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Granulosa cell tumor of the ovary.

Abstract

Adult granulosa cell tumor (GCT) of the ovary is oftentimes a hormonally active, stromal cell neoplasm that is distinguished by its ability to secrete sex steroids such as estrogen. Patients may present with vaginal bleeding caused by endometrial hyperplasia or uterine cancer as a result of prolonged exposure to tumor-derived estrogen. In addition, GCT is a vascular tumor that may occasionally rupture and result in abdominal pain, hemoperitoneum, and hypotension, mimicking an ectopic pregnancy in younger patients. GCT is usually associated with a mass on pelvic examination that is subsequently confirmed on ultrasonography. Surgery is required for definitive tissue diagnosis, staging, and tumor debulking. In older women, a total abdominal hysterectomy and bilateral salpingooophorectomy are typically performed. In women of childbearing age, a more conservative unilateral salpingo-oophorectomy may be performed, assuming that careful staging reveals that the disease has not extended outside of the involved ovary and that a concomitant uterine cancer has been excluded. Survival of patients with GCT is generally excellent because most patients present with early-stage disease, although certain high-risk patient groups may be identified. Stage is the most important prognostic factor, with a higher risk of relapse being associated with stages II through IV disease. In addition, patients with stage I disease associated with features such as large tumor size, high mitotic index, or tumor rupture may also be at higher risk in some series. The value of postoperative adjuvant therapy for high-risk patients has not been investigated by prospective randomized trials, which are difficult to perform because of the rarity of this tumor. Nonetheless, the use of adjuvant chemotherapy or radiation has sometimes been associated with prolonged disease-free survival in patients with high-risk features. Because of the propensity of GCT to recur years after initial diagnosis, prolonged surveillance with serial physical examination and serum tumor markers such as estradiol and inhibin is reasonable.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Program in Gynecologic Medical Oncology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. scannist@caregroup.harvard.edu

    Source

    MeSH

    Age Factors
    Anti-Mullerian Hormone
    Antineoplastic Combined Chemotherapy Protocols
    Biomarkers, Tumor
    Chemotherapy, Adjuvant
    Climacteric
    Estradiol
    Female
    Glycoproteins
    Granulosa Cell Tumor
    Growth Inhibitors
    Humans
    Incidence
    Inhibins
    Middle Aged
    Neoplasm Recurrence, Local
    Neoplasm Staging
    Organoplatinum Compounds
    Ovarian Neoplasms
    Population Surveillance
    Prognosis
    Radiotherapy, Adjuvant
    Risk Factors
    Survival Rate
    Testicular Hormones
    United States

    Pub Type(s)

    Journal Article
    Review

    Language

    eng

    PubMed ID

    12637488

    Citation

    Schumer, Susan Tinsley, and Stephen A. Cannistra. "Granulosa Cell Tumor of the Ovary." Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, vol. 21, no. 6, 2003, pp. 1180-9.
    Schumer ST, Cannistra SA. Granulosa cell tumor of the ovary. J Clin Oncol. 2003;21(6):1180-9.
    Schumer, S. T., & Cannistra, S. A. (2003). Granulosa cell tumor of the ovary. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, 21(6), pp. 1180-9.
    Schumer ST, Cannistra SA. Granulosa Cell Tumor of the Ovary. J Clin Oncol. 2003 Mar 15;21(6):1180-9. PubMed PMID: 12637488.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Granulosa cell tumor of the ovary. AU - Schumer,Susan Tinsley, AU - Cannistra,Stephen A, PY - 2003/3/15/pubmed PY - 2003/4/11/medline PY - 2003/3/15/entrez SP - 1180 EP - 9 JF - Journal of clinical oncology : official journal of the American Society of Clinical Oncology JO - J. Clin. Oncol. VL - 21 IS - 6 N2 - Adult granulosa cell tumor (GCT) of the ovary is oftentimes a hormonally active, stromal cell neoplasm that is distinguished by its ability to secrete sex steroids such as estrogen. Patients may present with vaginal bleeding caused by endometrial hyperplasia or uterine cancer as a result of prolonged exposure to tumor-derived estrogen. In addition, GCT is a vascular tumor that may occasionally rupture and result in abdominal pain, hemoperitoneum, and hypotension, mimicking an ectopic pregnancy in younger patients. GCT is usually associated with a mass on pelvic examination that is subsequently confirmed on ultrasonography. Surgery is required for definitive tissue diagnosis, staging, and tumor debulking. In older women, a total abdominal hysterectomy and bilateral salpingooophorectomy are typically performed. In women of childbearing age, a more conservative unilateral salpingo-oophorectomy may be performed, assuming that careful staging reveals that the disease has not extended outside of the involved ovary and that a concomitant uterine cancer has been excluded. Survival of patients with GCT is generally excellent because most patients present with early-stage disease, although certain high-risk patient groups may be identified. Stage is the most important prognostic factor, with a higher risk of relapse being associated with stages II through IV disease. In addition, patients with stage I disease associated with features such as large tumor size, high mitotic index, or tumor rupture may also be at higher risk in some series. The value of postoperative adjuvant therapy for high-risk patients has not been investigated by prospective randomized trials, which are difficult to perform because of the rarity of this tumor. Nonetheless, the use of adjuvant chemotherapy or radiation has sometimes been associated with prolonged disease-free survival in patients with high-risk features. Because of the propensity of GCT to recur years after initial diagnosis, prolonged surveillance with serial physical examination and serum tumor markers such as estradiol and inhibin is reasonable. SN - 0732-183X UR - https://www.unboundmedicine.com/medline/citation/12637488/full_citation L2 - http://ascopubs.org/doi/full/10.1200/JCO.2003.10.019?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -