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Park H, Goodman CP, Raymond SL, Sundin A, Khan FA, Radulescu A. A 12-Year-Old Girl with Juvenile Granulosa Cell Tumor of the Ovary, Presenting with Adolescent Hyperprolactinemia, Galactorrhea, and Amenorrhea. Am J Case Rep 2023; 24:e938249. [PMID: 36647328 PMCID: PMC9867898 DOI: 10.12659/ajcr.938249] [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: 12/30/2022] Open
Abstract
BACKGROUND Juvenile-type granulosa cell tumors (JGCTs) are a rare subtype of sex cord stromal tumor with a characteristic histology that is commonly found in the first 3 decades of life. It most commonly presents with symptoms of hyperestrogenism, which may present as precocious pseudopuberty or as menstruation-related symptoms, allowing for early detection of the tumor. CASE REPORT We present the case of a 12-year-old girl who presented to her primary care provider (PCP) with secondary amenorrhea with intermittent abdominal pain, who underwent an ultrasound for further evaluation, which revealed a large incidental pelvic mass. She was admitted to the Emergency Department (ED) and had findings of galactorrhea and hyperprolactinemia on examination. Imaging studies demonstrated a large ovarian mass measuring 15.0×9.0×18.8 cm that was resected, and subsequent pathology results showed JGCT stage 1A. CONCLUSIONS Prognosis of granulosa cell tumors (GCT) largely depends on its initial size, stage at diagnosis, residual tumors after surgery, and the subtype of GCT. If the patient is of reproductive age, fertility-sparing surgical options must be considered and patients must be regularly monitored for recurrence. JGCTs can present with minimal to no symptoms of precocious puberty in young girls but may present with amenorrhea, which may be considered normal for their developmental age. Although JGCTs are rare, they are important to include in differential diagnoses of younger female patients with abdominal pain, especially if accompanied by hormonal irregularities.
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Affiliation(s)
- Hyunsoo Park
- School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | | | - Steven L. Raymond
- School of Medicine, Loma Linda University, Loma Linda, CA, USA,Department of Pediatric Surgery, Loma Linda University Children’s Hospital, Loma Linda, CA, USA
| | - Andrew Sundin
- Department of General Surgery, Loma Linda University, Loma Linda, CA, USA
| | - Faraz A. Khan
- School of Medicine, Loma Linda University, Loma Linda, CA, USA,Department of Pediatric Surgery, Loma Linda University Children’s Hospital, Loma Linda, CA, USA
| | - Andrei Radulescu
- School of Medicine, Loma Linda University, Loma Linda, CA, USA,Department of Pediatric Surgery, Loma Linda University Children’s Hospital, Loma Linda, CA, USA
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Bergamini A, Ferrandina G, Candotti G, Taccagni G, Scarfone G, Bocciolone L, Cassani C, Marinaccio M, Pignata S, Candiani M, Mangili G. Stage I juvenile granulosa cell tumors of the ovary: A multicentre analysis from the MITO-9 study. Eur J Surg Oncol 2021; 47:1705-1709. [PMID: 33583630 DOI: 10.1016/j.ejso.2021.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/29/2021] [Accepted: 02/03/2021] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Juvenile type granulosa cell tumor (JGCTs) are extremely rare, mainly diagnosed in young women and pre-pubertal girls at stage I disease. Literature is scanty and guidelines regarding the optimal management are still controversial. The aim of this study is to add on the experience of the MITO group (Multicenter Italian Trials in Ovarian Cancer). METHODS Clinicopathological data from patients with stage I JGCTs were retrospectively collected. Descriptive statistics were used to characterize the patient population. Clinicopathological features and treatment variables were evaluated for association with relapse. RESULTS Seventeen patients were identified. Surgical approach was laparoscopic and open for 7 (41%) and 10 (59%) patients, respectively. Fertility sparing surgery (FSS) was performed in 15 patients (88%): unilateral salpingo-oophorectomy (USO) in 11 patients, cystectomy with subsequent USO in 2 patients and cystectomy alone in the remaining 2. Adjuvant chemotherapy was given in 2 cases. After a median follow up time of 80 months, no recurrences were registered. CONCLUSIONS Given the available data, minimally invasive surgery is safe in stage I JGCTs. Because of the good prognosis and of the young age of patients, FSS can be chosen in most of the cases. The role of cystectomy deserves further validation. The need of adjuvant chemotherapy in stage I disease is still unclear, even if available data does not seem to support treatment over surveillance.
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Affiliation(s)
- Alice Bergamini
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Milan, Italy; Università Vita Salute San Raffaele, Milan, Italy.
| | - Gabriella Ferrandina
- Dipartimento per La Salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Istituto di Ginecologia e Ostetricia, Roma, Italy
| | - Giorgio Candotti
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Milan, Italy; Università Vita Salute San Raffaele, Milan, Italy
| | - Gianluca Taccagni
- Department of Surgical Pathology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Giovanna Scarfone
- Department of Obstetrics, Gynecology, and Neonatology, University of Milan, Ospedale Maggiore Policlinico, Milan, Italy
| | - Luca Bocciolone
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Chiara Cassani
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo, Pavia, Italy
| | - Marco Marinaccio
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncological Science (DIMO), University of Bari, Bari, Italy
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80138 Naples, Italy
| | - Massimo Candiani
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Milan, Italy; Università Vita Salute San Raffaele, Milan, Italy
| | - Giorgia Mangili
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Milan, Italy
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Osman HA, Al-Jurayyan NAM, Babiker AMI, Al-Otaibi HMN, AlKhalifah RDH, Al Issa SDA, Mohamed S. Precocious puberty: An experience from a major teaching hospital in Central Saudi Arabia. Sudan J Paediatr 2017; 17:19-24. [PMID: 29213166 PMCID: PMC5621853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Precocious puberty is a developmental process that gives rise to secondary sexual characteristics before the age of 8 years in girls and 9 years in boys. In general, precocious puberty can be classified as central or peripheral. This is a retrospective hospital-based study was conducted at King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia, during the period January 1990 and December 2016. Data were abstracted from the medical records of patients diagnosed with precocious puberty, with special emphasis on age, sex, clinical characteristics, and relevant hormonal assay. A total of 62 patients were diagnosed with Precocious Puberty (PP); 43 had Central Precocious Puberty (CPP) while 19 had peripheral precocious puberty (PPP). The majority of girls with CPP (68%) had idiopathic PP, while pathological causes were found in (50%) of boys. The commonest cause of PPP was congenital adrenal hyperplasia (42%) and chronic hypothyroidism (26%). In conclusion, this study showed that precocious Puberty is a common endocrine problem in our center. The etiology of CPP was idiopathic in the majority of girls while it was caused by CNS pathology in most of the boys in this cohort. Peripheral precocious puberty is not that rare and mainly caused by congenital adrenal hyperplasia or hypothyroidism.
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Affiliation(s)
- Huda A Osman
- Department of Pediatrics, College of Medicine, King Saud University Medical City, (KSUMC), King Saud University, Riyadh, Saudi Arabia
| | - Nasir A M Al-Jurayyan
- Department of Pediatrics, College of Medicine, King Saud University Medical City, (KSUMC), King Saud University, Riyadh, Saudi Arabia
| | - Amir M I Babiker
- Department of Pediatrics, King Abdullah Specialized Children’s Hospital and King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Hessah M N Al-Otaibi
- Department of Pediatrics, College of Medicine, King Saud University Medical City, (KSUMC), King Saud University, Riyadh, Saudi Arabia
| | - Reem D H AlKhalifah
- Department of Pediatrics, College of Medicine, King Saud University Medical City, (KSUMC), King Saud University, Riyadh, Saudi Arabia
| | - Sharifah D A Al Issa
- Department of Pediatrics, College of Medicine, King Saud University Medical City, (KSUMC), King Saud University, Riyadh, Saudi Arabia
| | - Sarar Mohamed
- Department of Pediatrics, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
- Corresponding author
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Bús D, Buzogány M, Nagy G, Vajda G. Rare virilizing granulosa cell tumor in an adolescent. Mol Clin Oncol 2016; 6:88-90. [PMID: 28123736 DOI: 10.3892/mco.2016.1084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 09/14/2016] [Indexed: 11/05/2022] Open
Abstract
Hormone-producing malignancies are rare in children or adolescent patients: Only 0.1% of all ovarian tumors and 4-5% of granulosa cell tumors occur in the sexually non-active ages. Granulosa cell tumors (GCTs) are sex cord-stromal tumors of the ovary, representing 7-8% of all ovarian neoplasms. A total of 95% of all GCTs are adult-type, and only 5% are diagnosed as juvenile-type GCT. A majority of children with juvenile-type GCT present with isosexual precocious pseudopuberty due to excessive estrogen production, although virilizing, testosterone-producing, juvenile-type GCTs are rare, occurring only in 2-3% of cases. The present case study reports on a case of a virilizing, juvenile-type GCT in a 14-year-old girl, along with a review of the literature.
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Affiliation(s)
- Dorottya Bús
- Department of Obstetrics and Gynecology, Zala County Hospital, 8900 Zalaegerszeg, Hungary
| | - Mária Buzogány
- Department of Neonatology and Pediatrics, Zala County Hospital, 8900 Zalaegerszeg, Hungary
| | - Gyöngyi Nagy
- Department of Radiology, Zala County Hospital, 8900 Zalaegerszeg, Hungary
| | - György Vajda
- Department of Obstetrics and Gynecology, Zala County Hospital, 8900 Zalaegerszeg, Hungary
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Iqbal A, Novodvorsky P, Lubina-Solomon A, Kew FM, Webster J. Juvenile granulosa cell tumour of the ovary presenting with hyperprolactinaemic amenorrhoea and galactorrhoea. Endocrinol Diabetes Metab Case Rep 2016; 2016:160006. [PMID: 27047664 PMCID: PMC4815277 DOI: 10.1530/edm-16-0006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 02/23/2016] [Indexed: 11/10/2022] Open
Abstract
Secondary amenorrhoea and galactorrhoea represent a common endocrine presentation. We report a case of an oestrogen-producing juvenile granulosa cell tumour (JGCT) of the ovary in a 16-year-old post-pubertal woman with hyperprolactinaemia amenorrhoea and galactorrhoea which resolved following surgical resection of the tumour. This patient presented with a 9-month history of secondary amenorrhoea and a 2-month history of galactorrhoea. Elevated serum prolactin at 7081 mIU/l and suppressed gonadotropins (LH <0.1 U/l; FSH <0.1 U/l) were detected. Serum oestradiol was significantly elevated at 7442 pmol/l with undetectable β-human chorionic gonadotropin. MRI showed a bulky pituitary with no visible adenoma. MRI of the abdomen showed a 4.8 cm mass arising from the right ovary with no evidence of metastatic disease. Serum inhibin B was elevated at 2735 ng/l. A right salpingo-oophorectomy was performed, and histology confirmed the diagnosis of a JGCT, stage International Federation of Gynaecology and Obstetrics 1A. Immunohistochemical staining for prolactin was negative. Post-operatively, oestrogen and prolactin levels were normalised, and she subsequently had a successful pregnancy. In summary, we present a case of an oestrogen-secreting JGCT with hyperprolactinaemia manifesting clinically with galactorrhoea and secondary amenorrhoea. We postulate that observed hyperprolactinaemia was caused by oestrogenic stimulation of pituitary lactotroph cells, a biochemical state analogous to pregnancy. To the best of our knowledge, this is the first report of hyperprolactinaemia as a result of excessive oestrogen production in the context of a JGCT.
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Affiliation(s)
- Ahmed Iqbal
- Department of Diabetes and Endocrinology, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust , Herries Road, Sheffield, S5 7AU , UK
| | - Peter Novodvorsky
- Department of Diabetes and Endocrinology, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust , Herries Road, Sheffield, S5 7AU , UK
| | - Alexandra Lubina-Solomon
- Department of Diabetes and Endocrinology, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust , Herries Road, Sheffield, S5 7AU , UK
| | - Fiona M Kew
- Department of Gynaecological Oncology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust , Glossop Road, Sheffield, S10 2JF , UK
| | - Jonathan Webster
- Department of Diabetes and Endocrinology, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust , Herries Road, Sheffield, S5 7AU , UK
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