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Aydin E, Akdemir C, Erdoğan Ö, Şahin H, Karadeniz Ö, Yürük YY, Şahin Ş, Sanci M. Assessment of magnetic resonance imaging findings in ovarian granulosa cell tumors along with clinical prognostic factors. J Obstet Gynaecol Res 2024. [PMID: 39246055 DOI: 10.1111/jog.16068] [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: 06/26/2024] [Accepted: 08/15/2024] [Indexed: 09/10/2024]
Abstract
AIM To determine the role of preoperative MRI in the diagnosis and treatment of patients with granulosa cell tumors (GCTs) of the ovary. MATERIALS AND METHODS Twenty-four patients who were operated on between 2018 and 2022 and who were pathologically diagnosed with GHT and met the inclusion criteria were retrospectively examined. The findings were compared with the patients' demographic data, symptoms, surgical findings (laterality, stage, lymph node involvement, endometrial pathology, tumor size), and CA-125 levels. RESULTS The final cohort included 24 patients with a mean age of 54.71 ± 16.52. All the patients had the pathological diagnosis of adult type GCT. In the morphological evaluation, the most common finding was a solid-cystic mixed type (14 patients, 58.3%), while intratumoral hemorrhage signal was observed in 10 patients (41.7%). In the majority of cases (91.7%), the mass showed regular contours. The honeycomb/Swiss cheese sign was detected in 54.2% of the cases. When the T1 and T2 signal of the solid component of the mass were examined relative to the myometrium, the majority of GCTs appeared isointense on both sequences (83.3% and 62.5%, respectively). The mean ADC value of the solid component obtained from diffusion-weighted imaging was 0.78 ± 0.15 × 10-3. Pelvic fluid was observed in 41.7% of the cases. The average endometrial thickness was 9.74 ± 6.43 mm. Thickened endometrium more than 9 mm was observed in 9 out of the remaining 21 patients (42.9%). CONCLUSION Understanding the key imaging features for GCTs plays an essential role in the diagnosis and guiding the treatment effectively.
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Affiliation(s)
- Elçin Aydin
- Department of Radiology, Izmir Faculty of Medicine, University of Health Sciences, Izmir, Turkey
- Department of Radiology, Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Celal Akdemir
- Department of Gynecologic Oncology, Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Özgür Erdoğan
- Department of Gynecologic Oncology, Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Hilal Şahin
- Department of Radiology, Izmir Faculty of Medicine, University of Health Sciences, Izmir, Turkey
- Department of Radiology, Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Özden Karadeniz
- Department of Radiology, Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Yeşim Yekta Yürük
- Department of Radiology, Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Şükrü Şahin
- Department of Radiology, Fethi Sekin City Hospital, Elazığ, Turkey
| | - Muzaffer Sanci
- Department of Gynecologic Oncology, Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
- Department of Gynecologic Oncology, Izmir Faculty of Medicine, University of Health Sciences, Izmir, Turkey
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Moss E, Taylor A, Andreou A, Ang C, Arora R, Attygalle A, Banerjee S, Bowen R, Buckley L, Burbos N, Coleridge S, Edmondson R, El-Bahrawy M, Fotopoulou C, Frost J, Ganesan R, George A, Hanna L, Kaur B, Manchanda R, Maxwell H, Michael A, Miles T, Newton C, Nicum S, Ratnavelu N, Ryan N, Sundar S, Vroobel K, Walther A, Wong J, Morrison J. British Gynaecological Cancer Society (BGCS) ovarian, tubal and primary peritoneal cancer guidelines: Recommendations for practice update 2024. Eur J Obstet Gynecol Reprod Biol 2024; 300:69-123. [PMID: 39002401 DOI: 10.1016/j.ejogrb.2024.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 06/13/2024] [Indexed: 07/15/2024]
Affiliation(s)
- Esther Moss
- College of Life Sciences, University of Leicester, University Road, Leicester, LE1 7RH, UK
| | | | - Adrian Andreou
- Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath BA1 3NG, UK
| | - Christine Ang
- Northern Gynaecological Oncology Centre, Gateshead, UK
| | - Rupali Arora
- Department of Cellular Pathology, University College London NHS Trust, 60 Whitfield Street, London W1T 4E, UK
| | | | | | - Rebecca Bowen
- Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath BA1 3NG, UK
| | - Lynn Buckley
- Beverley Counselling & Psychotherapy, 114 Holme Church Lane, Beverley, East Yorkshire HU17 0PY, UK
| | - Nikos Burbos
- Department of Obstetrics and Gynaecology, Norfolk and Norwich University Hospital Colney Lane, Norwich NR4 7UY, UK
| | | | - Richard Edmondson
- Saint Mary's Hospital, Manchester and University of Manchester, M13 9WL, UK
| | - Mona El-Bahrawy
- Imperial College London, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | | | - Jonathan Frost
- Gynaecological Oncology, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, Bath BA1 3NG, UK; University of Exeter, Exeter, UK
| | - Raji Ganesan
- Department of Cellular Pathology, Birmingham Women's Hospital, Birmingham B15 2TG, UK
| | | | - Louise Hanna
- Department of Oncology, Velindre Cancer Centre, Whitchurch, Cardiff CF14 2TL, UK
| | - Baljeet Kaur
- North West London Pathology (NWLP), Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - Ranjit Manchanda
- Wolfson Institute of Population Health, Cancer Research UK Barts Centre, Queen Mary University of London and Barts Health NHS Trust, UK
| | - Hillary Maxwell
- Dorset County Hospital, Williams Avenue, Dorchester, Dorset DT1 2JY, UK
| | - Agnieszka Michael
- Royal Surrey NHS Foundation Trust, Guildford GU2 7XX and University of Surrey, School of Biosciences, GU2 7WG, UK
| | - Tracey Miles
- Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath BA1 3NG, UK
| | - Claire Newton
- Gynaecology Oncology Department, St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol BS1 3NU, UK
| | - Shibani Nicum
- Department of Oncology, University College London Cancer Institute, London, UK
| | | | - Neil Ryan
- The Centre for Reproductive Health, Institute for Regeneration and Repair (IRR), 4-5 Little France Drive, Edinburgh BioQuarter City, Edinburgh EH16 4UU, UK
| | - Sudha Sundar
- Institute of Cancer and Genomic Sciences, University of Birmingham and Pan Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham B18 7QH, UK
| | - Katherine Vroobel
- Department of Cellular Pathology, Royal Marsden Foundation NHS Trust, London SW3 6JJ, UK
| | - Axel Walther
- Bristol Cancer Institute, University Hospitals Bristol and Weston NHS Foundation Trust, UK
| | - Jason Wong
- Department of Histopathology, East Suffolk and North Essex NHS Foundation Trust, Ipswich Hospital, Heath Road, Ipswich IP4 5PD, UK
| | - Jo Morrison
- University of Exeter, Exeter, UK; Department of Gynaecological Oncology, GRACE Centre, Musgrove Park Hospital, Somerset NHS Foundation Trust, Taunton TA1 5DA, UK.
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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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Amirkashani D, Nasiri SJ, Dadakhani S, Mortazavi N, Khoshkbarforoushan M. Vaginal bleeding imitated rape in a 6-year old girl, a case report about granulosa cell tumor as a reason of peripheral precocious puberty. Int J Surg Case Rep 2024; 117:109546. [PMID: 38513413 PMCID: PMC10966188 DOI: 10.1016/j.ijscr.2024.109546] [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: 02/05/2024] [Revised: 03/10/2024] [Accepted: 03/14/2024] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION Although female victims of sexual child abuse present with symptoms such as local pain and vaginal bleeding, however, before any definitive diagnosis a comprehensive physical examination along with a detailed history related to vaginal bleeding should be taken from the patient. Undoubtedly, we must not forget that only one of the causes of vaginal bleeding is rape. Therefore, before making a final diagnosis, other causes of this symptom must be carefully examined. CASE PRESENTATION The patient was a 6-years-old female who was hospitalized for notable generalized abdominal distention, acute lower abdomen pain associated with nausea and mild fever lasting 5 days progressively worsening, thelarche and vaginal bleeding. Ultrasound examination showed that multilocular-solid masses located in right side of abdomen which led to surgery and mass excision. Histopathology diagnosis was a juvenile granulosa cell tumor of the ovary. DISCUSSION Among the various causes of peripheral premature puberty, granulosa cell tumor (GCT) is rare but very important. Since in the two age groups - prepuberty and menopause - we don't expect to see vaginal bleeding, the occurrence of this disorder especially in association with breast enlargement in prepubertal group, need to appropriate imaging including pelvic ultrasound and bone age determination also laboratory data such as level of sex hormones and tumor markers to avoid misdiagnosis. CONCLUSION We report the case of a granulosa cell tumor patient with vaginal bleeding that a complete history and examination provides the right path to a diagnosis.
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Affiliation(s)
- Davoud Amirkashani
- Department of Pediatric Endocrinology, Ali Asghar Children Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Seyyed Javad Nasiri
- Department of Pediatric Surgery, Ali-Asghar Children Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Samayeh Dadakhani
- Department of Pediatric Endocrinology, Ali Asghar Children Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | - Nafiseh Mortazavi
- Department of Pathology, Ali-Asghar Children Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mina Khoshkbarforoushan
- Department of Pediatric Surgery, Ali-Asghar Children Hospital, Iran University of Medical Sciences, Tehran, Iran
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Yaacoub S, Hajj L, Khairallah A. A clinicopathological study about the epidemiology of granulosa cell tumors in Lebanon. BMC Cancer 2024; 24:309. [PMID: 38448917 PMCID: PMC10916017 DOI: 10.1186/s12885-024-12047-6] [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: 08/31/2023] [Accepted: 02/23/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Granulosa Cell Tumors (GCT) are considered the most frequent type of sex-cord stromal tumors. These tumors constitute 3-6% of neoplasms of the ovaries. GCTs are divided into 2 types: Juvenile GCT (JGCT) and Adult GCT (AGCT). Most patients are diagnosed early in the course of the disease and tend to have a favorable prognosis. In the surgical treatment of GCT, two main factors play role in the determination of feasibility of the surgery: age and tumor stage. METHODS A retrospective study was conducted on 65 consecutive female patients diagnosed with ovarian GCT at different hospitals across Lebanon who were referred to the National Institute of Pathology, Beirut-Lebanon, between January 2000 and January 2020. Then, they were divided according to types: adult versus juvenile type. Statistical analysis was carried out using Stata, version 16. RESULTS The incidence of GCT in a Lebanese population was 16.2 per million per year. The mean age of the studied population was 55.6 years. AGCT was the most common with a prevalence of 91% versus 19% for JGCT. Also, inhibine (the most important immunomarker) was found in 77.2% of adult cases. High mitotic index and high tumor size which are predictors for poor prognosis were respectively 20% and 36.9%. Concerning the histopathological features, Grooved nuclei and Exner bodies were less frequently observed in juvenile type (16.7% for both) compared to adult type (36.9%). Most patients with GCT were diagnosed in the early course of disease mainly due to the manifestation of the symptoms as abdominal pain, postmenopausal bleeding or intermenstrual bleeding, and the good diagnosis and screening practices in Lebanon. Regarding the recurrent cases, a significant correlation with high mitotic index (76.9%), high tumor size (92.3%) and advanced stage (46% for stage 3 and 46% for stage 4) was found with a p < 0.05. CONCLUSIONS The incidence of GCT in the Lebanese population is 16.2 per million per year. The majority of patients with GCT in Lebanon are of Adult type representing around 90% of cases. Older age, high mitotic index and big tumor size are predictors for poor outcomes.
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Affiliation(s)
- Sana Yaacoub
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon.
| | - Labib Hajj
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Aya Khairallah
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
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Moro F, Giudice MT, Bolomini G, Moruzzi MC, Mascilini F, Quagliozzi L, Ciccarone F, Scambia G, Fagotti A, Valentin L, Testa AC. Imaging in gynecological disease (27): clinical and ultrasound characteristics of recurrent ovarian stromal cell tumors. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 63:399-407. [PMID: 37774092 DOI: 10.1002/uog.27504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVE To describe the clinical and ultrasound characteristics of recurrent granulosa cell and Sertoli-Leydig cell tumors. METHODS This was a retrospective observational study performed at Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, IRCCS, Rome (Gemelli center), Italy. Patients with a histological diagnosis of recurrent granulosa cell tumor or Sertoli-Leydig cell tumor were identified from the database of the Department of Gynecological Oncology. Those who had undergone a preoperative ultrasound examination at the Gemelli center between 2012 and 2020 were included, and the data retrieved from the original ultrasound reports. In all of these reports, the recurrent tumors were described using International Ovarian Tumor Analysis (IOTA) terminology. If a patient had more than one episode of relapse, information from all episodes was collected. If there was more than one recurrent tumor at the same ultrasound examination, all tumors were included. One expert sonographer also reviewed all available ultrasound images to identify typical ultrasound patterns using pattern recognition. RESULTS We identified 30 patients with a histological diagnosis of recurrent granulosa cell tumor (25 patients, 55 tumors) or Sertoli-Leydig cell tumor (five patients, seven tumors). All 30 had undergone at least one preoperative ultrasound examination at the Gemelli center and were included. These women had a total of 66 episodes of relapse, of which a preoperative ultrasound examination had been performed at the Gemelli center in 34, revealing 62 recurrent lesions: one in 22/34 (64.7%) episodes of relapse, two in 4/34 (11.8%) episodes and three or more in 8/34 (23.5%) episodes. Most recurrent granulosa cell tumors (38/55, 69.1%) and recurrent Sertoli-Leydig tumors (6/7, 85.7%) were classified as solid or multilocular-solid tumors, while 8/55 (14.5%) recurrent granulosa cell tumors and 1/7 (14.3%) recurrent Sertoli-Leydig cell tumors were unilocular cysts and 9/55 (16.4%) recurrent granulosa cell tumors were multilocular cysts. The nine unilocular cysts had contents that were anechoic (n = 2) or had low-level echogenicity (n = 7), had either smooth (n = 4) or irregular (n = 5) internal cyst walls, and ranged in largest diameter from 8 to 38 mm, with three being < 20 mm and five being 20-30 mm. On retrospective review of the images, two typical ultrasound patterns were described: small solid tumor measuring < 2 cm (15/62, 24.2%) and tumor with vascularized echogenic ground-glass-like content (12/62, 19.4%). CONCLUSIONS Some granulosa cell and Sertoli-Leydig cell recurrences manifest one of two typical ultrasound patterns, while some appear as unilocular cysts. These are usually classified as benign, but in patients being followed up for a granulosa cell tumor or Sertoli-Leydig cell tumor, a unilocular cyst should be considered suspicious of recurrence. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- F Moro
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - M T Giudice
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - G Bolomini
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - M C Moruzzi
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - F Mascilini
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - L Quagliozzi
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - F Ciccarone
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - G Scambia
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
- Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Fagotti
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
- Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - L Valentin
- Skåne University Hospital Malmö, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - A C Testa
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
- Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
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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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Sassarini J, Lumsden MA. Post cancer care in women with an increased risk of malignancy or previous malignancy: The use of hormone replacement therapy and alternative treatments. Best Pract Res Clin Endocrinol Metab 2024; 38:101854. [PMID: 38160182 DOI: 10.1016/j.beem.2023.101854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Affiliation(s)
- Jenifer Sassarini
- Consultant in Gynaecology and Obstetrics, Princess Royal Maternity Hospital, NHS Greater Glasgow, Argyll and Clyde, UK
| | - Mary Ann Lumsden
- Hon Prof of Gynaecology and Medical Education, University of Glasgow, UK.
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Zuckerman AL, Pourvaziri A, Ebb DH, Boyraz B. Case 26-2023: A 15-Year-Old Girl with Abdominal Pain and an Ovarian Mass. N Engl J Med 2023; 389:750-758. [PMID: 37611126 DOI: 10.1056/nejmcpc2211422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Affiliation(s)
- Andrea L Zuckerman
- From the Department of Obstetrics and Gynecology, Tufts Medical Center (A.L.Z.), the Departments of Radiology (A.P.), Pediatrics (D.H.E.), and Pathology (B.B.), Massachusetts General Hospital, and the Departments of Radiology (A.P.), Pediatrics (D.H.E.), and Pathology (B.B.), Harvard Medical School - all in Boston
| | - Ali Pourvaziri
- From the Department of Obstetrics and Gynecology, Tufts Medical Center (A.L.Z.), the Departments of Radiology (A.P.), Pediatrics (D.H.E.), and Pathology (B.B.), Massachusetts General Hospital, and the Departments of Radiology (A.P.), Pediatrics (D.H.E.), and Pathology (B.B.), Harvard Medical School - all in Boston
| | - David H Ebb
- From the Department of Obstetrics and Gynecology, Tufts Medical Center (A.L.Z.), the Departments of Radiology (A.P.), Pediatrics (D.H.E.), and Pathology (B.B.), Massachusetts General Hospital, and the Departments of Radiology (A.P.), Pediatrics (D.H.E.), and Pathology (B.B.), Harvard Medical School - all in Boston
| | - Baris Boyraz
- From the Department of Obstetrics and Gynecology, Tufts Medical Center (A.L.Z.), the Departments of Radiology (A.P.), Pediatrics (D.H.E.), and Pathology (B.B.), Massachusetts General Hospital, and the Departments of Radiology (A.P.), Pediatrics (D.H.E.), and Pathology (B.B.), Harvard Medical School - all in Boston
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10
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Babaei Z, Keyvanloo Shahrestanaki M, Aghaei M. MiR-1236: Key controller of tumor development and progression: Focus on the biological functions and molecular mechanisms. Pathol Res Pract 2023; 248:154671. [PMID: 37418995 DOI: 10.1016/j.prp.2023.154671] [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: 05/24/2023] [Accepted: 07/02/2023] [Indexed: 07/09/2023]
Abstract
Combating with the cancer, as one of the leading causes of morbidity and mortality worldwide, scientific community extensively evidenced microRNA 1236 (miR-1236) roles in the pathogenesis of malignant tumors. It has been mentioned that miR-1236 target genes and signal pathways that are key controller of tumor development and progression. Consistently, increasing evidence reports that miR-1236 participates in cancer cell growth, migration, invasion, apoptosis, and drug resistance, as well as tumor diagnosis, and prognosis. MiR-1236 is also implicated in epithelial-mesenchymal transition (EMT), which is a significant indicator of the metastatic process. Moreover, miR-1236 itself is regulated by several newly discovered long non-coding RNAs (lncRNAs) and circular RNAs (circRNAs). Current review aimed to summarize and discuss different dimensions of miR-1236 involvement in the fundamental cellular and molecular mechanisms of tumor progressions. We believe that miR-1236 may serve as a non-invasive diagnostic marker and potential therapeutic target for cancer.
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Affiliation(s)
- Zeinab Babaei
- Department of Clinical Biochemistry and Biophysics, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Mahmoud Aghaei
- Department of Clinical Biochemistry, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran.
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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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Barcellini A, Mangili G, Fodor A, Secondino S, Zerbetto F, Charalampopoulou A, Pignata S, Orlandi E, Bergamini A. Granulosa cell tumors (GCTs) of the ovary: What is the role of radiotherapy? Crit Rev Oncol Hematol 2023; 181:103889. [PMID: 36503888 DOI: 10.1016/j.critrevonc.2022.103889] [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: 07/21/2022] [Revised: 10/19/2022] [Accepted: 11/23/2022] [Indexed: 11/27/2022] Open
Abstract
Granulosa cell tumors of the ovary have an indolent behavior and a good prognosis, but a high incidence of local recurrence after surgery. The best treatment in the recurrent setting is unclear and randomized clinical trials on the management in the recurrent setting are lacking. The role of radiotherapy is controversial in adjuvant settings and unknown in case of relapse after surgery. This review aims to summarize the level of evidence of the role of radiation treatments for granulosa cell tumors of the ovary.
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Affiliation(s)
- Amelia Barcellini
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy; Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia.
| | - Giorgia Mangili
- Obstetrics & Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrei Fodor
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Simona Secondino
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Flavia Zerbetto
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alexandra Charalampopoulou
- Radiobiology Unit, Research and Development Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale Napoli, Italy
| | - Ester Orlandi
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy
| | - Alice Bergamini
- Obstetrics & Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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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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Le DT, Do TA, Nguyen LLT, Do KH, Van Nguyen C. Clinical and paraclinical features, outcome, and prognosis of ovarian granulosa cell tumor: A retrospective study of 28 Vietnamese women. Rare Tumors 2022; 14:20363613221148547. [PMID: 36582403 PMCID: PMC9793063 DOI: 10.1177/20363613221148547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: Granulosa cell tumor of the ovary is a rare disease and presents with two clinically and molecularly distinct subtypes: the juvenile and the adult type. GCT is considered as a malignant tumor with an indolent course and a tendency toward late recurrence. Purpose: To assess the clinical and paraclinical features, treatment findings, survival outcomes, and explored the prognostic factors in the granulosa cell tumor. Methods: The current study was conducted on 28 GCT patients who had surgical operations and adjuvant chemotherapy (stage IC-IV) by applying a retrospective cohort analysis. The clinical and paraclinical characteristics were recorded. Recurrent status was evaluated for analysis with clinical and paraclinical features and survival. All GCT patients' survival were analyzed by using Kaplan-Meier and Log-Rank models. Results: 17.9% of patients experienced a relapse and two patients died due to disease. The mean time from initial diagnose to recurrence was 40.21 months. The 5-year OS and DFS of stage I-II were 100% and 80.8%, and of stage III were 50% and 25%, respectively. In survival analyses, using the log-rank test, age ≥50 years, irregular menstruation, stage I-II, and absence of residual lesion were all significant predictors for the improved DFS. Stage I-II and absence of residual lesion were associated significantly with better OS. Mean of age, FIGO stage, and residual lesion during surgery had significant differences to recurrent rate (p < <0.05). The multivariate model revealed that these factors didn't remain as an independent prognostic variable. Conclusion: FIGO stage and residual lesion during surgery had significant differences in survival and recurrent rate.
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Affiliation(s)
- Duc Thanh Le
- National Cancer
Hospital, Hanoi, Vietnam,Chu Nguyen Van, Department of Quan Su
Pathology, National Cancer Hospital, 43 Quansu street, Hangbong Commune,
Hoankiem District, Hanoi 100000, Vietnam.
, Duc Thanh Le, Department of cancer
internal therapy, No5, National Cancer Hospital, 30 Caubuou, Tantrieu, Thanhtri,
Hanoi 100000, Vietnam.
| | - Tu Anh Do
- National Cancer
Hospital, Hanoi, Vietnam
| | | | | | - Chu Van Nguyen
- National Cancer
Hospital, Hanoi, Vietnam,Hanoi Medical
University, Hanoi, Vietnam,Chu Nguyen Van, Department of Quan Su
Pathology, National Cancer Hospital, 43 Quansu street, Hangbong Commune,
Hoankiem District, Hanoi 100000, Vietnam.
, Duc Thanh Le, Department of cancer
internal therapy, No5, National Cancer Hospital, 30 Caubuou, Tantrieu, Thanhtri,
Hanoi 100000, Vietnam.
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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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Ruptured granulosa cell tumor of the ovary presenting with catastrophic intra-abdominal hemorrhage: A case report. Int J Surg Case Rep 2022; 96:107317. [PMID: 35724501 PMCID: PMC9218371 DOI: 10.1016/j.ijscr.2022.107317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/01/2022] [Accepted: 06/13/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Adult granulosa cell tumor (GCT) is a rare stromal cell neoplasm that most often arises from the ovary. Presenting symptoms are related to external compression of adjacent structures (mass effect) or secretion of hormones such as estrogen. Patients most commonly present with irregular menstruation, postmenopausal bleeding, and abdominal pain. Prolonged estrogen exposure can contribute to endometrial adenocarcinoma development in untreated patients. The highly vascular nature of GCTs can lead to hemorrhagic rupture in rare cases. PRESENTATION OF CASE We describe a case of adult GCT in a 44-year-old female with a history of irregular menstrual bleeding and anemia. The patient presented with shortness of breath and abdominal pain. Computed tomography (CT) scan demonstrated possible hemorrhagic ascites of unclear etiology and a pelvic mass. The patient was brought to the operating room in hemorrhagic shock for surgical exploration where she was found to have active bleeding of a ruptured ovarian tumor for which she underwent left salpingo-oophorectomy. Postoperative course was unremarkable, and pathology demonstrated ruptured GCT. CLINICAL DISCUSSION Although rare, ovarian tumors can present with massive bleeding following rupture. Granulosa cell tumors are surreptitious as they grow slowly, and symptoms such as distention, abdominal pain, and irregular vaginal bleeding are nonspecific. CONCLUSION CT findings demonstrating a pelvic mass in the setting of spontaneous intra-abdominal bleeding should raise clinical suspicion, particularly in patients with histories of menstrual abnormalities. Patients with suspected intra-abdominal hemorrhage due to any cause are best treated by prompt surgical exploration and aggressive resuscitation.
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Causa-Andrieu P, Nicola R, Lipsich F, Adri D, Gomez M, Pol M, Wernicke A, Saraniti G, Chacon CRB. Characterization of Ovarian Granulosa Cell Tumors using Magnetic Resonance Imaging. MEDICAL RESEARCH ARCHIVES 2022; 10:10.18103/mra.v10i6.2813. [PMID: 36276660 PMCID: PMC9583456 DOI: 10.18103/mra.v10i6.2813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE To identify the MRI features that aid in the characterization of ovarian granulosa cell tumors. MATERIALS AND METHODS 11 MR pelvis of an adult woman with pathology-proven ovarian granulosa cell tumors with surgical pathology.We evaluated the patient's age, Ca-125, size, laterality, and with MRI features such as indirect signs (i.e., thickened endometrium > 0.9 cm), morphology (cystic, solid-cystic, or solid), subacute hemorrhage, T2 signal (low or intermediate-to-high), restricted diffusion (B values: 0, 50, 1000 sec/mm3/ADC), and dynamic enhancement (intense or similar to myometrium). Also, the presence of ascites, peritoneal implants, or adenopathy. RESULTS The final cohort included 11 women with a surgical-pathological diagnosis of granulosa cell tumors. The median age was 52.4 years (range, 17-80). The Ca-125 level was with a median within normal limits. The median size was 9.4 cm. Most cases were unilateral (81.8%) and more frequent on the left (54.5%). MRI ANALYSIS 36.4% had endometrial thickening. Ovarian granulosa cell tumors were polymorphous: cystic (54.6%), mixed solid-cystic (9.1%), and solid (36.3%). Most GC had intermediate to high signal on T2 (90.9%), restricted diffusion (81.8%), intense enhancement (81.8%), and 36.4% had intraparenchymal bleeding. 9.1% had associated implants/adenopathy/ascites at diagnosis. CONCLUSION The MRI features characteristic of ovarian granulosa cell tumors were the polymorphous morphology, an intense enhancement to the myometrium, restricted diffusion, and the presence of intraparenchymal hemorrhage.
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Affiliation(s)
| | - Refky Nicola
- Roswell Park Comprehensive Cancer Center, United States
| | | | - Daniel Adri
- Radiology Service. Hospital Italiano de Buenos Aires, Argentina
| | | | - Melina Pol
- Pathology Service. Hospital Italiano de Buenos Aires, Argentina
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Non-Epithelial Ovarian Cancers: How Much Do We Really Know? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031106. [PMID: 35162125 PMCID: PMC8834485 DOI: 10.3390/ijerph19031106] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/07/2022] [Accepted: 01/17/2022] [Indexed: 02/06/2023]
Abstract
Non-epithelial ovarian cancers (NEOC) are a group of uncommon malignancies that mainly includes germ cell tumours (GCT), sex cord-stromal tumours (SCST), and some extremely rare tumours, such as small cell carcinomas and sarcomas. Each of these classifications encompasses multiple histologic subtypes. The aetiology and molecular origins of each sub-group of NEOC require further investigation, and our understanding on the genetic changes should be optimised. In this article, we provide an update on the clinical presentation, pathology, genetics, treatment and survival of the main histological subtypes of the GCT and the SCST, as well as of ovarian small cell carcinomas. We also discuss miRNA expression profiles of NEOC and report the currently active clinical trials that include NEOC.
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19
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Romeo C, Le Saux O, Jacobs M, Joly F, Ferron G, Favier L, Fumet JD, Isambert N, Colombo PE, Sabatier R, Bastide L, Charreton A, Devouassoux-Shisheboran M, Gertych W, Dubot C, Bello Roufai D, Bataillon G, Berton D, Kalbacher E, Pautier P, Pomel C, Cornou C, Treilleux I, Lardy-Cleaud A, Ray-Coquard I. Therapeutic Challenges in Patients with Gynecologic Carcinosarcomas: Analysis of a Multicenter National Cohort Study from the French Prospective TMRG Network. Cancers (Basel) 2022; 14:354. [PMID: 35053517 PMCID: PMC8773830 DOI: 10.3390/cancers14020354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/28/2021] [Accepted: 01/06/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Gynecological carcinosarcomas are rare and aggressive diseases, with a poor prognosis. The rarity of these tumors explains the lack of robust and specific data available in the literature. The objective of this study was to investigate the impact of initial adjuvant treatment and recurrent therapeutic strategies. PATIENTS AND METHODS A multicentric cohort study within the French national prospective Rare Malignant Gynecological Tumors (TMRG) network was conducted. Data from all included carcinosarcomas diagnosed between 2011 and 2018 were retrospectively collected. RESULTS 425 cases of uterine and ovarian carcinosarcomas (n = 313 and n = 112, respectively) were collected and analyzed from 12 participating centers. At diagnosis, 140 patients (48%) had a FIGO stage III-IV uterine carcinosarcoma (UCS) and 88 patients (83%) had an advanced ovarian carcinosarcoma (OCS) (FIGO stage ≥ III). Two hundred sixty-seven patients (63%) received adjuvant chemotherapy, most preferably carboplatin-paclitaxel regimen (n = 227, 86%). After a median follow-up of 47.4 months, the median progression-free survival (mPFS) was 15.1 months (95% CI 12.3-20.6) and 14.8 months (95% CI 13.1-17.1) for OCS and UCS, respectively. The median overall survival for OCS and UCS was 37.1 months (95% CI 22.2-49.2) and 30.6 months (95% CI 24.1-40.9), respectively. With adjuvant chemotherapy followed by radiotherapy, mPFS was 41.0 months (95% CI 17.0-NR) and 18.9 months (95% CI 14.0-45.6) for UCS stages I-II and stages III-IV, respectively. In the early stage UCS subgroup (i.e., stage IA, n = 86, 30%), mPFS for patients treated with adjuvant chemotherapy (n = 24) was not reached (95% CI 22.2-NR), while mPFS for untreated patients (n = 62) was 19.9 months (95% IC 13.9-72.9) (HR 0.44 (0.20-0.95) p = 0.03). At the first relapse, median PFS for all patients was 4.2 months (95% CI 3.5-5.3). In the first relapse, mPFS was 6.7 months (95% CI 5.1-8.5) and 2.2 months (95% CI 1.9-2.9) with a combination of chemotherapy or monotherapy, respectively (p < 0.001). CONCLUSIONS Interestingly, this vast prospective cohort of gynecological carcinosarcoma patients from the French national Rare Malignant Gynecological Tumors network (i) highlights the positive impact of adjuvant CT on survival in all localized stages (including FIGO IA uterine carcinosarcomas), (ii) confirms the importance of platinum-based combination as an option for relapse setting, and (iii) reports median PFS for various therapeutic strategies in the relapse setting.
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Affiliation(s)
- Clémence Romeo
- Medical Oncology Department, Centre Léon Bérard, 69008 Lyon, France; (A.C.); (I.R.-C.)
| | - Olivia Le Saux
- Cancer Research Center of Lyon CRCL, UMR Inserm 1052, CNRS 5286, Centre Léon Bérard, 69008 Lyon, France;
| | - Margaux Jacobs
- Medical Oncology Department, Centre François Baclesse, 14000 Caen, France; (M.J.); (F.J.)
| | - Florence Joly
- Medical Oncology Department, Centre François Baclesse, 14000 Caen, France; (M.J.); (F.J.)
- GINECO Group, 75008 Paris, France; (G.F.); (L.F.); (N.I.); (P.-E.C.); (R.S.); (M.D.-S.); (C.D.); (G.B.); (D.B.); (E.K.); (P.P.); (C.P.); (I.T.)
| | - Gwenael Ferron
- GINECO Group, 75008 Paris, France; (G.F.); (L.F.); (N.I.); (P.-E.C.); (R.S.); (M.D.-S.); (C.D.); (G.B.); (D.B.); (E.K.); (P.P.); (C.P.); (I.T.)
- Department of Surgical Oncology, Institut Claudius Regaud-IUCT, 31100 Toulouse, France
| | - Laure Favier
- GINECO Group, 75008 Paris, France; (G.F.); (L.F.); (N.I.); (P.-E.C.); (R.S.); (M.D.-S.); (C.D.); (G.B.); (D.B.); (E.K.); (P.P.); (C.P.); (I.T.)
- Medical Oncology Department, Centre Georges François Leclerc, 21000 Dijon, France;
| | - Jean-David Fumet
- Medical Oncology Department, Centre Georges François Leclerc, 21000 Dijon, France;
| | - Nicolas Isambert
- GINECO Group, 75008 Paris, France; (G.F.); (L.F.); (N.I.); (P.-E.C.); (R.S.); (M.D.-S.); (C.D.); (G.B.); (D.B.); (E.K.); (P.P.); (C.P.); (I.T.)
- Medical Oncology Department, Centre Georges François Leclerc, 21000 Dijon, France;
| | - Pierre-Emmanuel Colombo
- GINECO Group, 75008 Paris, France; (G.F.); (L.F.); (N.I.); (P.-E.C.); (R.S.); (M.D.-S.); (C.D.); (G.B.); (D.B.); (E.K.); (P.P.); (C.P.); (I.T.)
- Surgical Oncology Department, Institut du Cancer de Montpellier, 34090 Montpellier, France
| | - Renaud Sabatier
- GINECO Group, 75008 Paris, France; (G.F.); (L.F.); (N.I.); (P.-E.C.); (R.S.); (M.D.-S.); (C.D.); (G.B.); (D.B.); (E.K.); (P.P.); (C.P.); (I.T.)
- Medical Oncology Department, Institut Paoli Calmettes, 13009 Marseille, France;
| | - Ludovic Bastide
- Medical Oncology Department, Institut Paoli Calmettes, 13009 Marseille, France;
| | - Amandine Charreton
- Medical Oncology Department, Centre Léon Bérard, 69008 Lyon, France; (A.C.); (I.R.-C.)
| | - Mojgan Devouassoux-Shisheboran
- GINECO Group, 75008 Paris, France; (G.F.); (L.F.); (N.I.); (P.-E.C.); (R.S.); (M.D.-S.); (C.D.); (G.B.); (D.B.); (E.K.); (P.P.); (C.P.); (I.T.)
- Tumor Biology Department, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Witold Gertych
- Gynaecologic Surgery Department, Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Lyon, France;
| | - Coraline Dubot
- GINECO Group, 75008 Paris, France; (G.F.); (L.F.); (N.I.); (P.-E.C.); (R.S.); (M.D.-S.); (C.D.); (G.B.); (D.B.); (E.K.); (P.P.); (C.P.); (I.T.)
- Medical Oncology Department, Institut Curie, Saint-Cloud, 92210 Paris, France;
| | - Diana Bello Roufai
- Medical Oncology Department, Institut Curie, Saint-Cloud, 92210 Paris, France;
| | - Guillaume Bataillon
- GINECO Group, 75008 Paris, France; (G.F.); (L.F.); (N.I.); (P.-E.C.); (R.S.); (M.D.-S.); (C.D.); (G.B.); (D.B.); (E.K.); (P.P.); (C.P.); (I.T.)
- Tumor Biology Department, Institut Curie, 75005 Paris, France
| | - Dominique Berton
- GINECO Group, 75008 Paris, France; (G.F.); (L.F.); (N.I.); (P.-E.C.); (R.S.); (M.D.-S.); (C.D.); (G.B.); (D.B.); (E.K.); (P.P.); (C.P.); (I.T.)
- Medical Oncology Department, Institut de Cancérologie de l’Ouest, 44800 Saint Herblain, France
| | - Elsa Kalbacher
- GINECO Group, 75008 Paris, France; (G.F.); (L.F.); (N.I.); (P.-E.C.); (R.S.); (M.D.-S.); (C.D.); (G.B.); (D.B.); (E.K.); (P.P.); (C.P.); (I.T.)
- Medical Oncology Department, CHRU de Besançon, 25000 Besançon, France
| | - Patricia Pautier
- GINECO Group, 75008 Paris, France; (G.F.); (L.F.); (N.I.); (P.-E.C.); (R.S.); (M.D.-S.); (C.D.); (G.B.); (D.B.); (E.K.); (P.P.); (C.P.); (I.T.)
- Medical Oncology Department, Gustave Roussy, 94805 Villejuif, France
| | - Christophe Pomel
- GINECO Group, 75008 Paris, France; (G.F.); (L.F.); (N.I.); (P.-E.C.); (R.S.); (M.D.-S.); (C.D.); (G.B.); (D.B.); (E.K.); (P.P.); (C.P.); (I.T.)
- Surgical Oncology Department, Centre Jean Perrin, 63011 Clermont-Ferrand, France;
| | - Caroline Cornou
- Surgical Oncology Department, Centre Jean Perrin, 63011 Clermont-Ferrand, France;
| | - Isabelle Treilleux
- GINECO Group, 75008 Paris, France; (G.F.); (L.F.); (N.I.); (P.-E.C.); (R.S.); (M.D.-S.); (C.D.); (G.B.); (D.B.); (E.K.); (P.P.); (C.P.); (I.T.)
- Tumor Biology Department, Centre Léon Bérard, 69008 Lyon, France
| | | | - Isabelle Ray-Coquard
- Medical Oncology Department, Centre Léon Bérard, 69008 Lyon, France; (A.C.); (I.R.-C.)
- GINECO Group, 75008 Paris, France; (G.F.); (L.F.); (N.I.); (P.-E.C.); (R.S.); (M.D.-S.); (C.D.); (G.B.); (D.B.); (E.K.); (P.P.); (C.P.); (I.T.)
- University Claude Bernard Lyon 1, 69100 Villeurbanne, France
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Adult granulosa cell tumor with minor foci of juvenile granulosa cell tumor in postmenopausal woman: A rare case report. Int J Surg Case Rep 2021; 88:106531. [PMID: 34688077 PMCID: PMC8536526 DOI: 10.1016/j.ijscr.2021.106531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/15/2021] [Accepted: 10/16/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction Granulosa cell tumor (GCT) is a rare neoplasm that is divided into adult GCT (AGCT) and juvenile GCT (JGCT). Generally, a patient will only have the AGCT or JGCT subtypes. Here, we presented the first case of AGTC accompanied by focal JGTC in a postmenopausal woman. Presentation of case A 63-year-old postmenopausal woman came with distended abdomen accompanied by postmenopausal bleeding. CT scan shows a solid mass with cystic degeneration. Laparotomy found a solid mass from the right ovary measuring 18 × 15 × 14 cm. The pathological results showed a diffuse tumor representing AGCT, accompanied by Call-Exner bodies and nuclear groove. In addition, minor foci were also found, which consist of well-defined margins tumor and follicular-like structures that resemble JGCT. The patient underwent bilateral salpingo-oophorectomy with a total hysterectomy and no recurrence in three months follow-up. Discussion Age and clinical symptoms cannot be used as specific differentiators between AGTC and JGTC. Radiological imaging also shows a similar appearance of solid masses tumors with hemorrhagic or fibrotic changes, multilocular cystic lesions, or completely cystic tumors. The concomitant findings of JGCT and AGCT could be distinguished very carefully by anatomical pathology examination. It is crucial to differentiate AGCT from JGCT, especially to see the prognosis. Conclusion The role of pathologists is needed in differentiating AGCT and JGCT, primarily when found simultaneously. Granulosa cell tumor (GCT) is a rare neoplasm that accounts for about 2–5% of all ovarian neoplasms. Only 3% of JGTCs are reported in women over 30 years. AGCT with minor foci of JGCT patients has clinical and radiological conditions similar to GCT in general. The role of pathologists is needed in differentiating AGCT and JGCT, primarily when found simultaneously.
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21
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Ohta M, Hara Y, Kashiwadate T, Chin M, Hagiwara M, Nakanishi W, Ito K, Nishida A, Hashizume E. Recurrence of Adult Granulosa Cell Tumor in the Greater Omentum 11 Years after Surgery. Case Rep Gastroenterol 2021; 15:639-644. [PMID: 34616269 PMCID: PMC8454241 DOI: 10.1159/000515412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 02/19/2021] [Indexed: 11/19/2022] Open
Abstract
Adult-type ovarian granulosa cell tumors (AGCTs) are very rare tumors that account for <5% of all ovarian carcinomas. AGCTs have low malignancy potential and rarely metastasize 5-30 years after the initial diagnosis. Because time has passed from the first surgery and because recurrence develops in various locations, the differential diagnosis is difficult. In particular, tumors developing in the greater omentum are encountered rarely, and it is necessary to carefully consider the differential diagnosis, including primary and secondary neoplasms. Although CT is useful to detect omental tumors, the diagnosis requires invasive procedures. We report a case of AGCT recurrence in the greater omentum that was resected during laparoscopic cholecystectomy. A patient visited our hospital with right-sided abdominal pain. The CT revealed gallbladder stones, a ureteral stone, and a right abdominal mass. The diagnosis of the abdominal tumor was difficult on the basis of blood biochemical testing, gastrointestinal endoscopy, or image inspection. Although the patient underwent several previous surgeries and there were no findings of malignancy with positron emission tomography, we chose to resect the tumor for combined diagnosis and treatment during laparoscopic cholecystectomy. Intraoperative findings showed that the tumor originated from the greater omentum, and the tumor was diagnosed as AGCT recurrence by pathology. A recurrence of AGCT in the greater omentum is very rare, and laparoscopic surgery was safe and useful for resection, in our case.
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Affiliation(s)
- Mineto Ohta
- Department of Surgery, Nihonkai General Hospital, Yamagata, Japan.,Department of Gastroenterological Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Yasuyuki Hara
- Department of Surgery, Nihonkai General Hospital, Yamagata, Japan
| | - Toshiaki Kashiwadate
- Department of Surgery, Nihonkai General Hospital, Yamagata, Japan.,Department of Gastroenterological Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Masahiro Chin
- Department of Surgery, Nihonkai General Hospital, Yamagata, Japan
| | | | - Wataru Nakanishi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Ken Ito
- Department of Surgery, Nihonkai General Hospital, Yamagata, Japan
| | - Akiko Nishida
- Department of Pathology, Nihonkai General Hospital, Yamagata, Japan
| | - Eiji Hashizume
- Department of Surgery, Nihonkai General Hospital, Yamagata, Japan
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22
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Akbulut S, Ceylan SD, Tuncali T, Sogutcu N. Coexistence of Ovarian Granulose Cell Tumor, Congenital Adrenal Hyperplasia, and Triple Translocation: Is a Consequence or Coincidence? J Gastrointest Cancer 2021; 52:508-514. [PMID: 32388791 DOI: 10.1007/s12029-020-00408-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Congenital adrenal hyperplasia (CAH) is rare autosomal recessive disease. CAH due to 21-hydroxylase deficiency accounts for 95% of cases. We aimed to share the first case of coexistence of simple virilizing-type congenital adrenal hyperplasia [I172N mutation in the CYP21A], triple translocation [t(9;11;12)], and ovarian granulose cell tumor. METHODS A 59-year-old female patient was presented to our clinic, complaining with abdominal pain and distension. Physical examination revealed palpable abdominal mass, virilism, ambiguous genitalia, clitoramegaly, and hyperpigmentation. Contrast-enhanced abdominal computed tomography showed a giant mass originating from the right tubo-ovarian structure. RESULTS The patient was operated in the light of the clinico-radiological features mentioned above. A giant mass weighing 3500 g was detected on the right tubo-ovarian structure during laparotomy, and mass was excised with right tubo-ovarian structure. Immunohistochemical examination revealed ovarian granulosa cell tumor. The high serum concentration of 17-OH progesterone was measured at baseline and after 250-μg bolus of synthetic ACTH. In genetic analysis, we screened for six-point mutations, large deletions, and non-common mutations using restriction fragment length polymorphism (RFLP) methods, PCR, and sequencing of CYP21 gene respectively. The patient was detected to be homozygous for the I172N mutation. In addition, 50% of the metaphases examined had triple translocation [t(9;11;12)]. CONCLUSION The coexistence of congenital adrenal hyperplasia, triple chromosomal translocations, and ovarian granulosa cell tumor has not been described previously. This coexistence may be a sign of a new syndrome.
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Affiliation(s)
- Sami Akbulut
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Elazig Yolu 10. Km, 44280, Malatya, Turkey.
| | - Senay Durmaz Ceylan
- Department of Endocrinology, Kirikkale University Faculty of Medicine, 71450, Kirikkale, Turkey
| | - Timur Tuncali
- Department of Genetics, Ankara University Faculty of Medicine, 06100, Ankara, Turkey
| | - Nilgun Sogutcu
- Department of Pathology, Diyarbakir Education and Research Hospital, 21400, Diyarbakir, Turkey
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23
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Secchi C, Benaglio P, Mulas F, Belli M, Stupack D, Shimasaki S. FOXO1 mitigates the SMAD3/FOXL2 C134W transcriptomic effect in a model of human adult granulosa cell tumor. J Transl Med 2021; 19:90. [PMID: 33639972 PMCID: PMC7913442 DOI: 10.1186/s12967-021-02754-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/16/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Adult granulosa cell tumor (aGCT) is a rare type of stromal cell malignant cancer of the ovary characterized by elevated estrogen levels. aGCTs ubiquitously harbor a somatic mutation in FOXL2 gene, Cys134Trp (c.402C < G); however, the general molecular effect of this mutation and its putative pathogenic role in aGCT tumorigenesis is not completely understood. We previously studied the role of FOXL2C134W, its partner SMAD3 and its antagonist FOXO1 in cellular models of aGCT. METHODS In this work, seeking more comprehensive profiling of FOXL2C134W transcriptomic effects, we performed an RNA-seq analysis comparing the effect of FOXL2WT/SMAD3 and FOXL2C134W/SMAD3 overexpression in an established human GC line (HGrC1), which is not luteinized, and bears normal alleles of FOXL2. RESULTS Our data shows that FOXL2C134W/SMAD3 overexpression alters the expression of 717 genes. These genes include known and novel FOXL2 targets (TGFB2, SMARCA4, HSPG2, MKI67, NFKBIA) and are enriched for neoplastic pathways (Proteoglycans in Cancer, Chromatin remodeling, Apoptosis, Tissue Morphogenesis, Tyrosine Kinase Receptors). We additionally expressed the FOXL2 antagonistic Forkhead protein, FOXO1. Surprisingly, overexpression of FOXO1 mitigated 40% of the altered genome-wide effects specifically related to FOXL2C134W, suggesting it can be a new target for aGCT treatment. CONCLUSIONS Our transcriptomic data provide novel insights into potential genes (FOXO1 regulated) that could be used as biomarkers of efficacy in aGCT patients.
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Affiliation(s)
- Christian Secchi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
| | - Paola Benaglio
- Department of Pediatrics, University of California San Diego, School of Medicine, La Jolla, CA, USA
| | - Francesca Mulas
- Department of Pediatrics, University of California San Diego, School of Medicine, La Jolla, CA, USA
| | - Martina Belli
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Dwayne Stupack
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Shunichi Shimasaki
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093, USA
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24
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Al Harbi R, McNeish IA, El-Bahrawy M. Ovarian sex cord-stromal tumors: an update on clinical features, molecular changes, and management. Int J Gynecol Cancer 2021; 31:161-168. [PMID: 33414107 DOI: 10.1136/ijgc-2020-002018] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/24/2020] [Accepted: 11/30/2020] [Indexed: 12/17/2022] Open
Abstract
Sex cord stromal-tumors are rare tumors of the ovary that include numerous tumor subtypes of variable histological features and biological behavior. Surgery is the main therapeutic modality for the management of these tumors, while chemotherapy and hormonal therapy may be used in some patients with progressive and recurrent tumors. Several studies investigated molecular changes in the different tumor types. Understanding molecular changes underlying the development and progression of sex cord-stromal tumors provides valuable information for diagnostic and prognostic biomarkers and potential therapeutic targets for these tumors. In this review, we provide an update on the clinical presentation, molecular changes, and management of sex cord-stromal tumors.
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Affiliation(s)
- Rehab Al Harbi
- Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, UK
| | - Iain A McNeish
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Mona El-Bahrawy
- Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, UK .,Department of Pathology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
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25
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Magnetic Resonance Imaging of Recurrent Adult Granulosa Cell Tumor of the Ovary: A Retrospective Analysis of 11 Cases. J Comput Assist Tomogr 2020; 44:887-892. [PMID: 32976259 PMCID: PMC7668338 DOI: 10.1097/rct.0000000000001096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective The aim of the study was to characterize magnetic resonance imaging findings in patients with recurrent ovarian adult granulosa cell tumors (AGCTs). Methods Clinical and magnetic resonance imaging manifestations of recurrent AGCTs were evaluated in 11 patients. Results Initial recurrences of AGCT were diagnosed between 13 months and 30 years (mean, 11.3 years). Recurrent tumors were located in the pelvic peritoneum, the abdominal peritoneum, the retroperitoneum, and bone. The number of recurrent tumors varied from 1 to 5. Tumors varied in morphology and all margins were well circumscribed. The internal structures noted were as follows: multilocular cystic and solid and cystic. Furthermore, internal hemorrhage and sponge-like multicystic components were identified. Conclusions Ovarian AGCTs recurred in the pelvic peritoneum, abdominal peritoneum, and the retroperitoneal lymph nodes. Large recurrent AGCTs were commonly well circumscribed, round or lobulated, and multilocular cystic or solid and cystic. Moreover, they frequently included internal hemorrhage and sponge-like multicystic components.
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26
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Guleria P, Kumar L, Kumar S, Bhatla N, Ray R, Singhal S, Meena J, Mathur SR. A clinicopathological study of granulosa cell tumors of the ovary: Can morphology predict prognosis? INDIAN J PATHOL MICR 2020; 63:53-59. [PMID: 32031123 DOI: 10.4103/ijpm.ijpm_403_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objective Granulosa cell tumors (GCT) are low-grade malignant sex cord-stromal tumors (SCST) with late metastasis/recurrences and long disease-free periods. We performed a clinicopathological evaluation of GCT to ascertain features having prognostic impact. Materials and Methods All cases of GCT of ovary from January 2006 to December 2018 were assessed for architectural patterns, nuclear grooves, and Call-Exner bodies. Each feature was graded on frequency of occurrence: not present (0)-very frequent (3). Anisonucleosis, necrosis, and inflammation were noted. Cases were grouped on mitotic count; <10 mitosis/10 High power field (HPF) or >=11 mitoses/10 HPF and Ki-67 index; <10% Ki-67 and >=11% Ki-67. Results GCT formed 60.1% of SCST. Sixty cases' ages were in the range of 15-78 years (median 45). Clinical details were available in 37. Commonest presentation was abnormal uterine bleeding. Serum CA125 was raised in 16.1% and Inhibin in 58.8%. Seventy percent were in stage I. Disease recurrence was associated with higher stage (P = 0.007). The most frequent pattern was diffuse sheets (47%). Call-Exner bodies were absent in 22.2%. Grooves with score 1, 2, and 3 were seen in 35.8%, 23.5%, and 13.6%, respectively. Anisonucleosis was present in 26.7%, necrosis in 11.1%, and lympho-plasmacytic infiltrate in 43%. Out of total, 93.3% had <10 mitosis/10 HPF and 43.2% had recurrence, most with high Ki-67 (P = 0.064). Conclusion Our study outlines histomorphological spectrum of GCT and emphasizes its frequent occurrence in lower stages with late recurrences. The presence of grooves may indicate granulosa-cell origin. Call-Exner bodies are not a necessity. Histomorphological features are not prognostically important. However, prognostic value of Ki-67 cannot be excluded. Limitation of the study was a small number of cases with follow-up.
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Affiliation(s)
- Prerna Guleria
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Lalit Kumar
- Department of Medical Oncology, Dr. BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sunesh Kumar
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Neerja Bhatla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Ruma Ray
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Singhal
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Jyoti Meena
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep R Mathur
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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27
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Weis-Banke SE, Lerdrup M, Kleine-Kohlbrecher D, Mohammad F, Sidoli S, Jensen ON, Yanase T, Nakamura T, Iwase A, Stylianou A, Abu-Rustum NR, Aghajanian C, Soslow R, Da Cruz Paula A, Koche RP, Weigelt B, Christensen J, Helin K, Cloos PAC. Mutant FOXL2 C134W Hijacks SMAD4 and SMAD2/3 to Drive Adult Granulosa Cell Tumors. Cancer Res 2020; 80:3466-3479. [PMID: 32641411 DOI: 10.1158/0008-5472.can-20-0259] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/26/2020] [Accepted: 06/30/2020] [Indexed: 12/11/2022]
Abstract
The mutant protein FOXL2C134W is expressed in at least 95% of adult-type ovarian granulosa cell tumors (AGCT) and is considered to be a driver of oncogenesis in this disease. However, the molecular mechanism by which FOXL2C134W contributes to tumorigenesis is not known. Here, we show that mutant FOXL2C134W acquires the ability to bind SMAD4, forming a FOXL2C134W/SMAD4/SMAD2/3 complex that binds a novel hybrid DNA motif AGHCAHAA, unique to the FOXL2C134W mutant. This binding induced an enhancer-like chromatin state, leading to transcription of nearby genes, many of which are characteristic of epithelial-to-mesenchymal transition. FOXL2C134W also bound hybrid loci in primary AGCT. Ablation of SMAD4 or SMAD2/3 resulted in strong reduction of FOXL2C134W binding at hybrid sites and decreased expression of associated genes. Accordingly, inhibition of TGFβ mitigated the transcriptional effect of FOXL2C134W. Our results provide mechanistic insight into AGCT pathogenesis, identifying FOXL2C134W and its interaction with SMAD4 as potential therapeutic targets to this condition. SIGNIFICANCE: FOXL2C134W hijacks SMAD4 and leads to the expression of genes involved in EMT, stemness, and oncogenesis in AGCT, making FOXL2C134W and the TGFβ pathway therapeutic targets in this condition. GRAPHICAL ABSTRACT: http://cancerres.aacrjournals.org/content/canres/80/17/3466/F1.large.jpg.
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Affiliation(s)
- Stine E Weis-Banke
- Biotech Research and Innovation Centre (BRIC), University of Copenhagen, Copenhagen N, Denmark.,The Novo Nordisk Foundation Center for Stem Cell Research (DanStem), University of Copenhagen, Copenhagen N, Denmark
| | - Mads Lerdrup
- Center for Chromosome Stability, University of Copenhagen, Copenhagen N, Denmark
| | - Daniela Kleine-Kohlbrecher
- Biotech Research and Innovation Centre (BRIC), University of Copenhagen, Copenhagen N, Denmark.,The Novo Nordisk Foundation Center for Stem Cell Research (DanStem), University of Copenhagen, Copenhagen N, Denmark
| | - Faizaan Mohammad
- Biotech Research and Innovation Centre (BRIC), University of Copenhagen, Copenhagen N, Denmark.,The Novo Nordisk Foundation Center for Stem Cell Research (DanStem), University of Copenhagen, Copenhagen N, Denmark
| | - Simone Sidoli
- Department of Biochemistry and Molecular Biology, VILLUM Centre for Bioanalytical Sciences, University of Southern Denmark, Odense, Denmark.,Department of Biochemistry, Albert Einstein College of Medicine, Bronx, New York
| | - Ole N Jensen
- Department of Biochemistry and Molecular Biology, VILLUM Centre for Bioanalytical Sciences, University of Southern Denmark, Odense, Denmark
| | - Toshihiko Yanase
- Seiwakai Muta Hospital, 3-9-1 Hoshikuma, Sawara-ku, Fukuoka, Japan
| | - Tomoko Nakamura
- Departments of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Akira Iwase
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Anthe Stylianou
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nadeem R Abu-Rustum
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Carol Aghajanian
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Robert Soslow
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Arnaud Da Cruz Paula
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Richard P Koche
- Center for Epigenetics Research, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Britta Weigelt
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jesper Christensen
- Biotech Research and Innovation Centre (BRIC), University of Copenhagen, Copenhagen N, Denmark.,The Novo Nordisk Foundation Center for Stem Cell Research (DanStem), University of Copenhagen, Copenhagen N, Denmark
| | - Kristian Helin
- Biotech Research and Innovation Centre (BRIC), University of Copenhagen, Copenhagen N, Denmark. .,The Novo Nordisk Foundation Center for Stem Cell Research (DanStem), University of Copenhagen, Copenhagen N, Denmark.,Cell Biology Program and Center for Epigenetics Research, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Paul A C Cloos
- Biotech Research and Innovation Centre (BRIC), University of Copenhagen, Copenhagen N, Denmark. .,The Novo Nordisk Foundation Center for Stem Cell Research (DanStem), University of Copenhagen, Copenhagen N, Denmark
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28
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Ji JX, Cochrane DR, Tessier-Cloutier B, Chen SY, Ho G, Pathak KV, Alcazar IN, Farnell D, Leung S, Cheng A, Chow C, Colborne S, Negri GL, Kommoss F, Karnezis A, Morin GB, McAlpine JN, Gilks CB, Weissman BE, Trent JM, Hoang L, Pirrotte P, Wang Y, Huntsman DG. Arginine Depletion Therapy with ADI-PEG20 Limits Tumor Growth in Argininosuccinate Synthase-Deficient Ovarian Cancer, Including Small-Cell Carcinoma of the Ovary, Hypercalcemic Type. Clin Cancer Res 2020; 26:4402-4413. [PMID: 32409304 DOI: 10.1158/1078-0432.ccr-19-1905] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 01/02/2020] [Accepted: 05/11/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE Many rare ovarian cancer subtypes, such as small-cell carcinoma of the ovary, hypercalcemic type (SCCOHT), have poor prognosis due to their aggressive nature and resistance to standard platinum- and taxane-based chemotherapy. The development of effective therapeutics has been hindered by the rarity of such tumors. We sought to identify targetable vulnerabilities in rare ovarian cancer subtypes. EXPERIMENTAL DESIGN We compared the global proteomic landscape of six cases each of endometrioid ovarian cancer (ENOC), clear cell ovarian cancer (CCOC), and SCCOHT to the most common subtype, high-grade serous ovarian cancer (HGSC), to identify potential therapeutic targets. IHC of tissue microarrays was used as validation of arginosuccinate synthase (ASS1) deficiency. The efficacy of arginine-depriving therapeutic ADI-PEG20 was assessed in vitro using cell lines and patient-derived xenograft mouse models representing SCCOHT. RESULTS Global proteomic analysis identified low ASS1 expression in ENOC, CCOC, and SCCOHT compared with HGSC. Low ASS1 levels were validated through IHC in large patient cohorts. The lowest levels of ASS1 were observed in SCCOHT, where ASS1 was absent in 12 of 31 cases, and expressed in less than 5% of the tumor cells in 9 of 31 cases. ASS1-deficient ovarian cancer cells were sensitive to ADI-PEG20 treatment regardless of subtype in vitro. Furthermore, in two cell line mouse xenograft models and one patient-derived mouse xenograft model of SCCOHT, once-a-week treatment with ADI-PEG20 (30 mg/kg and 15 mg/kg) inhibited tumor growth in vivo. CONCLUSIONS Preclinical in vitro and in vivo studies identified ADI-PEG20 as a potential therapy for patients with rare ovarian cancers, including SCCOHT.
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Affiliation(s)
- Jennifer X Ji
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Dawn R Cochrane
- Department of Molecular Oncology, BC Cancer Agency, Vancouver, Canada
| | - Basile Tessier-Cloutier
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Shary Yutin Chen
- Department of Molecular Oncology, BC Cancer Agency, Vancouver, Canada
| | - Germain Ho
- Department of Molecular Oncology, BC Cancer Agency, Vancouver, Canada
| | - Khyatiben V Pathak
- Collaborative Center for Translational Mass Spectrometry, The Translational Genomics Research Institute, Phoenix, Arizona
| | - Isabel N Alcazar
- Collaborative Center for Translational Mass Spectrometry, The Translational Genomics Research Institute, Phoenix, Arizona
| | - David Farnell
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Samuel Leung
- Genetic Pathology Evaluation Center, Vancouver, Canada
| | - Angela Cheng
- Genetic Pathology Evaluation Center, Vancouver, Canada
| | | | - Shane Colborne
- Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, Canada
| | - Gian Luca Negri
- Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, Canada
| | - Friedrich Kommoss
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany
| | - Anthony Karnezis
- Department of Pathology and Laboratory Medicine, University of California, Davis, California
| | - Gregg B Morin
- Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, Canada.,Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - Jessica N McAlpine
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada
| | - C Blake Gilks
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Bernard E Weissman
- Department of Pathology and Laboratory Medicine, UNC-Chapel Hill, Chapel Hill, North Carolina
| | - Jeffrey M Trent
- Integrated Cancer Genomics, The Translational Genomics Research Institute, Phoenix, Arizona
| | - Lynn Hoang
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Patrick Pirrotte
- Collaborative Center for Translational Mass Spectrometry, The Translational Genomics Research Institute, Phoenix, Arizona
| | - Yemin Wang
- Department of Molecular Oncology, BC Cancer Agency, Vancouver, Canada
| | - David G Huntsman
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada. .,Department of Molecular Oncology, BC Cancer Agency, Vancouver, Canada.,Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada
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29
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The French national network dedicated to rare gynecological cancers diagnosis and management could improve the quality of surgery in daily practice of granulosa cell tumors. A TMRG and GINECO group Study. Gynecol Oncol 2020; 157:78-84. [PMID: 32131977 DOI: 10.1016/j.ygyno.2020.02.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 12/31/2019] [Accepted: 02/07/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The French national rare gynecological tumor network has been established to improve the quality of care through offering expertise in double reading histological diagnosis, reviewing cases and guiding management of these tumors through specialized multidisciplinary tumor boards and online clinical guidelines (www.ovaire-rare.com). The aim of this study is to evaluate the impact of the development and implementation of this network by assessing the conformity of medical practice with the guidelines concerning the granulosa cell tumors (GCTs). METHODS This is a French nationwide study, including 463 patients (out of the 639 identified patients) with a definitive diagnosis of GCT between 2011 and 2016. Surgical practices were analyzed for conformity with the current guidelines (www.ovaire-rare.org). Medical records, surgical and pathological reports were systematically analyzed. Total conformity was defined by a conservative (unilateral salpingo-oophorectomy) or radical surgery (hysterectomy and bilateral salpingo-oophorectomy) including surgical staging (omentectomy, peritoneal biopsies and peritoneal cytology) according to the FIGO stage. Partial conformity referred to a conservative or radical surgery without surgical staging and non-conformity was defined as a non-optimal surgery as recommended by the guidelines. RESULTS Median age at diagnosis was 49 years old (range 10-89). The median size of tumor was 94 mm (range 5-400). Radical surgery was performed in 240 patients (52%); while a fertility-sparing surgery was performed in 98 cases (21%). A surgical staging was performed in 76 cases (16%) and an evaluation of the endometrium in 289 cases (62%). Surgery was fully compliant with the guidelines in 65 patients (14%), partially compliant in 213 patients (46%), non-compliant in 137 patients (30%) and not assessable in 48 cases (10%). A statistically significant difference for compliance was observed in restaging surgery (p < 0,001), radical surgery (p = 0,017) and the period (before or after) of the implementation of the network (p < 0,001). Survival analyses did not allow us to demonstrate a significant difference in overall survival nor in PFS although there was a trend in favor of optimal surgery compared to incomplete/non optimal surgery. CONCLUSION Surgical management's conformity to the guidelines increases over time from 2011 to 2016. According to this study, the implementation of a national network dedicated to rare gynecologic tumors seems to significantly improve the surgical management of the patients with ovarian granulosa cell tumors.
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Abstract
OBJECTIVE The purpose of this article is to review the imaging findings and genomics of granulosa cell tumors (GCTs) in order to aid in diagnosis and management of GCTs. GCTs are the most common type of sex cord-stromal tumors of the ovary. They are usually diagnosed initially with ultrasound and are subsequently further characterized with CT and MRI. PET/CT is often ordered as well to measure the extent of disease and for follow-up, but its usefulness is in question as some GCTs lack FDG avidity. There is significant variability in imaging phenotypes of GCTs, ranging from mostly cystic to almost solid. More resources have recently been dedicated to understanding the genetics and molecular mechanisms of GCT development. Current research shows that the main cause of GCT carcinogenesis is the FOXL2 mutation, but there are several other noteworthy mutations that contribute to the pathogenesis of this disease. Certain mutations, like GATA4, are known to be associated with more aggressive disease and higher rates of recurrence. CONCLUSION Using this information, imaging protocols can be altered depending on the genotype of the tumor. Further understanding of the genetic alterations that underpin the development of GCTs is indicated as genotypic knowledge could be used to guide optimal imaging and management strategies.
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Belli M, Secchi C, Stupack D, Shimasaki S. FOXO1 Negates the Cooperative Action of FOXL2 C134W and SMAD3 in CYP19 Expression in HGrC1 Cells by Sequestering SMAD3. J Endocr Soc 2019; 3:2064-2081. [PMID: 31701078 PMCID: PMC6797057 DOI: 10.1210/js.2019-00279] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 08/23/2019] [Indexed: 12/25/2022] Open
Abstract
Adult granulosa cell tumor (aGCT) is a rare type of ovarian cancer characterized by estrogen excess. Interestingly, only the single somatic mutation FOXL2 C134W was found across virtually all aGCTs. We previously reported that FOXL2C134W stimulates CYP19 transcription synergistically with SMAD3, leading to elevated estradiol synthesis in a human granulosa cell line (HGrC1). This finding suggested a key role for FOXL2C134W in causing the typical estrogen overload in patients with aGCTs. We have now investigated the effect of FOXO1, a tumor suppressor, on CYP19 activation by FOXL2C134W in the presence of SMAD3. Intriguingly, FOXO1 antagonized the positive, synergistic effect of FOXL2C134W and SMAD3 on CYP19 transcription. Similar to FOXL2C134W, FOXO1 binds SMAD3 but not the proximal FOXL2C134W binding site (-199 bp) of the CYP19 promoter identified in our earlier studies. The results of a competitive binding assay suggested a possible underlying mechanism in which FOXO1 sequesters SMAD3 away from FOXL2C134W, thereby negating the cooperative action of FOXL2C134W and SMAD3 in inducing CYP19 expression. To our knowledge, this study is the first to demonstrate the ability of FOXO1 to restore an altered CYP19 expression by FOXL2C134W and SMAD3 and provides insight as to why FOXO1 deficiency promotes GCT development in mice.
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Affiliation(s)
- Martina Belli
- Department of Reproductive Medicine, School of Medicine, University of California San Diego, La Jolla, California
| | - Christian Secchi
- Department of Reproductive Medicine, School of Medicine, University of California San Diego, La Jolla, California
| | - Dwayne Stupack
- Department of Reproductive Medicine, School of Medicine, University of California San Diego, La Jolla, California
| | - Shunichi Shimasaki
- Department of Reproductive Medicine, School of Medicine, University of California San Diego, La Jolla, California
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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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Poddubskaya EV, Baranova MP, Allina DO, Sekacheva MI, Makovskaia LA, Kamashev DE, Suntsova MV, Barbara VS, Kochergina-Nikitskaya IN, Aleshin AA. Personalized prescription of imatinib in recurrent granulosa cell tumor of the ovary: case report. Cold Spring Harb Mol Case Stud 2019; 5:mcs.a003434. [PMID: 30655270 PMCID: PMC6549576 DOI: 10.1101/mcs.a003434] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 01/10/2019] [Indexed: 02/06/2023] Open
Abstract
Ovarian cancer is the fifth leading cause of cancer-related female mortality and the most lethal gynecological cancer. In this report, we present a rare case of recurrent granulosa cell tumor (GCT) of the ovary. We describe the case of a 26-yr-old woman with progressive GCT of the right ovary despite multiple lines of therapy who underwent salvage therapy selection based on a novel bioinformatical decision support tool (Oncobox). This analysis generated a list of potentially actionable compounds, which when used clinically lead to partial response and later long-term stabilization of the patient's disease.
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Affiliation(s)
- Elena V Poddubskaya
- Clinical Center Vitamed, Moscow, 121309, Russia.,I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, 119991, Russia
| | - Madina P Baranova
- Clinical Center Vitamed, Moscow, 121309, Russia.,FSBEI FPE Russian Medical Academy of Continuing Professional Education MOH, Moscow, 125993, Russia
| | - Daria O Allina
- Department of Pathology, Morozov Children's City Hospital, Moscow, 119049, Russia
| | - Marina I Sekacheva
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, 119991, Russia
| | - Lyudmila A Makovskaia
- Faculty of Fundamental Medicine, Lomonosov Moscow State University, Moscow, 119991, Russia
| | - Dmitriy E Kamashev
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, 119991, Russia
| | - Maria V Suntsova
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Moscow, 117997, Russia
| | - Viktoria S Barbara
- Oncological Dispensary of the Republic of Karelia, Petrozavodsk, 185002, Russia
| | | | - Alexey A Aleshin
- Stanford University School of Medicine, Stanford, California 94305, USA
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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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Bezircioglu I, Yetimalar MH, Ocal I. Post hysterectomy occurrence of endometrial adenocarcinoma in association with granulosa cell tumour: a case report. J OBSTET GYNAECOL 2016; 37:264-265. [PMID: 27922275 DOI: 10.1080/01443615.2016.1242561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Incim Bezircioglu
- a Obstetrics and Gynaecology Department , Faculty of Medicine, Izmir University of Economics , Izmir , Turkey
| | - Mehmet Hakan Yetimalar
- b Obstetrics and Gynaecology Department , Izmir Katip Celebi University Ataturk Training and Research Hospital , Izmir , Turkey
| | - Irfan Ocal
- c Pathology Department , Izmir Katip Celebi University Ataturk Training and Research Hospital , Izmir , Turkey
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Chi HP, Tozzi R, Moore NR. Pre-operative CT-guided wire localization of a retroperitoneal mass for laparoscopic surgery. BJR Case Rep 2016; 3:20150416. [PMID: 30363313 PMCID: PMC6159273 DOI: 10.1259/bjrcr.20150416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 06/07/2016] [Indexed: 11/05/2022] Open
Abstract
A 48-year-old female with a 9-year history of granulosa cell tumour presented with progression of a mass in the left flank after the recent gradual rise of her inhibin B levels. She had experienced multiple recurrences and had undergone multiple operations to resect previous tumour recurrences. Initial laparoscopy did not identify the most recent recurrent mass. MRI was repeated a month after the surgery; it confirmed the presence of the mass and demonstrated an increase in the size of the tumour. Owing to difficulties in finding the tumour, a CT-guided wire localization of the mass was performed immediately prior to a second elective laparoscopy, leading to successful removal of the recurrent granulosa cell tumour. We describe the use of a conventional localization wire under CT guidance to facilitate the resection of a unique retroperitoneal tumour. This case report discusses the current applications of the wire localization technique, the evolution of the hook wire system, the potential complications that may occur and the factors influencing the likelihood of success of wire localization in the retroperitoneal space.
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Affiliation(s)
| | - Roberto Tozzi
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, UK
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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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Carrillo Angeles LG, Flores Hernández D, Aguilar Priego JM, García-Salazar JM. Tumor de células de la granulosa tipo juvenil. GACETA MEXICANA DE ONCOLOGÍA 2016. [DOI: 10.1016/j.gamo.2016.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Zhang P, Wang N, Lin X, Jin L, Xu H, Li R, Huang H. Expression and localization of heterogeneous nuclear ribonucleoprotein K in mouse ovaries and preimplantation embryos. Biochem Biophys Res Commun 2016; 471:260-5. [PMID: 26850853 DOI: 10.1016/j.bbrc.2016.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 02/01/2016] [Indexed: 01/08/2023]
Abstract
Heterogeneous nuclear ribonucleoprotein K (hnRNP K), an evolutionarily conserved protein, is involved in several important cellular processes that are relevant to cell proliferation, differentiation, apoptosis, and cancer development. However, details of hnRNP K expression during mammalian oogenesis and preimplantation embryo development are lacking. The present study investigates the expression and cellular localization of K protein in the mouse ovaries and preimplantation embryos using immunostaining. We demonstrate, for the first time, that hnRNP K is abundantly expressed in the nuclei of mouse oocytes in primordial, primary and secondary follicles. In germ vesicle (GV)-stage oocytes, hnRNP K accumulates in the germinal vesicle in a spot distribution manner. After germinal vesicle breakdown, speckled hnRNP K is diffusely distributed in the cytoplasm. However, after fertilization, the K protein relocates into the female and male pronucleus and persists in the blastomere nuclei. Localization of K protein in the human ovary and ovarian granulosa cell tumor (GCT) was also investigated. Overall, this study provides important morphological evidence to better understand the possible roles of hnRNP K in mammalian oogenesis and early embryo development.
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Affiliation(s)
- Ping Zhang
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ningling Wang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xianhua Lin
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Li Jin
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hong Xu
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Rong Li
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hefeng Huang
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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