Granulosa cell tumors of the ovary are rare, indolent stromal tumors which often secrete hormones like estrogen. They typically present with abdominal pain and vaginal bleeding. A majority of these tumors are diagnosed in the early stages and therefore are associated with a favorable outcome.
Granulosa cell tumors (GCT) of the ovary arise from the granulosa cells. Histologically, GCTs are divided into two types: the adult onset GCT (AGCT) type and the juvenile onset GCT (JGCT) type, both of which present with distinctly different clinical features and histopathological characteristics. Although both types produce estrogen, AGCTs are more frequent and occur in perimenopausal and postmenopausal women, typically in the fifth decade of life, while JGCTs are relatively infrequent and occur in prepubertal girls and young women. Several chromosomal abnormalities detected in patients with GCTs are trisomy 12, monosomy 22, and chromosome 6 deletion. Peutz Jeghers syndrome and Potters syndrome are associated with GCTs, while JGCT has been associated with Ollier disease and Maffucci disease .
The clinical presentation of both AGCT and JGCT is usually non-specific with abdominal pain and progressive increase in abdominal girth or related to hyperestrogenic effects. A majority of the cases present in the early stages of the disease and have a favorable outcome  . Women in the reproductive age present with menstrual irregularities such as amenorrhoea, intermenstrual bleeding, and menorrhagia . Elevated estrogen levels cause symptoms of breast enlargement and tenderness which are seen in patients with GCTs at all ages . Precocious puberty with vaginal bleeding can be the presenting feature in prepubertal patients while postmenopausal vaginal bleeding without provocation may be the presenting symptom in postmenopausal women . GCTs with a Sertoli-Leydig cell component secrete androgens which cause virilization, acne, and hirsutism . Occasionally patients may present with either acute pain in the abdomen, nausea, and vomiting due to ovarian torsion or hypotension with acute abdominal pain due to tumor rupture and hemoperitoneum . It is very rare for patients with GCTs to present with symptoms related to skeletal or pulmonary metastases .
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Her symptom of left leg swelling disappeared after therapy. Radiotherapy is highly effective in treating recurrent or residual GCTO. [ncbi.nlm.nih.gov]
Surgical complications occurred in two patients including two wound infections, one urinary tract infection, and one enterocutaneous fistula. Six patients had no complications. [degruyter.com]
Schedule dependent tumour growth delay, DNA cross-linking and pharmacokinetic parameters in target tissues with cis-diamminedichloroplatinum(II) and etanidazole with or without hyperthermia or radiation. Int J Hyperthermia 1991;7(5):773–84. [degruyter.com]
They typically present with abdominal pain and vaginal bleeding. A majority of these tumors are diagnosed in the early stages and therefore are associated with a favorable outcome. [symptoma.com]
Abdominal pain and hemoperitoneum, which occasionally can occur, are attributable to tumor rupture. The most common finding in pelvic examination is a tumor mass, which is subsequently confirmed with imaging techniques. [ncbi.nlm.nih.gov]
She presented with a 20 x 22 cm pelvic mass and received a right salpingo-oophorectomy. [ncbi.nlm.nih.gov]
mass * Abdominal discomfot * Abdominal distention * Abdominal pain * Dysuria * Increased urination frequency * Constipation * Asymptomatic in early stages Causes - Granulosa cell tumor of the ovary Not supplied. [checkorphan.org]
Precocious puberty was the presenting symptom in all five prepubertal children; abdominal distension due to mass effect was the presenting symptom in three children older than 9 years of age. [ncbi.nlm.nih.gov]
In all women presenting with menstrual irregularities, vaginal bleeding, hirsutism or abdominal distension, a detailed pelvic examination, hormonal and radiological workup along with menstrual history and history of hormonal therapy (estrogen receptor [symptoma.com]
She has presented the same symptoms associated with 1-year history of abdominal distension for the second nausea and vomiting, urinary symptoms with bilateral kidney dilatation, and hypertension. [frontiersin.org]
These patients may present with abdominal mass, abdominal distension or menstrual irregularities. [jpgo.org]
The clinical manifestations ranges from pain abdomen, abdominal distension, menstrual abnormalities like menorrhagia, intermenstrual, postmenopausal bleeding or amenorrhea. , ,  In the present study two of our patients presented with menorrhagia [jmidlifehealth.org]
Her symptom of abdominal bloating and early satiety abated. Case #3: An 83-year-old woman with a 20 x 20 x 15-cm mass in the left abdomen was treated with radiotherapy to a dose of 45 Gy in 25 fractions. [ncbi.nlm.nih.gov]
Definition / general Differentiation towards follicular granulosa cells Usually women age 15 years; 75% associated with hyperestrogenism, causes precocious puberty in children, metrorrhagia (bleeding between periods), endometrial hyperplasia / carcinoma [pathologyoutlines.com]
Menstrual irregularities such as postmenopausal bleeding and metrorrhagia Increased risk of endometrial cancer Precocious puberty Sertoli-Leydig cell tumor : can produce either estrogen or testosterone Yolk sac tumor, dysgerminoma : rapid growth, acute [amboss.com]
Clinically, AGCT are often detected at an early stage and affected women show features of hyperestrogenism with breast pain, menorrhagia, and metrorrhagia. Other presenting symptoms are nonspecific such as abdominal pain and swelling. [degruyter.com]
In all women presenting with menstrual irregularities, vaginal bleeding, hirsutism or abdominal distension, a detailed pelvic examination, hormonal and radiological workup along with menstrual history and history of hormonal therapy (estrogen receptor modulators, gonadotropins, and clomiphene citrate are considered to be risk factors for GCT) is important for diagnosis. An adnexal mass is almost always palpated on pelvic and rectal examination.
A pregnancy test is performed in the majority of patients, while blood tests for beta–human chorionic gonadotropin (bhCG), alpha-fetoprotein (AFP), lactate dehydrogenase (LDH), serum inhibin, serum anti-Müllerian hormone (AMH) or Müllerian-inhibiting substance (MIS), and cancer antigen 125 (CA125) levels are ordered in all patients with suspected ovarian malignancies. Serum inhibin is currently considered the most specific marker for GCTs and is useful for diagnosis as well as a follow-up, while CA125 levels are useful for long-term patient monitoring  . Serum AMH/MIS levels are very specific for GCT in postmenopausal as well as women who have undergone an oophorectomy as they indicate the disease extent . Based on the clinical findings, blood levels of serum estrogen, testosterone and dehydroepiandrosterone can be checked. Routine laboratory tests like complete blood count, blood chemistries, and urinalysis are ordered in all patients prior to surgical intervention.
Ultrasonography, especially transvaginal, is the mainstay of diagnosing the site, size, extent, and free fluid in the pelvic cavity. GCTs appear as heterogeneous solid or cystic masses ranging in size from 1 to 20 inches. Endometrial hyperplasia is often noticed on ultrasonography and it is important to look for uterine malignancy as 5-10% of cases of GCTs are associated with endometrial carcinoma . Ascites may be present in rare cases  .
Preoperative abdominopelvic computed tomographic or magnetic resonance scan and chest radiography are useful to diagnose metastatic spread of disease. Mammography is also included in the workup for older patients as breast malignancies are known to metastasize to the ovaries. Histopathological testing of the tumor is necessary for confirming the diagnosis of GCT and is performed after tumor excision.
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