Belghith C1*, Ksontini M2, Armi S1, Abdeljabbar A1, Bouzidi S1, Chaouechi A1, Belhadj Kacem L2, Makhlouf T1, Mathlouthi N1, Rammeh S2, Slimani O1 and Attia L1
1Department of Obstetrics and Gynecology, Charles Nicolle Hospital, Tunisia
2Department of Anatomopathology, Charles Nicolle Hospital, Tunisia
Introduction: Ovarian Granulosa Cell Tumors (GCT) is rare cancers which arise from sex cord stromal cells of the ovaries. They represent 2% to 5% of all ovarian neoplasms. There are two different types, the adult and the juvenile type. They are characterized by distinct clinical course and outcome. Preoperative imaging features may be helpful for disease recognition. Anti-Müllerian Hormone and inhibin B are currently the most accurate biomarkers. The definitive diagnosis is obtained by the
histopathological analysis. Surgery remains the cornerstone of treatment.
Objective: To study clinicopathological features and therapeutic options of GCT.
Methods: This is a retrospective single-center analysis of six cases of GCT of the ovary, collected in the obstetrics gynecology department “A” of the Charles Nicolle Hospital over a period of four years (2016 to 2019). Histopathologic observations were collected from records of the pathology department of the same hospital.
Results: An Adult-Type Granulosa Cell Tumor (AGCT) was found on the histopathological analysis of 83.33% of cases. Only one patient had a Juvenile-Type Granulosa Cell Tumor (JGCT). The average age of our women ranged from 19 to 61 years. For patients who have been diagnosed with an AGCT, the mean age of onset was 51 years. The mean gestity was 4.6 and the mean parity was 3. Pelvic pain was the most common symptom.
Pelvic ultrasound objectified the ovary tumors in all cases. The inhibin b test was done in one case and its level was high. Demons-Meigs' syndrome is diagnosed in 20% of cases. Two patients underwent emergency surgery. Five women were treated with hysterectomy with bilateral salpingooophorectomy. One patient who had undergone a previous abdominal inter adnexal hysterectomy at the age of 47, had bilateral adnexectomy. 83.33% of tumors were unilateral and confined to the ovary, with capsule rupture during surgery in one case. One tumor had spread to the peritoneal cavity.
For the case of JGCT, it was diagnosed at the age of 19. The patient did not have signs of hyperestrogenia and her pubertal development was normal. Pelvic ultrasound allowed objectifying a heterogeneous pelvic mass. The patient underwent emergency laparotomy because of severe acute pelvic pain. The diagnosis was a tumor confined to the right ovary, complicated by adnexal torsion. The histopathological examination with an immunohistochemistry study confirmed the diagnosis of JGCT. A unilateral adnexectomy was then performed.
Conclusion: A long natural history and recurrency are the main evolutionary characteristics of GCT. In order to optimize treatments and disease management, it is important to undergo an appropriate surgical staging and to assess the recurrence risk. Actually, prospective multi-center randomized studies are still needed to evaluate the effectiveness of other therapeutic options.
Belghith C, Ksontini M, Armi S, Abdeljabbar A, Bouzidi S, Chaouechi A, et al. Granulosa Cell Tumor of the Ovary: A Study of Six Cases. Clin Oncol. 2021;6:1828..