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Tokui H, Yahata H, Okabe Y, Magarifuchi N, Maenohara S, Hachisuga K, Tomonobe H, Kodama K, Yagi H, Yasunaga M, Onoyama I, Asanoma K, Oda Y, Nakamura M, Kato K. Complete reduction surgery of a huge recurrent adult granulosa cell tumor after neoadjuvant chemotherapy. Int Cancer Conf J 2024; 13:162-166. [PMID: 38524644 PMCID: PMC10957856 DOI: 10.1007/s13691-024-00659-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/10/2024] [Indexed: 03/26/2024] Open
Abstract
Adult granulosa cell tumors are rare, accounting for only 3-5% of all ovarian tumors. Adult granulosa cell tumors have late recurrences, for which complete resection is an effective option. We report a patient who underwent complete resection of a huge recurrent adult granulosa cell tumor after neoadjuvant chemotherapy. A 72-year-old woman underwent primary surgery for an adult granulosa cell tumor 19 years earlier. A huge recurrent tumor, 11 × 10 cm in size, was noted to elevate the hepatic hilum, inferior vena cava, and right renal vein. The recurrent tumor was too large to resect, thus paclitaxel and carboplatin were administered as neoadjuvant chemotherapy. The tumor shrank to 6 × 5 cm after 6 cycles of chemotherapy, then complete tumor extirpation with resection of the right kidney and temporary scission of inferior vena cava was performed. The patient was alive and well without evidence of a recurrence 1 y postoperatively. Paclitaxel and carboplatin, as neoadjuvant chemotherapy, might be an effective treatment option to achieve complete reduction surgery. This is the first report demonstrating the effectiveness of paclitaxel and carboplatin for huge recurrent adult granulosa cell tumor.
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Affiliation(s)
- Hiroha Tokui
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582 Japan
| | - Hideaki Yahata
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582 Japan
| | - Yasuhiro Okabe
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Naomi Magarifuchi
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shoji Maenohara
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582 Japan
| | - Kazuhisa Hachisuga
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582 Japan
| | - Hiroshi Tomonobe
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582 Japan
| | - Keisuke Kodama
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582 Japan
| | - Hiroshi Yagi
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582 Japan
| | - Masafumi Yasunaga
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582 Japan
| | - Ichiro Onoyama
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582 Japan
| | - Kazuo Asanoma
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582 Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kiyoko Kato
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582 Japan
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Tokalioglu AA, Oktar O, Sahin M, Ozturk C, Erdogan O, Yildirim HEK, Ucar Y, Kilic F, Ersak B, Yalcin N, Ozmen F, Alci A, Bas S, Gorgulu G, Selcuk I, Ucar G, Kocak O, Cakir C, Kilic C, Comert GK, Ureyen I, Toptas T, Narin MA, Tasci T, Taskin S, Boran N, Ozdal B, Sanci M, Uncu D, Korkmaz V, Tekin OM, Ustun Y, Ortac F, Turan T. Defining the relationship between ovarian adult granulosa cell tumors and synchronous endometrial pathology: Does ovarian tumor size correlate with endometrial cancer? J Obstet Gynaecol Res 2024; 50:655-662. [PMID: 38304973 DOI: 10.1111/jog.15896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 01/17/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVE The main feature of adult granulosa cell tumors (AGCT) is their capacity to secrete hormones, with nearly all of them capable of synthesizing oestradiol. The primary goal of this study is to identify synchronized endometrial pathologies, particularly endometrial cancer, in AGCT patients who had undergone a hysterectomy. MATERIALS AND METHODS The study cohort comprised retrospectively of 316 AGCT patients from 10 tertiary gynecological oncology centers. AGCT surgery consisted of bilateral salpingo-oophorectomy, hysterectomy, peritoneal cytology, omentectomy, and the excision of any suspicious lesion. The median tumor size value was used to define the relationship between tumor size and endometrial cancer. The relationship between each value and endometrial cancer was evaluated. RESULTS Endometrial intraepithelial neoplasia, or hyperplasia with complex atypia, was detected in 7.3% of patients, and endometrial cancer in 3.1% of patients. Age, menopausal status, tumor size, International Federation of Gynecology and Obstetrics stage, ascites, and CA-125 level were not statistically significant factors to predict endometrial cancer. There was no endometrial cancer under the age of 40, and 97.8% of women diagnosed with endometrial hyperplasia were over the age of 40. During the menopausal period, the endometrial cancer risk was 4.5%. Developing endometrial cancer increased to 12.1% from 3.2% when the size of the tumor was >150 mm in menopausal patients (p = 0.036). CONCLUSION Endometrial hyperplasia, or cancer, occurs in approximately 30% of AGCT patients. Patients diagnosed with AGCT, especially those older than 40 years, should be evaluated for endometrial pathologies. There may be a relationship between tumor size and endometrial cancer, especially in menopausal patients.
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Affiliation(s)
- Abdurrahman Alp Tokalioglu
- Department of Gynecologic Oncology, Ankara Bilkent City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Okan Oktar
- Department of Gynecologic Oncology, Ankara Etlik City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Mustafa Sahin
- Department of Gynecologic Oncology, Ankara Bilkent City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Cagatayhan Ozturk
- Department of Gynecologic Oncology, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Ozgur Erdogan
- Department of Gynecologic Oncology, Tepecik Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Izmir, Turkey
| | - Hande Esra Koca Yildirim
- Department of Gynecologic Oncology, Ankara Etlik City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Yesim Ucar
- Department of Gynecologic Oncology, Ankara Bilkent City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Fatih Kilic
- Department of Gynecologic Oncology, Ankara Bilkent City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Burak Ersak
- Department of Gynecologic Oncology, Ankara Etlik City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Necim Yalcin
- Department of Gynecologic Oncology, Antalya Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Antalya, Turkey
| | - Fatma Ozmen
- Department of Gynecologic Oncology, Adana City Hospital, Faculty of Medicine, University of Health Sciences, Adana, Turkey
| | - Aysun Alci
- Department of Gynecologic Oncology, Antalya Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Antalya, Turkey
| | - Sevda Bas
- Department of Gynecologic Oncology, Adana City Hospital, Faculty of Medicine, University of Health Sciences, Adana, Turkey
| | - Goksen Gorgulu
- Department of Gynecologic Oncology, Tepecik Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Izmir, Turkey
| | - Ilker Selcuk
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Gokhan Ucar
- Department of Medical Oncology, Ankara Bilkent City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Ozgur Kocak
- Department of Gynecologic Oncology, Hitit University, Faculty of Medicine, Corum, Turkey
| | - Caner Cakir
- Department of Gynecologic Oncology, Ankara Etlik City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Cigdem Kilic
- Department of Gynecologic Oncology, Hitit University, Faculty of Medicine, Corum, Turkey
| | - Gunsu Kimyon Comert
- Department of Gynecologic Oncology, Ankara Bilkent City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Isin Ureyen
- Department of Gynecologic Oncology, Antalya Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Antalya, Turkey
| | - Tayfun Toptas
- Department of Gynecologic Oncology, Antalya Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Antalya, Turkey
| | - Mehmet Ali Narin
- Department of Gynecologic Oncology, Adana City Hospital, Faculty of Medicine, University of Health Sciences, Adana, Turkey
| | - Tolga Tasci
- Department of Gynecologic Oncology, Bahcesehir University, Faculty of Medicine, Istanbul, Turkey
| | - Salih Taskin
- Department of Gynecologic Oncology, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Nurettin Boran
- Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Bulent Ozdal
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Muzaffer Sanci
- Department of Gynecologic Oncology, Tepecik Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Izmir, Turkey
| | - Dogan Uncu
- Department of Medical Oncology, Ankara Bilkent City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Vakkas Korkmaz
- Department of Gynecologic Oncology, Ankara Etlik City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Ozlem Moraloglu Tekin
- Department of Obstetrics and Gynecology, Ankara City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Yaprak Ustun
- Department of Obstetrics and Gynecology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Fırat Ortac
- Department of Gynecologic Oncology, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Taner Turan
- Department of Gynecologic Oncology, Ankara Bilkent City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
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Yu SY, Luan Y, Xu PC, Zhang Y, Dong R, Abazarikia A, Kim SY. Metabolic characteristics of granulosa cell tumor: role of PPARγ signaling†. Biol Reprod 2024; 110:509-520. [PMID: 38123510 PMCID: PMC10941086 DOI: 10.1093/biolre/ioad173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/27/2023] [Accepted: 12/18/2023] [Indexed: 12/23/2023] Open
Abstract
Granulosa cell tumors are relatively rare, posing challenges for comprehension and therapeutic development due to limited cases and preclinical models. Metabolic reprogramming, a hallmark of cancer, manifests in granulosa cell tumors with notable lipid accumulation and increased expression of peroxisome proliferator-activated receptor gamma (PPARγ), a key lipid metabolism regulator. The roles of these features, however, remain unclear. In our previous work, we established a granulosa cell tumor model in mice by introducing a constitutively active Pik3ca mutant in oocytes, enabling the study of predictable tumor patterns from postnatal day 50. In this study, we characterized metabolic alterations during tumorigenesis (postnatal day 8 to day 50) and tumor growth (day 50 to day 65) in this model and explored the impact of PPARγ antagonism on human granulosa cell tumor proliferation. The tumor exhibited significant lipid accumulation, with PPARγ and the proliferation marker Ki67 co-localizing at postnatal day 65. Transcriptome analysis demonstrates that pathways for lipid metabolism and mitochondrial oxidation are promoted during tumorigenesis and tumor growth, respectively. Overlappingly upregulated genes during tumorigenesis and tumor growth are associated with lipid metabolism pathways. Correspondingly, mouse granulosa cell tumor shows overexpression of peroxisome proliferator-activated receptor gamma and DGAT2 proteins at postnatal day 65. Furthermore, GW9662 reduces the proliferation of KGN human granulosa cell tumor cells and decreases the phosphorylation of AKT and SMAD3. Our findings identify metabolic abnormalities in ooPIK3CA* granulosa cell tumor model and suggest peroxisome proliferator-activated receptor gamma as a potential driver for primary granulosa cell tumor growth.
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Affiliation(s)
- Seok-Yeong Yu
- Department of Obstetrics and Gynecology, Olson Center for Women’s Health, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Yi Luan
- Department of Obstetrics and Gynecology, Olson Center for Women’s Health, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Pauline C Xu
- Department of Obstetrics and Gynecology, Olson Center for Women’s Health, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Yaqi Zhang
- Division of Reproductive Science in Medicine, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Rosemary Dong
- Department of Obstetrics and Gynecology, Olson Center for Women’s Health, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Amirhossein Abazarikia
- Department of Obstetrics and Gynecology, Olson Center for Women’s Health, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - So-Youn Kim
- Department of Obstetrics and Gynecology, Olson Center for Women’s Health, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
- Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, 985860 Nebraska Med Center, Omaha, NE, 68198, USA
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Zhang Y, Zhang Z, Ding X, Zhang K, Dai Y, Cheng W, Luo C. Identification of prognostic factors and construction of nomogram to predict cancer-specific survival for patients with ovarian granulosa cell tumors. Cancer Rep (Hoboken) 2024; 7:e2046. [PMID: 38507268 PMCID: PMC10953832 DOI: 10.1002/cnr2.2046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 02/26/2024] [Accepted: 03/05/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Ovarian granulosa cell tumors (OGCTs) feature low incidence, indolent growth and late recurrence. Treatment for recurrent OGCTs is challenging. METHODS The present study was designed to explore the prognostic factors and establish a nomogram to predict cancer-specific survival (CSS) for OGCTs patients. Enrolled in the study were 1459 eligible patients in the Surveillance, Epidemiology, and End Results (SEER) database, who were randomized to the training (n = 1021) or testing set (n = 438) at a ratio of 7:3. Univariate and multivariate Cox regression analyses were employed to screen the prognostic factors. The predictors were determined by using the Least absolute shrinkage and selection operator (LASSO) regression analysis. The model was constructed via the Cox proportional hazards risk regression analysis. The performance and clinical value of the nomograms was assessed with C-index, calibration plots, and decision curve analysis. RESULTS Age, pTNM stage, tumor size, surgery of the primary tumor, surgery of regional lymph nodes (LNs), residual disease after surgery, and chemotherapy were considered as significant predictive factors for CSS in OGCTs patients. After screening, the prognostic factors except surgery of regional LNs and chemotherapy were employed to build the nomogram. With desirable discrimination and calibration, the nomogram was more powerful in predicting CSS than the American Joint Committee on Cancer staging system in clinical use. CONCLUSION This novel prognostic nomogram, which comprises a stationary nomogram and a web-based calculator, offers convenience for clinicians in personalized decision-making including optimal treatment plans and prognosis assessments for OGCTs patients.
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Affiliation(s)
- Yue Zhang
- Department of GynecologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Zhen Zhang
- Department of GynecologySuqian First HospitalSuqianChina
| | - Xinyao Ding
- Department of GynecologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Keyi Zhang
- Department of GynecologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Youren Dai
- Department of GynecologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Wenjun Cheng
- Department of GynecologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Chengyan Luo
- Department of GynecologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
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Liu Y, Chen J, Lu Z, Chang X, Wang P, Ma H, Chen X, Mo S, Lv Z, Mao X, Zong L, Yu S, Chen J. Clinicopathological analysis of patients with molecularly confirmed stage I adult granulosa cell tumors and prediction of recurrence. Gynecol Oncol 2023; 176:106-114. [PMID: 37481922 DOI: 10.1016/j.ygyno.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/06/2023] [Accepted: 07/11/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVE Adult granulosa cell tumors (AGCTs) are rare malignancies that accounts for approximately 1% of ovarian neoplasms. As there are currently no well-recognized models for predicting relapse-free survival (RFS), we performed a clinicopathological analysis to identify risk factors for AGCT recurrence. METHODS We investigated 130 patients with pathologically diagnosed AGCT as confirmed by the presence of the characteristic FOXL2 C402G mutation. RESULTS Most patients had International Federation of Gynecology and Obstetrics stage I disease (n = 122, 95.3%). The 10-year RFS rate was 31.4% (22/70) and mean 10-year RFS was 74.4 (95% CI, 65.2-83.7) months. Ten patients experienced recurrence beyond the 10-year follow-up period. Undergoing fertility sparing surgery, an estrogen receptor-α (ERα) score (>0.25), and a Ki-67 index >15% were independent risk factors for recurrence in patients with stage I disease (bias-corrected C-index: 0.776). We constructed a nomogram with well-fitting calibration plots; the areas under the curve (AUCs) for 5-, and 10-year RFS prediction were 0.883 and 0.906 respectively. A simplified model with 3 predictive factors (ERα score, Ki-67 index, and primary surgical procedure) and 2 risk stratification subgroups (low- and high-risk) was constructed; its AUCs for 5-, and 10-year RFS prediction were 0.825 and 0.850 respectively. Kaplan-Meier survival curves showed significant differences in 10-year RFS between the low- and high-risk groups (p < 0.001). CONCLUSIONS The type of primary surgical procedure, ERα score, and Ki-67 index are independent predictors of recurrence for patients with stage I AGCT. Our predictive model based on these factors showed good performance.
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Affiliation(s)
- Yilin Liu
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jingci Chen
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Zhaohui Lu
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xiaoyan Chang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Pengyan Wang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Heng Ma
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xianlong Chen
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Shengwei Mo
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Zhuoyao Lv
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xinxin Mao
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Liju Zong
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Shuangni Yu
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
| | - Jie Chen
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
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Jung D, Almstedt K, Battista MJ, Seeger A, Jäkel J, Brenner W, Hasenburg A. Immunohistochemical markers of prognosis in adult granulosa cell tumors of the ovary - a review. J Ovarian Res 2023; 16:50. [PMID: 36869369 PMCID: PMC9983179 DOI: 10.1186/s13048-023-01125-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 02/23/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Granulosa cell tumors (GCT) are rare malignant ovarian tumors. The two subtypes, adult and juvenile granulosa cell tumors, differ in clinical and molecular characteristics. GCT are low-malignant tumors and are generally associated with favorable prognosis. However, relapses are common even years and decades after diagnosis. Prognostic and predictive factors are difficult to assess in this rare tumor entity. The purpose of this review is to provide a comprehensive overview of the current state of knowledge on prognostic markers of GCT to identify patients with a high risk of recurrence. METHODS Systematic research for adult ovarian granulosa cell tumors and prognosis revealed n = 409 English full text results from 1965 to 2021. Of these articles, n = 35 were considered for this review after title and abstract screening and topic-specific matching. A specific search for pathologic markers with prognostic relevance for GCT identified n = 19 articles that were added to this review. RESULTS FOXL2 mutation and FOXL2 mRNA were inverse and immunohistochemical (IHC) expression of CD56, GATA-4 and SMAD3 was associated with reduced prognosis. IHC analysis of estrogen receptor, Anti-Mullerian hormone (AMH) and inhibin was not associated with prognosis for GCT. Analyses of mitotic rate, Ki-67, p53, β-catenin and HER2 revealed inconsistent results.
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Affiliation(s)
- Dennis Jung
- Department of Gynecology and Obstetrics, University Mainz, Langenbeckstr. 1, Mainz, 55131, Germany.
| | - Katrin Almstedt
- Department of Gynecology and Obstetrics, University Mainz, Langenbeckstr. 1, Mainz, 55131, Germany
| | - Marco J Battista
- Department of Gynecology and Obstetrics, University Mainz, Langenbeckstr. 1, Mainz, 55131, Germany
| | - Alexander Seeger
- Department of Gynecology and Obstetrics, University Mainz, Langenbeckstr. 1, Mainz, 55131, Germany
| | - Jörg Jäkel
- Department of Pathology, University Mainz, Langenbeckstr. 1, Mainz, 55131, Germany
| | - Walburgis Brenner
- Department of Gynecology and Obstetrics, University Mainz, Langenbeckstr. 1, Mainz, 55131, Germany
| | - Annette Hasenburg
- Department of Gynecology and Obstetrics, University Mainz, Langenbeckstr. 1, Mainz, 55131, Germany
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Fischer AK, Schömig-Markiefka B, Heydt C, Ratiu D, Mallmann P, Meinel J, Büttner R, Schmidt D, Quaas A. Incidental FOXL2 mutated adult granulosa cell tumour of the ovary with thecoma-like foci. Virchows Arch 2022:10.1007/s00428-022-03452-y. [DOI: 10.1007/s00428-022-03452-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/25/2022] [Accepted: 11/02/2022] [Indexed: 11/19/2022]
Abstract
Abstract
We report on the incidental finding of a FOXL2 mutated adult granulosa cell tumour of the ovary with thecoma-like foci, a rare entity recently described by Jennifer N. Stall and Robert H. Young in a series of sixteen cases in 2019, displaying features differing from conventional adult granulosa cell tumour. Our aim is to specify the morphologic and molecular particularities of this presumably underrecognized finding, with a short presentation of the typical clinical context. Awareness of this rare and challenging neoplasm with indeterminate clinical course is crucial in routine diagnostics.
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Alhusaini H, Elshenawy MA, Badran A, Elshentenawy A, Mohieldin A, Mostafa Gad A, Omar A, Shaheen A, Elhassan T, Soudy H. Adult-Type Ovarian Granulosa Cell Tumour: Treatment Outcomes From a Single-Institution Experience. Cureus 2022; 14:e31045. [DOI: 10.7759/cureus.31045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2022] [Indexed: 11/07/2022] Open
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9
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Zhuang Y, Zhang S, Liu Y, Yang H. Can adjuvant chemotherapy improve the prognosis of adult ovarian granulosa cell tumors?: A narrative review. Medicine (Baltimore) 2022; 101:e29062. [PMID: 35356927 PMCID: PMC10513366 DOI: 10.1097/md.0000000000029062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 02/24/2022] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Adult granulosa cell tumors (aGCTs) are rare ovarian neoplasms with a relatively favorable prognosis. They follow an indolent course, characterized by a prolonged natural history and a tendency to late recurrences, Around a quarter of patients develop recurrence and More than 70% of women with recurrence die from their disease, The percentage of patients received chemotherapy increases over time, whether adjuvant chemotherapy improve the prognosis of aGCTs is equivocal? The purpose of this review is to summarize the previously published evidence to evaluate whether adjuvant chemotherapy improve the prognosis of aGCTs to provide guidance for clinical practice. EMBASE, PubMed, Web of Science, WanFang Data and Chinese National Knowledge Infrastructure are searched up to December 2020, used the search strategy of ovar* and granulosa cell* and (tumor* or tumour* or malignan* or cancer* or carcinom* or neoplasm*) and chemotherapy. The screening process was conducted strictly based on inclusion and exclusion criteria. Clinical studies based on human including randomized controlled trial, quasi-randomised controlled trials, nonrandomised trials cohort study and case control study were included without restriction of time. The percentage of patients received chemotherapy increases over time, but the benefit of adjuvant chemotherapy is lack of high-grade evidence of prospective study, based on the current retrospective studies, we still do not have the evidence to confirm the survival benefit of adjuvant chemotherapy in early stage, advanced stage or recurrent aGCT with no residual tumor, but for inoperable disseminated disease or disease with suboptimal cytoreduction, adjuvant chemotherapy maybe an Optable options. Multinational prospective randomised controlled trials are urgently needed to validate the role of adjuvant chemotherapy. Further research on molecular mechanisms and developing novel targeted medicines may improve the survival of aGCTs.
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Affiliation(s)
- Yuan Zhuang
- Department of Gynecology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China,Sun Yat-sen University, Zhuhai, China
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Li J, Li J, Jiang W. Oncological Prognosis and Fertility Outcomes of Different Surgical Extents for Malignant Ovarian Sex-Cord Stromal Tumors: A Narrative Review. Cancer Manag Res 2022; 14:697-717. [PMID: 35221723 PMCID: PMC8864408 DOI: 10.2147/cmar.s350457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/28/2022] [Indexed: 12/22/2022] Open
Abstract
Background Malignant ovarian sex-cord stromal tumors (MOSCSTs) are rare neoplasms that account for approximately 5–7% of all ovarian malignancies. The majority (70%) of patients had an early stage; thus, surgery is the predominant treatment. Patients were relatively young at the onset of the tumor. Moreover, the prognosis of patients with this tumor is better than that of malignant epithelial ovarian tumors and tends to recur late with an indolent clinical course. Thus, patients may be more inclined to conservative surgical procedures. There is, however, no objective criterion for selecting a suitable surgical procedure. Clinically, surgical extent depended on the preoperative evaluations, age, and willingness of patients, and gynecologists were relatively subjective when choosing surgery. The prognosis of patients with different surgical extents is still controversial. The review aimed to summarize the impacts of different surgical extents on oncological prognosis and fertility outcomes. Methods The literature search was performed in PubMed (https://www.ncbi.nlm.nih.gov/pubmed/), and publications between January 2011 and December 2021 in English including clinical cohort studies and case reports were eligible for inclusion. Results We finally identified 12 large-sample retrospective studies and 18 cases of MOSCSTs. The primary surgical procedures include fertility-spring surgery (FSS), total hysterectomy with unilateral or bilateral salpingo-oophorectomy (TAH-USO/BSO), FSS with complete staging procedure, complete staging surgery (CSS), and debulking surgery. FSS includes cystectomy (CYS), unilateral salpingo-oophorectomy (USO) or bilateral salpingo-oophorectomy (BSO) with uterine preservation that allows for potential future assisted reproductive approaches. Complete staging procedure includes peritoneal cytologic examinations, inspections of peritoneal surfaces, random peritoneal biopsies and omentectomy. FSS with complete staging procedure means surgical procedure with uterine preservation and complete staging procedure. And, generally, CSS means TAH-BSO with complete staging procedure. Conclusion It can be concluded that USO can be done in young, fertility-desired patients with tumors confined to the ovary but avoid CYS. FSS with complete staging procedure is feasible among stage IC-III patients who have fertility desire. Patients can choose to have a complete surgery once their family is complete or without fertility requirements. CSS is recommended for patients with risk factors such as high stage, poor differentiation, and large tumor size and without fertility desire. A close follow-up is essential.
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Affiliation(s)
- Jiawei Li
- Department of Gynecologic Oncology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Jun Li
- Department of Gynecologic Oncology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Wei Jiang
- Department of Gynecologic Oncology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, People’s Republic of China
- Correspondence: Wei Jiang, Department of Gynecologic Oncology, Obstetrics and Gynecology Hospital, Fudan University, No. 419, Fangxie Road, Shanghai, 200011, People’s Republic of China, Tel +86 13916922627, Email
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11
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Ohta M, Hara Y, Kashiwadate T, Chin M, Hagiwara M, Nakanishi W, Ito K, Nishida A, Hashizume E. Recurrence of Adult Granulosa Cell Tumor in the Greater Omentum 11 Years after Surgery. Case Rep Gastroenterol 2021; 15:639-644. [PMID: 34616269 PMCID: PMC8454241 DOI: 10.1159/000515412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 02/19/2021] [Indexed: 11/19/2022] Open
Abstract
Adult-type ovarian granulosa cell tumors (AGCTs) are very rare tumors that account for <5% of all ovarian carcinomas. AGCTs have low malignancy potential and rarely metastasize 5-30 years after the initial diagnosis. Because time has passed from the first surgery and because recurrence develops in various locations, the differential diagnosis is difficult. In particular, tumors developing in the greater omentum are encountered rarely, and it is necessary to carefully consider the differential diagnosis, including primary and secondary neoplasms. Although CT is useful to detect omental tumors, the diagnosis requires invasive procedures. We report a case of AGCT recurrence in the greater omentum that was resected during laparoscopic cholecystectomy. A patient visited our hospital with right-sided abdominal pain. The CT revealed gallbladder stones, a ureteral stone, and a right abdominal mass. The diagnosis of the abdominal tumor was difficult on the basis of blood biochemical testing, gastrointestinal endoscopy, or image inspection. Although the patient underwent several previous surgeries and there were no findings of malignancy with positron emission tomography, we chose to resect the tumor for combined diagnosis and treatment during laparoscopic cholecystectomy. Intraoperative findings showed that the tumor originated from the greater omentum, and the tumor was diagnosed as AGCT recurrence by pathology. A recurrence of AGCT in the greater omentum is very rare, and laparoscopic surgery was safe and useful for resection, in our case.
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Affiliation(s)
- Mineto Ohta
- Department of Surgery, Nihonkai General Hospital, Yamagata, Japan.,Department of Gastroenterological Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Yasuyuki Hara
- Department of Surgery, Nihonkai General Hospital, Yamagata, Japan
| | - Toshiaki Kashiwadate
- Department of Surgery, Nihonkai General Hospital, Yamagata, Japan.,Department of Gastroenterological Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Masahiro Chin
- Department of Surgery, Nihonkai General Hospital, Yamagata, Japan
| | | | - Wataru Nakanishi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Ken Ito
- Department of Surgery, Nihonkai General Hospital, Yamagata, Japan
| | - Akiko Nishida
- Department of Pathology, Nihonkai General Hospital, Yamagata, Japan
| | - Eiji Hashizume
- Department of Surgery, Nihonkai General Hospital, Yamagata, Japan
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12
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Gică C, Cigăran RG, Botezatu R, Panaitescu AM, Cimpoca B, Peltecu G, Gică N. Secondary Amenorrhea and Infertility Due to an Inhibin B Producing Granulosa Cell Tumor of the Ovary. A Rare Case Report and Literature Review. ACTA ACUST UNITED AC 2021; 57:medicina57080829. [PMID: 34441035 PMCID: PMC8398809 DOI: 10.3390/medicina57080829] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/12/2021] [Accepted: 08/15/2021] [Indexed: 01/13/2023]
Abstract
Granulosa cell tumor of the ovary (GCT) is a rare ovarian tumor with nonspecific symptoms. Studies reported that GCT are usually secreting estrogens and inhibins, especially inhibin B. It is considered that, in premenopausal women, irregular menses or secondary amenorrhea may be an early symptom of GCT and, in postmenopausal women, the most common manifestation is vaginal bleeding. Additionally, endometrial abnormalities can be associated due to estrogenic secretion. At reproductive age, high levels of inhibin, lead to low levels of FSH and secondary amenorrhea causing infertility. At times, increased levels of LH in women with GCT are observed and the pathogenesis is still unclear. Therefore, inhibin B level can differentiate GCT from other causes of secondary amenorrhea. We report the case of a 26-year-old nulliparous, women who presented in our clinic with secondary infertility lasting longer than 2 years, secondary amenorrhea, polycystic ovarian syndrome, and suspicion of right ovarian endometrioma on CT scan. The ultrasound examination revealed that the right ovary was transformed in an anechoic mass with increased peripheral vascularity having a volume of 10 cm3. This patient had high serum levels of inhibin B and LH but normal levels of FSH and estradiol. The preliminary diagnosis of granulosa cell tumor of the ovary was made. After counseling, the informed consent for treatment was obtained and the patient agreed to undergo surgery. An uneventful laparoscopy was performed with right oophorectomy and multiple peritoneal sampling. The histological diagnosis confirmed adult GCT limited to right ovary, with negative peritoneal biopsies (FIGO IA). After surgery the patient recovered fully and had normal menstrual cycles with normal serum levels of hormones. Two months later she conceived spontaneously and had an uneventful pregnancy. In conclusion, for cases with secondary amenorrhea, the evaluation of inhibin B level is essential. Elevated inhibin B level may be a sign for the presence of an unsuspected tumor. With early diagnosis and treatment, the prognosis is generally good and the fertility may be preserved, especially in young patients with GCT.
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Affiliation(s)
- Corina Gică
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 71117 Bucharest, Romania; (C.G.); (R.B.); (A.M.P.); (B.C.); (G.P.); (N.G.)
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 71117 Bucharest, Romania
| | - Ruxandra-Gabriela Cigăran
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 71117 Bucharest, Romania; (C.G.); (R.B.); (A.M.P.); (B.C.); (G.P.); (N.G.)
- Correspondence: ; Tel.: +40-746308422
| | - Radu Botezatu
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 71117 Bucharest, Romania; (C.G.); (R.B.); (A.M.P.); (B.C.); (G.P.); (N.G.)
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 71117 Bucharest, Romania
| | - Anca Maria Panaitescu
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 71117 Bucharest, Romania; (C.G.); (R.B.); (A.M.P.); (B.C.); (G.P.); (N.G.)
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 71117 Bucharest, Romania
| | - Brîndușa Cimpoca
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 71117 Bucharest, Romania; (C.G.); (R.B.); (A.M.P.); (B.C.); (G.P.); (N.G.)
| | - Gheorghe Peltecu
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 71117 Bucharest, Romania; (C.G.); (R.B.); (A.M.P.); (B.C.); (G.P.); (N.G.)
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 71117 Bucharest, Romania
| | - Nicolae Gică
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 71117 Bucharest, Romania; (C.G.); (R.B.); (A.M.P.); (B.C.); (G.P.); (N.G.)
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 71117 Bucharest, Romania
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13
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Li J, Chu R, Chen Z, Meng J, Yao S, Song K, Kong B. Progress in the management of ovarian granulosa cell tumor: A review. Acta Obstet Gynecol Scand 2021; 100:1771-1778. [PMID: 34027996 DOI: 10.1111/aogs.14189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 05/14/2021] [Accepted: 05/15/2021] [Indexed: 11/29/2022]
Abstract
Ovarian granulosa cell tumor (GCT) is a rare, low-grade malignant tumor that accounts for 70% of the sex cord-stromal tumors. It has two histopathologic types with different clinical and biologic features: adult GCT and juvenile GCT. Most women diagnosed with the adult GCT have a favorable prognosis, with a 5-year survival rate of 97%-98%, but adult GCT has a feature of late relapse; the recurrence time could be more than 20 years after diagnosis. Juvenile GCT has a survival rate of 97% in stage I and a 5-year survival rate of 0%-22% in advanced stage with earlier recurrence than adult GCT. Consequently, the scenario emphasizes the need for early diagnosis, standardized treatment protocols, and long-term follow up. However, there is a lack of consensus regarding accurate diagnosis of GCT and adjuvant treatment. Furthermore, GCT tends to occur in young women, which emphasizes the viability of fertility-sparing surgery. The current review performed a systematic literature review of 60 articles to summarize the latest advances in GCT, with an emphasis on the molecular pathogenesis and survival after fertility-sparing surgery. We found that young women with fertility-sparing surgery had a desirable reproductive and survival outcome compared with those undergoing radical surgery.
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Affiliation(s)
- Junting Li
- Department of Obstetrics and Gynecology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Ran Chu
- Department of Obstetrics and Gynecology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Zhongshao Chen
- Department of Obstetrics and Gynecology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Jinyu Meng
- Department of Obstetrics and Gynecology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Shu Yao
- Department of Obstetrics and Gynecology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Kun Song
- Department of Obstetrics and Gynecology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,Gynecology Oncology Key Laboratory, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Beihua Kong
- Department of Obstetrics and Gynecology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,Gynecology Oncology Key Laboratory, Qilu Hospital, Shandong University, Jinan, Shandong, China
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14
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Abstract
OBJECTIVE The purpose of this article is to review the imaging findings and genomics of granulosa cell tumors (GCTs) in order to aid in diagnosis and management of GCTs. GCTs are the most common type of sex cord-stromal tumors of the ovary. They are usually diagnosed initially with ultrasound and are subsequently further characterized with CT and MRI. PET/CT is often ordered as well to measure the extent of disease and for follow-up, but its usefulness is in question as some GCTs lack FDG avidity. There is significant variability in imaging phenotypes of GCTs, ranging from mostly cystic to almost solid. More resources have recently been dedicated to understanding the genetics and molecular mechanisms of GCT development. Current research shows that the main cause of GCT carcinogenesis is the FOXL2 mutation, but there are several other noteworthy mutations that contribute to the pathogenesis of this disease. Certain mutations, like GATA4, are known to be associated with more aggressive disease and higher rates of recurrence. CONCLUSION Using this information, imaging protocols can be altered depending on the genotype of the tumor. Further understanding of the genetic alterations that underpin the development of GCTs is indicated as genotypic knowledge could be used to guide optimal imaging and management strategies.
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15
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Zhao D, Zhang Y, Ou Z, Zhang R, Zheng S, Li B. Characteristics and treatment results of recurrence in adult-type granulosa cell tumor of ovary. J Ovarian Res 2020; 13:19. [PMID: 32059683 PMCID: PMC7020364 DOI: 10.1186/s13048-020-00619-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 02/04/2020] [Indexed: 02/06/2023] Open
Abstract
Background The aim of this study was to explore the clinicopathological characteristics of recurrent adult-type granulosa cell tumor of the ovary (AGCOT) and evaluated the treatment results to define the prognostic parameters for survival after recurrence. Results A retrospective review of 40 patients with recurrent AGCOT, who were treated in the Cancer Hospital at the Chinese Academy of Medical Sciences from 2000 to 2015 was conducted. The impact of clinical and pathological characteristics, progression-free survival (PFS), and post-recurrence therapeutic approaches on prognosis were analyzed. Among the 40 recurrent patients, there were 10 cases where the relapse was uncontrolled, 24 cases had second relapses, and 6 cases without further relapses at the time of our follow-up. The median PFS was 61 months (range, 7-408 months), and the median time interval between the first and the second relapses (R-PFS) was 25 months (range, 0–94 months). The median time interval between the first relapse and death (R-OS) was 90 months (range, 2–216 months). PFS ≥ 61 months (P = 0.004) and post-recurrence therapeutic approach (P < 0.001) were independent risk factors for repeated recurrences. The age at recurrence (P = 0.031) and post-recurrence therapeutic approach (P = 0.001) were independent risk factors for death after recurrence. Conclusion Among patients with recurrent AGCOT, those with long PFS had good prognoses. Maximal cytoreductive effort should be made after recurrence. Complete resection and postoperative adjuvant chemotherapy may improve the prognosis of patients with recurrent AGCOT.
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Affiliation(s)
- Dan Zhao
- Department of Gynecology Oncology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17, South Panjiayuan Residential, Chaoyang District, Beijing, 100021, China
| | - Yanan Zhang
- Department of Gynecology Oncology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17, South Panjiayuan Residential, Chaoyang District, Beijing, 100021, China
| | - Zhengjie Ou
- Department of Gynecology Oncology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17, South Panjiayuan Residential, Chaoyang District, Beijing, 100021, China
| | - Rong Zhang
- Department of Gynecology Oncology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17, South Panjiayuan Residential, Chaoyang District, Beijing, 100021, China
| | - Shan Zheng
- Department of Pathology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17, South Panjiayuan Residential, Chaoyang District, Beijing, 100021, China.
| | - Bin Li
- Department of Gynecology Oncology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17, South Panjiayuan Residential, Chaoyang District, Beijing, 100021, China.
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16
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Erkılınç S, Taylan E, Karataşlı V, Uzaldı İ, Karadeniz T, Gökçü M, Sancı M. Does lymphadenectomy effect postoperative surgical morbidity and survival in patients with adult granulosa cell tumor of ovary? J Obstet Gynaecol Res 2019; 45:1019-1025. [PMID: 30761709 DOI: 10.1111/jog.13928] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 01/03/2019] [Indexed: 11/30/2022]
Abstract
AIM To evaluate the effect of lymphadenectomy on surgical morbidity and survival in adult granulosa cell tumor (AGCT) of the ovary. METHODS Patients who underwent surgical treatment for AGCT between January 1993 and January 2016 were identified. Data were collected for patient age, menopausal status, surgical staging, lymphadenectomy, postoperative complications (anemia, wound infection, incisional hernia), length of hospital stay, follow-up duration, site and time for recurrence, management of recurrence and vital status. Histopathological records were also evaluated for number of cellular mitosis. RESULTS Lymphadenectomy (pelvic-paraaortic) was performed in 53 (53%) of 98 patients. Decrease in postoperative hemoglobin level and increased wound infection and longer hospital stay were significantly higher in lymphadenectomy group (P = 0.003, 0.043 and <0.001, respectively). Tumor stage (HR 95% CI 14.9 [2.43-92.8]) and number of mitoses >5 (HR 95% CI 14.9 [2.43-92.8]) were significantly associated with recurrence (P = <0.001 and 0.02, respectively). Tumor stage was the only prognostic factor for predicting overall survival (HR 95% CI 8.47 [2.17-33.2]). Lymphadenectomy showed no effect on disease-free survival and overall survival both in multivariate Cox regression analyses (P = 0.46 and 0.69, respectively). Disease-free survival and overall survival were similar in lymphadenectomy and no lymphadenectomy groups (Log Rank P = 0.382, 0.741, respectively). CONCLUSION Lymphadenectomy had no improved effect on survival and had negative effect on surgical morbidity in patients with AGCT.
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Affiliation(s)
- Selçuk Erkılınç
- Division of Gynecologic Oncology, University of Medical Sciences Tepecik Education and Research Hospital, Izmir, Turkey
| | - Enes Taylan
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Volkan Karataşlı
- Division of Gynecologic Oncology, University of Medical Sciences Tepecik Education and Research Hospital, Izmir, Turkey
| | - İpek Uzaldı
- Division of Gynecologic Oncology, University of Medical Sciences Tepecik Education and Research Hospital, Izmir, Turkey
| | - Tuğba Karadeniz
- Division of Pathology, University of Medical Sciences Tepecik Education and Research Hospital, Izmir, Turkey
| | - Mehmet Gökçü
- Division of Gynecologic Oncology, University of Medical Sciences Tepecik Education and Research Hospital, Izmir, Turkey
| | - Muzaffer Sancı
- Division of Gynecologic Oncology, University of Medical Sciences Tepecik Education and Research Hospital, Izmir, Turkey
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17
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Fayek IS, Amira G, Habashy NF, Attia MAAE. A Retrospective Study of Ovarian Sex Cord Stromal Tumors at the Egyptian National Cancer Institute. JOURNAL OF CANCER THERAPY 2019; 10:920-937. [DOI: 10.4236/jct.2019.1012079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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18
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Huo Z, Guo LN, Shi XH, Liang ZY, Wang JH, Liu XG, Lu T, Pang JY. A Clinicopathological Study on Stage I Ovarian Adult Granulosa Cell Tumors with Recurrence within 5 Years. Chin Med J (Engl) 2018; 131:2877-2879. [PMID: 30511696 PMCID: PMC6278191 DOI: 10.4103/0366-6999.246066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Zhen Huo
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Li-Na Guo
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xiao-Hua Shi
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Zhi-Yong Liang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jin-Hui Wang
- Department of Obstetrics and Gynaecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xu-Guang Liu
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Tao Lu
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jun-Yi Pang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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19
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Ghalleb M, Bouzaiene H, Sghaier S, Bouaziz H, Hechiche M, Hassouna JB, Rahal K. Fertility sparing surgery for ovarian sex cord stromal tumors: a nine case series. Pan Afr Med J 2018; 31:221. [PMID: 31447979 PMCID: PMC6691291 DOI: 10.11604/pamj.2018.31.221.15531] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 07/01/2018] [Indexed: 12/23/2022] Open
Abstract
Ovarian Sex Cord Stromal Tumors (SCST) are a rare disease carrying a good prognosis. They generally affect young women; therefore fertility preservation is a critical issue. Fertility Sparing Surgery (FSS) showed promising results in both oncologic safety and fertility preservation. A retrospective case series involving 9 patients diagnosed with SCST and treated with fertility sparing surgery at our institution was conducted between January 2000 and May 2015. The median age was 24 years old (10 to 39). The main clinical manifestation was pelvic pain seen in seven patients. Five patients complained about menstrual cycle disorders. The nine patients went through fertility sparing surgery; seven had conservative staging and the other two had a unilateral salpingo-oophorectomy. Three patients out of nine had a pelvic unilateral lymphadenectomy. Two patients received adjuvant chemotherapy. Only two patients presented locoregional recurrence that occurred respectively after 7 and 192 months. The treatment combined chemotherapy and surgery based on mass resection. One patient achieved a natural pregnancy after the treatment. FSS seems to be a suitable approach for SCST. However, more case series and meta-analysis should be conducted.
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Affiliation(s)
- Montassar Ghalleb
- Surgical Oncology Department, Institut Salah Azaiez de Cancérologie, Tunis, Tunisie.,Faculté de Médicine Tunis El Manar, Tunis, Tunisia
| | - Hatem Bouzaiene
- Surgical Oncology Department, Institut Salah Azaiez de Cancérologie, Tunis, Tunisie.,Faculté de Médicine Tunis El Manar, Tunis, Tunisia
| | - Sarah Sghaier
- Surgical Oncology Department, Institut Salah Azaiez de Cancérologie, Tunis, Tunisie.,Faculté de Médicine Tunis El Manar, Tunis, Tunisia
| | - Hanen Bouaziz
- Surgical Oncology Department, Institut Salah Azaiez de Cancérologie, Tunis, Tunisie.,Faculté de Médicine Tunis El Manar, Tunis, Tunisia
| | - Monia Hechiche
- Surgical Oncology Department, Institut Salah Azaiez de Cancérologie, Tunis, Tunisie.,Faculté de Médicine Tunis El Manar, Tunis, Tunisia
| | - Jamel Ben Hassouna
- Surgical Oncology Department, Institut Salah Azaiez de Cancérologie, Tunis, Tunisie.,Faculté de Médicine Tunis El Manar, Tunis, Tunisia
| | - Khaled Rahal
- Surgical Oncology Department, Institut Salah Azaiez de Cancérologie, Tunis, Tunisie.,Faculté de Médicine Tunis El Manar, Tunis, Tunisia
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20
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Wang D, Cao D, Jia C, Huang H, Yang J, Wu M, Pan L, Shen K, Xiang Y. Analysis of oncologic and reproductive outcomes after fertility-sparing surgery in apparent stage I adult ovarian granulosa cell tumors. Gynecol Oncol 2018; 151:275-281. [DOI: 10.1016/j.ygyno.2018.09.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 08/30/2018] [Accepted: 09/04/2018] [Indexed: 10/28/2022]
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21
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Adult Granulosa Cell Tumors of the Ovary: A Retrospective Study of 36 FIGO Stage I Cases with Emphasis on Prognostic Pathohistological Features. Anal Cell Pathol (Amst) 2018; 2018:9148124. [PMID: 30186737 PMCID: PMC6116457 DOI: 10.1155/2018/9148124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 07/31/2018] [Indexed: 11/18/2022] Open
Abstract
Objective Adult granulosa cell tumors (AGCTs) represent 2%-5% of all ovarian malignancies. The aim of this study was to analyze clinical and pathohistological parameters and their impact on recurrence, overall, and disease-free survival in FIGO stage I AGCT patients. Methods The tumor specimens analyzed in this retrospective study were obtained from a total of 36 patients with diagnosis of ovarian AGCT surgically treated at the Department of Gynecology, Rijeka University Hospital Centre, between 1994 and 2012. Clinical, pathological, and follow-up data were collected. Results The mean age at diagnosis was 54.5 years with a range of 24-84. The majority of the patients, 30 (83%), were in FIGO stage IA, 3 (8%) in stage IC1, 1 (3%) in stage IC2, and 2 (6%) in stage IC3. During follow-up period (median 117.5 months, range 26-276), recurrence occurred in 4 patients (12%) with 2 deaths of the disease recorded. In univariate analysis, the 5-year survival rates were significantly shorter in patients with FIGO substage IC (p = 0.019), with positive LVSI (p = 0.022), with presence of necrosis (p = 0.040), and with hemorrhage (p = 0.017). In univariate analysis, the 5-year disease-free survival rates were significantly shorter in patients treated with fertility surgery (p = 0.004), with diffuse growth pattern (p = 0.012), with moderate and severe nuclear atypia (p = 0.032), and with presence of hemorrhage (p = 0.022). FIGO substage IC proved to be independent predictor for recurrence (OR = 16.87, p = 0.015, and OR = 23.49, p = 0.023, resp.) and disease-free survival (p = 0.0002; HR 20.84, p = 0.02) at the uni- and multivariate analyses. Conclusions FIGO substage IC is predictive of recurrence and disease-free survival in patients with early-stage AGCTs. LVSI, presence of necrosis and hemorrhage, diffuse growth pattern, and nuclear atypia in AGCTs seem to be associated with overall and disease-free survival, so these pathological features should be taken into consideration when managing patients with AGCT.
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Granulosa Cell Tumor of the Ovary: A Retrospective Study of 31 Cases and a Review of the Literature. Int J Surg Oncol 2018; 2018:4547892. [PMID: 29796312 PMCID: PMC5896205 DOI: 10.1155/2018/4547892] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 06/18/2017] [Accepted: 09/13/2017] [Indexed: 12/11/2022] Open
Abstract
Background Adult granulosa cell tumors (AGCTs) are the most common sex cord-stromal tumors. Unlike epithelial ovarian tumors, they occur in young women and are usually detected at an early stage. The aim of this study was to report the clinical and pathological characteristics of AGCT patients and to identify the prognostic factors. Methods All cases of AGCTs, treated at Salah Azaïz Institute between 1995 and 2010, were retrospectively included. Kaplan-Meier's statistical method was used to assess the relapse-free survival and the overall survival. Results The final cohort included 31 patients with AGCT. The mean age was 53 years (35–73 years). Patients mainly presented with abdominal mass and/or pain (61%, n = 19). Mean tumor size was 20 cm. The majority of patients had a stage I disease (61%, n = 19). Two among 3 patients with stage IV disease had liver metastasis. Mitotic index was low in 45% of cases (n = 14). Surgical treatment was optimal in almost all cases (90%, n = 28). The median follow-up time was 14 years (1–184 months). Ten patients relapsed (32%) with a median RFS of 8.4 years (6.8–9.9 years). Mean overall survival was 13 years (11–15 years). Stage I disease and low-to-intermediate mitotic index were associated with a better prognosis in univariate analysis (resp., p = 0.05 and p = 0.02) but were not independent prognostic factors. Conclusion GCTs have a long natural history with common late relapses. Hence, long active follow-up is recommended. In Tunisian patients, hepatic metastases were more frequent than occidental series. The prognosis remains good and initial staging at diagnosis is an important prognostic factor.
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Safety of Fertility-Sparing Surgery for Premenopausal Women With Sex Cord-Stromal Tumors Confined to the Ovary. Int J Gynecol Cancer 2017; 27:1826-1832. [DOI: 10.1097/igc.0000000000001110] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectiveThe aim of this retrospective population-based study was to investigate the oncologic safety of fertility-sparing surgery (FSS) for premenopausal women with malignant sex cord-stromal tumors (SCSTs) confined to the ovary.MethodsA cohort of women aged 18 to 49 years and diagnosed with a stage I malignant SCST between 1984 and 2013 was drawn from the National Cancer Institute's Surveillance, Epidemiology, and End Results database. Based on site-specific surgery codes, women who had FSS, defined as unilateral oophorectomy/tumor resection without hysterectomy, and definite surgery were identified. Cancer-specific survival and overall survival were evaluated after generation of Kaplan-Meier curves, whereas comparisons between the 2 groups were made with the log-rank test.ResultsA total of 255 women who met the inclusion criteria were identified; 161 (63.1%) underwent FSS whereas 94 (36.9%) had definitive surgery (bilateral salpingo-oophorectomy and hysterectomy). Median follow-up was 104 months. Cancer-specific survival (P= 0.015) but not overall survival (P= 0.76) was superior for women who had definite surgery.ConclusionsIn this retrospective population-based cohort of premenopausal women with SCSTs confined to the ovary, FSS was associated only with a worse long-term cancer-specific survival compared with definitive surgery. Women undergoing FSS for early stage SCSTs should be extensively counseled and closely monitored.
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Kuru O, Boyraz G, Uckan H, Erturk A, Gultekin M, Ozgul N, Salman C, Yuce K. Retroperitoneal nodal metastasis in primary adult type granulosa cell tumor of the ovary: Can routine lymphadenectomy be omitted? Eur J Obstet Gynecol Reprod Biol 2017; 219:70-73. [PMID: 29055817 DOI: 10.1016/j.ejogrb.2017.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/03/2017] [Accepted: 10/07/2017] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To investigate the incidence of retroperitoneal lymph node metastasis among patients with primary adult type granulosa cell tumor (AGCT) of the ovary. STUDY DESIGN Between January 1982 and February 2017, patients with a pathological diagnosis of AGCT were identified. Clinical and pathological data were obtained from database records. RESULTS A total of 151 patients with primary AGCT were identified with a mean age of 47.8 years (range, 17-91 years). 98 patients (64.9%) had stage IA, 24 (15.9%) had stage IC, 4 (2.6%) had stage IIB, 2 (1.3%) had stage IIIB, 6 (4.0%) had stage IIIC disease according to International Federation of Gynecology and Obstetrics (FIGO) 1988 criteria. In the remaining 17 patients (11.3%), primary stage was not detected. In 134 (88.7%) patients, pelvic and para-aortic lymphadenectomy was performed at primary staging surgery depending on the frozen section analysis or at re-staging surgery following initial diagnosis. In these patients, six (4.5%) of them had pelvic or paraaortic lymph node metastasis. The median number of lymph nodes removed was 43 (range, 10-96 lymph nodes). CONCLUSION Lymph node metastasis in initially staged AGCT is rare. Routine pelvic and paraaortic lymph node dissection may be omitted in these patients.
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Affiliation(s)
- Oguzhan Kuru
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Gokhan Boyraz
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Hasan Uckan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Anıl Erturk
- Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Murat Gultekin
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nejat Ozgul
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Coskun Salman
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Kunter Yuce
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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