility rate and lifestyle in general during the study period and among different occupational categories do not appear to have a marked effect on the incidence of GCT. CONCLUSION Our findings support the concept of GCT as a primarily sporadic, not exposure-related, cancer. TWEETABLE ABSTRACT The Nordic incidence rates of GCTs show stability over time and among different occupational categories.
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Affiliation(s)
- S Bryk
- Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - E Pukkala
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland.,School of Health Sciences, University of Tampere, Tampere, Finland
| | - J-I Martinsen
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - L Unkila-Kallio
- Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - L Tryggvadottir
- Icelandic Cancer Registry, Reykjavik, Iceland.,Faculty of Medicine, Laeknagardur, University of Iceland, Reykjavik, Iceland
| | - P Sparén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - K Kjaerheim
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - E Weiderpass
- Department of Research, Cancer Registry of Norway, Oslo, Norway.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - A Riska
- Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Clinical characteristics and survival of patients with an adult-type ovarian granulosa cell tumor: a 56-year single-center experience. Int J Gynecol Cancer 2015; 25:33-41. [PMID: 25347095 DOI: 10.1097/igc.0000000000000304] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate clinical prognostic factors and survival of patients with ovarian granulosa cell tumors (GCTs) in a long-term follow-up study. METHODS A total of 240 adult-type GCTs diagnosed in Helsinki University Central Hospital from 1956 to 2012 were histologically reevaluated. Data were analyzed for several clinical factors in relation to major developments in imaging, surgery, and chemotherapy: the old era (1956-1983) and the new era (1984-2012). Prognostic factors for survival were evaluated in the univariate and multivariate analyses. RESULTS The original diagnosis was confirmed in 187 (77.9%) patients. The International Federation of Gynecology and Obstetrics stage I disease was present in 89.2%; stage II, in 7.0%; stage III, in 3.8%; and stage IV, in 0% of cases. The mean age at diagnosis (52.9 years) and the mean tumor size (10.8 cm) did not change significantly over time. The most common presenting symptom was abnormal bleeding, but 14% were asymptomatic. The mean follow-up period was 15.7 years. Recurrence rate was similar in both eras. The GCT-specific 5-, 10-, and 20-year survival rates were 95.6%, 88.1%, and 79.8% in the old era as well as 97.2%, 94.8%, and 94.8% in the new era, respectively. In the univariate analyses, old era, patient age older than 60 years, tumor size greater than 10 cm, advanced stage, residual tumor, and use of hormonal adjuvant treatment were associated with GCT-related deaths. Prior use of oral contraceptives and history of infertility improved survival rates. In the multivariate analysis, stage was the only independent prognostic factor for GCT-specific survival. CONCLUSIONS An accurate histological diagnosis of GCT is essential. Stage IV disease is an extreme rarity. However, tumor stage overcomes other possible clinical prognostic factors for GCT-specific survival. Fertility-sparing surgery, the use of oral contraceptives, or hormonal replacement therapy seems not to be risk factors for survival.
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Wang PH, Sun HD, Lin H, Wang KL, Liou WS, Hung YC, Chiang YC, Lu CH, Lai HC, Chang TC. Outcome of patients with recurrent adult-type granulosa cell tumors – A Taiwanese Gynecologic Oncology Group study. Taiwan J Obstet Gynecol 2015; 54:253-9. [DOI: 10.1016/j.tjog.2014.12.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2014] [Indexed: 12/30/2022] Open
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Is the endometrial evaluation routinely required in patients with adult granulosa cell tumors of the ovary? Gynecol Oncol 2015; 136:230-4. [DOI: 10.1016/j.ygyno.2014.12.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 12/09/2014] [Accepted: 12/11/2014] [Indexed: 11/19/2022]
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Chabrol A, Rousset P, Charlot M, Chateau F, Cotton F, Golfier F, Rety F. Lesions of the ovary with T1-hypersignal. Clin Radiol 2014; 69:e404-13. [PMID: 25017450 DOI: 10.1016/j.crad.2014.05.107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 05/08/2014] [Accepted: 05/23/2014] [Indexed: 11/28/2022]
Abstract
Pelvic magnetic resonance imaging (MRI) has been used successfully to diagnose ovarian masses that cannot be adequately evaluated using pelvic ultrasound. T1 hyperintensity is a common finding in an ovarian mass and has important diagnostic implications. The aims of this review are to list the substances that may produce high signal intensity on T1-weighted MRI, to explain the physical basis for causes of the high T1 signal intensity, and to describe common and uncommon T1 hyperintense ovarian lesions. The morphological findings, the imaging features of the additional sequences, and clinical variables can help in the differential diagnosis, and in some cases, enable a specific diagnosis, leading to appropriate management of the patient.
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Affiliation(s)
- A Chabrol
- Department of Radiology, Centre Hospitalier Lyon Sud, chemin du grand revoyet, 69310 Pierre Bénite, France.
| | - P Rousset
- Department of Radiology, Centre Hospitalier Lyon Sud, chemin du grand revoyet, 69310 Pierre Bénite, France
| | - M Charlot
- Department of Radiology, Centre Hospitalier Lyon Sud, chemin du grand revoyet, 69310 Pierre Bénite, France
| | - F Chateau
- Department of Radiology, Centre Hospitalier Lyon Sud, chemin du grand revoyet, 69310 Pierre Bénite, France
| | - F Cotton
- Department of Radiology, Centre Hospitalier Lyon Sud, chemin du grand revoyet, 69310 Pierre Bénite, France
| | - F Golfier
- Department of Gynaecological and Oncological Surgery-Obstetrics, Centre Hospitalier Lyon Sud, chemin du grand revoyet, 69310 Pierre Bénite, France
| | - F Rety
- Department of Radiology, Centre Hospitalier Lyon Sud, chemin du grand revoyet, 69310 Pierre Bénite, France
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van Meurs HS, Schuit E, Horlings HM, van der Velden J, van Driel WJ, Mol BWJ, Kenter GG, Buist MR. Development and internal validation of a prognostic model to predict recurrence free survival in patients with adult granulosa cell tumors of the ovary. Gynecol Oncol 2014; 134:498-504. [PMID: 24983647 DOI: 10.1016/j.ygyno.2014.06.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 06/18/2014] [Accepted: 06/23/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Models to predict the probability of recurrence free survival exist for various types of malignancies, but a model for recurrence free survival in individuals with an adult granulosa cell tumor (GCT) of the ovary is lacking. We aimed to develop and internally validate such a prognostic model. METHODS We performed a multicenter retrospective cohort study of patients with a GCT. Demographic, clinical and pathological information were considered as potential predictors. Univariable and multivariable analyses were performed using a Cox proportional hazards model. Using backward stepwise selection we identified the combination of predictors that best predicted recurrence free survival. Discrimination (c-statistic) and calibration were used to assess model performance. The model was internally validated using bootstrapping techniques to correct for overfitting. To increase clinical applicability of the model we developed a nomogram to allow individual prediction of recurrence free survival. RESULTS We identified 127 patients with a GCT (median follow-up time was 131 months (IQR 70-215)). Recurrence of GCT occurred in 81 out of 127 patients (64%). The following four variables jointly best predicted recurrence free survival; clinical stage, Body Mass Index (BMI), tumor diameter and mitotic index. The model had a c-statistic of 0.73 (95% CI 0.66-0.80) and showed accurate calibration. CONCLUSIONS Recurrence free survival in patients with an adult GCT of the ovary can be accurately predicted by a combination of BMI, clinical stage, tumor diameter and mitotic index. The introduced nomogram could facilitate in counseling patients and may help to guide patients and caregivers in joint decisions on post-treatment surveillance.
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Affiliation(s)
- Hannah S van Meurs
- Department of Obstetrics and Gynecology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Ewoud Schuit
- Department of Obstetrics and Gynecology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands.
| | - Hugo M Horlings
- Department of Pathology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Jacobus van der Velden
- Department of Obstetrics and Gynecology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Willemien J van Driel
- Department of Gynecology, Center for Gynecologic Oncology Amsterdam, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
| | - Ben Willem J Mol
- The Robinson Institute, School of Pediatrics and Reproductive Health, University of Adelaide, Level 3 Medical School South Building, Frome Road, SA 5005 Adelaide, Australia.
| | - Gemma G Kenter
- Department of Obstetrics and Gynecology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Marrije R Buist
- Department of Obstetrics and Gynecology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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Lauszus FF, Petersen AC, Neumann G, Cleemann L, Rosgaard A, Jørgensen A, Vandborg M, Jakobsen A. Less extensive surgery compared to extensive surgery: survival seems similar in young women with adult ovarian granulosa cell tumor. Eur J Obstet Gynecol Reprod Biol 2014; 177:61-6. [DOI: 10.1016/j.ejogrb.2014.02.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 12/18/2013] [Accepted: 02/22/2014] [Indexed: 11/15/2022]
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Gurumurthy M, Bryant A, Shanbhag S. Effectiveness of different treatment modalities for the management of adult-onset granulosa cell tumours of the ovary (primary and recurrent). Cochrane Database Syst Rev 2014; 2014:CD006912. [PMID: 24753008 PMCID: PMC6513416 DOI: 10.1002/14651858.cd006912.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Granulosa cell tumour is a rare gynaecological tumour of the ovary with recurrences many years after initial diagnosis and treatment. Evidence-based management of granulosa cell tumour of the ovary is limited, and treatment has not been standardised. Surgery, including fertility-sparing procedures for young women, has traditionally been the standard treatment. Adjuvant treatments following surgery have been based on non-randomised trials. A combination of bleomycin, etoposide and cisplatin (BEP) has traditionally been used for treatment of advanced and/or recurrent disease that cannot be optimally managed surgically. OBJECTIVES To evaluate the effectiveness and safety of different treatment modalities offered in current practice for the management of primary, residual and recurrent adult-onset granulosa cell tumours (GCTs) of the ovary. SEARCH METHODS We searched the Cochrane Gynaecological Cancer Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE up to December 2013. We also searched registers of clinical trials, abstracts of scientific meetings and reference lists of included studies. SELECTION CRITERIA We searched for randomised controlled trials (RCTs), quasi-RCTs and observational studies that examined women with adult-onset granulosa cell tumours of the ovary (primary and recurrent). For non-randomised studies, we included studies that used multivariate analysis to adjust for baseline characteristics. DATA COLLECTION AND ANALYSIS Two review authors independently abstracted data and assessed risk of bias. Studies were heterogeneous with respect to treatment comparisons, so data were not synthesised in meta-analyses, and methods for assessing heterogeneity were not needed. Risk of bias in included studies was assessed by using the six core items used to assess RCTs and by evaluating four additional criteria specifically addressing risk of bias in non-randomised studies. MAIN RESULTS Five retrospective cohort studies (535 women with a diagnosis of GCT) that used appropriate statistical methods for adjustment were included in the review.Two studies, which carried out multivariate analyses that attempted to identify factors associated with better outcomes (in terms of overall survival), reported no apparent evidence of a difference in overall survival between surgical approaches, whether a participant underwent lymphadenectomy or received adjuvant chemotherapy or radiotherapy. Only percentage of survival for all participants combined was reported in two trials and was not reported at all in one study.One study showed that women who received postoperative radiotherapy had lower risk of disease recurrence compared with those who underwent surgery alone (adjusted hazard ratio (HR) 0.3, 95% confidence interval (CI) 0.1 to 0.6, P value 0.04). Three studies reportedthat there was no evidence of differences in disease recurrence based on execution and type of adjuvant chemotherapy or on type of surgery or surgical approach, other than that surgical staging may be important. One study described no apparent evidence of a difference in disease recurrence between fertility-sparing surgery and conventional surgery. Recurrence-free survival was not reported in one study.Toxicity and adverse event data were incompletely reported in the five studies. None of the five studies reported on quality of life (QoL). All studies were at very high risk of bias. AUTHORS' CONCLUSIONS One study showed a lower recurrence rate with the use of adjuvant radiotherapy, although this study was at high risk of bias and the results should be interpreted with caution. After evaluating the five small retrospective studies, we are unable to reach any firm conclusions as to the effectiveness and safety of different types and approaches of surgery, including conservative surgery, as well as adjuvant chemotherapy or radiotherapy, for management of GCTs of the ovary. The available evidence is very limited, and the review provides only low-quality evidence. Further research is very likely to have an important impact on our confidence in the estimate of effect and may alter our findings.Ideally, multinational RCTs are needed to answer these questions. The disease is relatively rare and generally has a good prognosis. RCTs are challenging to conduct, but three ongoing trials have been identified, demonstrating that they are feasible, although two of these studies are single-arm trials. The study that may be able to provide answers to the question of which chemotherapeutic regimen should be selected for management of sex cord stromal tumours is an ongoing, randomised, phase 2 study, led by the Gynaecological Oncology Group to compare the efficacy of carboplatin and paclitaxel versus standard BEP. These investigators are also looking into the value of inhibin A and inhibin B as predictive biomarkers. Additional trials are required to assess toxicity and QoL associated with different treatment regimens as well as the safety of conservative surgical options.
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Affiliation(s)
- Mahalakshmi Gurumurthy
- University Hospital of LlandoughGynaecological Oncology UnitPenalan RoadPenarthUKCF64 2XX
| | - Andrew Bryant
- Newcastle UniversityInstitute of Health & SocietyMedical School New BuildRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Smruta Shanbhag
- Glasgow Royal InfirmaryGynaecological OncologyWard 56B, Level 1 QEB16 Alexandra ParadeGlasgowUKG31 2ER
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Khosla D, Dimri K, Pandey AK, Mahajan R, Trehan R. Ovarian granulosa cell tumor: clinical features, treatment, outcome, and prognostic factors. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2014; 6:133-8. [PMID: 24741552 PMCID: PMC3978936 DOI: 10.4103/1947-2714.128475] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background: Granulosa cell tumors are rare neoplasms characterized by long natural history and favorable prognosis. Aims: The objective of this study was to determine the clinical presentation, treatment, outcome, and prognostic factors for patients of granulosa cell tumors. Materials and Methods: A retrospective analysis of 26 patients of granulosa cell tumor of ovary from 2002 to 2011 was carried out. The records of all patients were analyzed to determine clinical presentation, treatment, survival, and prognostic factors. Results: The median age of the patients was 50 years (range, 17-71 years). Abdominal pain was the most common presenting symptom. The median follow-up was 71.4 months (range, 21.6-149.9 months). The estimated 5 and 10 year overall survival (OS) was 84.6 and 72.5%, respectively. Event-free survival (EFS) was 76.5 and 52.9% at 5 and 10 years, respectively. Advanced stage was significant independent poor prognostic indicator for both OS and EFS. Conclusion: Majority of the patients with granulosa cell tumors of the ovary present in early stage. Surgery is the primary treatment modality for granulosa cell tumors. Advanced stage and presence of residual disease were associated with inferior survival, but only prospective studies can ascertain their definite role.
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Affiliation(s)
- Divya Khosla
- Department of Radiotherapy and Oncology, Government Medical College and Hospital, Chandigarh, India
| | - Kislay Dimri
- Department of Radiotherapy and Oncology, Government Medical College and Hospital, Chandigarh, India
| | - Awadhesh K Pandey
- Department of Radiotherapy and Oncology, Government Medical College and Hospital, Chandigarh, India
| | - Rohit Mahajan
- Department of Radiotherapy and Oncology, Government Medical College and Hospital, Chandigarh, India
| | - Romeeta Trehan
- Department of Radiotherapy and Oncology, Government Medical College and Hospital, Chandigarh, India
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Färkkilä A, Andersson N, Bützow R, Leminen A, Heikinheimo M, Anttonen M, Unkila-Kallio L. HER2 and GATA4 are new prognostic factors for early-stage ovarian granulosa cell tumor-a long-term follow-up study. Cancer Med 2014; 3:526-36. [PMID: 24687970 PMCID: PMC4101743 DOI: 10.1002/cam4.230] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 02/10/2014] [Accepted: 02/14/2014] [Indexed: 12/11/2022] Open
Abstract
Granulosa cell tumors (GCTs) carry a risk of recurrence also at an early stage, but reliable prognostic factors are lacking. We assessed clinicopathological prognostic factors and the prognostic roles of the human epidermal growth factor receptors (HER 2–4) and the transcription factor GATA4 in GCTs. We conducted a long-term follow-up study of 80 GCT patients with a mean follow-up time of 16.8 years. A tumor-tissue microarray was immunohistochemically stained for HER2–4 and GATA4. Expression of HER2–4 mRNA was studied by means of real time polymerase chain reaction and HER2 gene amplification was analyzed by means of silver in situ hybridization. The results were correlated to clinical data on recurrences and survival. We found that GCTs have an indolent prognosis, with 5-year disease-specific survival (DSS) being 97.5%. Tumor recurrence was detected in 24% of the patients at a median of 7.0 years (range 2.6–18 years) after diagnosis. Tumor stage was not prognostic of disease-free survival (DFS). Of the molecular prognostic factors, high-level expression of HER2, and GATA4, and high nuclear atypia were prognostic of shorter DFS. In multivariate analyses, high-level coexpression of HER2 and GATA4 independently predicted DFS (hazard ratio [HR] 8.75, 95% CI 2.20–39.48, P = 0.002). High-level expression of GATA4 also predicted shorter DSS (HR 3.96, 95% CI 1.45–12.57, P = 0.006). In multivariate analyses, however, tumor stage (II–III) and nuclear atypia were independent prognostic factors of DSS. In conclusion HER2 and GATA4 are new molecular prognostic markers of GCT recurrence, which could be utilized to optimize the management and follow-up of patients with early-stage GCTs.
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Affiliation(s)
- Anniina Färkkilä
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland; Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
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Abstract
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.
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49
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A Comprehensive Review of Diagnostic and Treatment Options for Granulosa Cell Tumors of the Ovary. Obstet Gynecol Surv 2014; 69:29-38. [DOI: 10.1097/ogx.0000000000000010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Vyas M N, Manjeera L, Rai S. Delayed menopause due to ovarian granulosa cell tumour. J Clin Diagn Res 2013; 7:2306-7. [PMID: 24298512 DOI: 10.7860/jcdr/2013/6911.3507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 09/01/2013] [Indexed: 11/24/2022]
Abstract
A patient presented to us with complaints of inability to attain menopause even at the age of 64. She has been having irregular cycles of bleeding for 5 days every 2-3 months from the age of 54. On evaluation, she was found to have endometrial hyperplasia and ultrasonography showed a homogenous solid ovarian mass of size of the 4 cm x 3.5 cm. She underwent staging laparotomy with total abdominal hysterectomy bilateral salpingo-oophorectomy and infra colic omentectomy. Histopathology confirmed granulosa cell tumour of the ovary. Most commonly granulosa cell tumour presented with post-menopausal bleeding and abnormal uterine bleeding, however, women with delayed menopause also have to be evaluated thoroughly for estrogen secreting ovarian tumours. There should be an element of suspicion if patient doesn't attain menopause as specified and they need to be evaluated in detail.
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Affiliation(s)
- Neetha Vyas M
- Assistant Professor, Department of Obstetrics and Gynaecology, K.S. Hegde Medical Academy, Nitte University , Deralakatte, Mangalore, India
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