Granulosa cell tumor of the ovary
Citation, DOI and article data
Granulosa cell tumors of the ovary are a type of sex cord / stromal ovarian tumor.
Sex cord-stromal tumors represent approximately 8% of all ovarian tumors and are believed to arise from and/or to contain combinations of the sex cord and stromal components of the developing gonad. Granulosa cell tumors of the ovary comprise a distinct subset of ovarian cancers that account for approximately 5% of all ovarian malignancies 6. They occur most commonly in perimenopausal and postmenopausal women (peak incidence at age 50)7.
Patients may present with nonspecific symptoms such as abdominal pain, distention, or bloating. In a majority of cases, there may be hormonal manifestations due to estrogen activity of the tumor 6.
They are thought to arise from normal proliferating granulosa cells of the late preovulatory follicle and exhibit many morphological and biochemical features of these cells. GCT is distinct from other ovarian carcinomas in their hormonal activity; their ability to secrete estrogen, inhibin, and Müllerian inhibiting substance accounts for some of the clinical manifestations of the disease and also provides useful tumor markers for disease surveillance 6.
- the hyperoestrogenemia may produce
- Maffucci syndrome: with juvenile granulosa cell tumor
It can be divided into two broad subtypes:
- adult granulosa cell tumor of the ovary: much more common and accounts for ~95% of cases 5
- juvenile granulosa cell tumor of the ovary
They are slow-growing, predominantly solid masses with variable amounts of cystic change and intratumoral hemorrhage. Bilaterality is rare.
Oestrogenic effects on the uterus may manifest as uterine enlargement or as endometrial thickening or hemorrhage.6
- appearance varies widely: may appear anywhere from a solid mass to a multiloculated solid and cystic mass, to a purely cystic lesion
- varying degrees of hemorrhage or fibrosis
- less likely to have intracystic papillary projections than epithelial ovarian tumors
The CT appearance of a granulosa cell tumor is usually that of a large, well-defined low-attenuation ovarian mass.
Treatment and prognosis
It is suggested that stage I granulosa cell tumors should go for fertility-sparing surgery, unilateral salpingo-oophorectomy appears to be the most appropriate course of action.6
- 1. Kim SH, Kim SH. Granulosa cell tumor of the ovary: common findings and unusual appearances on CT and MR. J Comput Assist Tomogr. 26 (5): 756-61. J Comput Assist Tomogr (link) - Pubmed citation
- 2. Rha SE, Oh SN, Jung SE et-al. Recurrent ovarian granulosa cell tumors: clinical and imaging features. Abdom Imaging. 33 (1): 119-25. doi:10.1007/s00261-007-9197-1 - Pubmed citation
- 3. Morikawa K, Hatabu H, Togashi K et-al. Granulosa cell tumor of the ovary: MR findings. J Comput Assist Tomogr. 21 (6): 1001-4. J Comput Assist Tomogr (link) - Pubmed citation
- 4. Saini A, Dina R, Mcindoe GA et-al. Characterization of adnexal masses with MRI. AJR Am J Roentgenol. 2005;184 (3): 1004-9. AJR Am J Roentgenol (full text) - Pubmed citation
- 5. Jung SE, Lee JM, Rha SE et-al. CT and MR imaging of ovarian tumors with emphasis on differential diagnosis. Radiographics. 22 (6): 1305-25. doi:10.1148/rg.226025033 - Pubmed citation
- 6. Jamieson S, Fuller PJ. Molecular pathogenesis of granulosa cell tumors of the ovary. Endocr. Rev. 2012;33 (1): 109-44. doi:10.1210/er.2011-0014 - Pubmed citation
- 7. Khosla D, Dimri K, Pandey AK, Mahajan R, Trehan R. Ovarian granulosa cell tumor: clinical features, treatment, outcome, and prognostic factors. (2014) North American journal of medical sciences. 6 (3): 133-8. doi:10.4103/1947-2714.128475 - Pubmed