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Wang Y, Wang N, Zhang X, Fu Z, Pang C, Zhang Y, Li X. Adult-type granulosa cell tumor associated with elevated luteinizing hormone: Two rare case reports. Medicine (Baltimore) 2024; 103:e37069. [PMID: 38363935 PMCID: PMC10869085 DOI: 10.1097/md.0000000000037069] [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: 06/30/2023] [Accepted: 09/08/2023] [Indexed: 02/18/2024] Open
Abstract
INTRODUCTION Adult-type granulosa cell tumors (AGCTs), which account for 2% to 5% of all malignant ovarian tumors, are rare sex cord-stromal tumors that usually secrete excess estrogens, but they can also secrete androgens. PATIENT CONCERNS We report 2 patients of childbearing age with AGCT who presented with the complaint of abnormal menstruation and elevated luteinizing hormone (LH), and mildly elevated testosterone. DIAGNOSIS The ovarian tumors had hormonal activity. INTERVENTIONS The 2 patients underwent laparoscopic left adnexectomy. The second patient underwent 4 cycles of chemotherapy with paclitaxel and carboplatin as adjuvant treatments. OUTCOMES Their postoperative pathology confirmed AGCTs. Also, their menstrual cycle returned to normal, with normal serum LH and testosterone levels. There was no sign of recurrence. CONCLUSION The cases suggest that elevated serum LH levels may be a sign of unknown tumors in cases of oligomenorrhea or secondary amenorrhea. It is useful to evaluate the serum levels of inhibin B and anti-Müllerian hormone to improve the early recognition of ovarian granulosa cell tumors.
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Affiliation(s)
- Yujing Wang
- Department of Gynecology, The First Hospital of Hebei Medical University, 050030, Shijiazhuang, China
| | - Na Wang
- Department of Gynecology, The First Hospital of Hebei Medical University, 050030, Shijiazhuang, China
| | - Xuejiao Zhang
- Department of Gynecology, The First Hospital of Hebei Medical University, 050030, Shijiazhuang, China
| | - Zijie Fu
- Department of Gynecology, The First Hospital of Hebei Medical University, 050030, Shijiazhuang, China
| | - Chao Pang
- Department of Pathology, The First Hospital of Hebei Medical University, 050030, Shijiazhuang, China
| | - Yuan Zhang
- Department of Gynecology, The Second Hospital of Hebei Medical University, 050004, Shijiazhuang, China
| | - Xiaodong Li
- Department of Gynecology, The First Hospital of Hebei Medical University, 050030, Shijiazhuang, China
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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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Fang X, Li Q. New insights into testicular granulosa cell tumors. Oncol Lett 2020; 20:293. [PMID: 33101487 PMCID: PMC7576989 DOI: 10.3892/ol.2020.12156] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/26/2020] [Indexed: 12/25/2022] Open
Abstract
Testicular granulosa cell tumors (TGCTs) are rare tumors of sex cord-stromal origin. TGCTs are mostly benign and can be classified into the adult type and the juvenile type. Due to the rarity of clinical cases and limited research efforts, the mechanism underpinning the development of TGCTs remains poorly understood. A landmark study has identified a forkhead box L2 mutation (C134W) in nearly all adult ovarian GCTs, but its implications in TGCTs are unclear. The present study focuses on reviewing the major signaling pathways (e.g., the transforming growth factor β signaling pathway) critical for the development of TGCTs, as revealed by genetically modified mouse models, with a goal of providing new insights into the pathogenesis of TGCTs and offering directions for future studies in this area. We posit that a comparative approach between testicular and ovarian GCTs is valuable, as granulosa cells and Sertoli cells arise from the same progenitor cells during gonadal development. Developing pre-clinical mouse models that recapitulate TGCTs will help answer the remaining questions around this type of rare tumor.
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Affiliation(s)
- Xin Fang
- Department of Veterinary Integrative Biosciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843, USA
| | - Qinglei Li
- Department of Veterinary Integrative Biosciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843, USA
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Ran S, Yu Q, Deng S, Xu L. Luteinizing hormone elevation in ovarian granulosa cell tumor: a case report and review of the literature. J Ovarian Res 2017; 10:30. [PMID: 28438188 PMCID: PMC5404692 DOI: 10.1186/s13048-017-0327-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 04/18/2017] [Indexed: 11/15/2022] Open
Abstract
Background Ovarian granulosa cell tumors (GCTs) are the most common type of potentially malignant ovarian sex cord-stromal tumor. GCTs often produce estrogen and/or progesterone; consequently, symptoms related to hyperestrogenism are common at diagnosis. Nonspecific symptoms or signs associated with this neoplasm include amenorrhea and changes in various sex hormone levels, which can be hard to diagnose or explain. The aims of this report were to describe a case of GCT with rare presentations and to review the pertinent literature. Case presentation A 33-year-old woman presented with secondary amenorrhea and elevated LH with normal FSH and low estradiol levels. Laparoscopy revealed an ovarian GCT, and the patient underwent left adnexectomy and platinum-based chemotherapy. Removal of the ovarian GCT resulted in the normalization of LH levels and a return to spontaneous menses. Conclusions The mechanisms responsible for elevations in serum LH due to GCTs require further investigation. However, addressing the patient’s clinical problems remains the most important treatment consideration.
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Affiliation(s)
- Shengyuan Ran
- Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, People's Republic of China
| | - Qi Yu
- Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, People's Republic of China.
| | - Shan Deng
- Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, People's Republic of China
| | - Ling Xu
- Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, People's Republic of China
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Chand AL, Pathirage N, Lazarus K, Chu S, Drummond AE, Fuller PJ, Clyne CD. Liver receptor homologue-1 expression in ovarian epithelial and granulosa cell tumours. Steroids 2013; 78:700-6. [PMID: 23537609 DOI: 10.1016/j.steroids.2013.03.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 02/18/2013] [Accepted: 03/11/2013] [Indexed: 01/12/2023]
Abstract
Granulosa cell tumours of the ovary (GCT) express aromatase and produce oestrogens. The ovarian-specific aromatase promoter (pII) is regulated by members of the group 5A nuclear receptor family, SF-1 and LRH-1. Since both SF-1 and LRH-1 are implicated in proliferation and cancer, we hypothesised that alteration in the expression of either or both receptors may be associated with GCT. We therefore determined the expression of LRH-1, SF-1 and aromatase in a cohort of GCT, mucinous and serous cystadenocarcinomas, and normal ovaries. LRH-1 mRNA was present at low level in normal ovary and serous cystadenocarcinoma, but was elevated approximately 30-fold in GCT, and 8-fold in mucinous cystadenocarcinoma, compared to normal ovary. LRH-1 protein expression was confirmed in GCT by immunohistochemistry. SF-1 mRNA was significantly lower that of LRH-1 in all samples and not significantly altered in GCT, compared to normal ovary. Aromatase mRNA was present at low level in normal ovary and serous and mucinous cystadenocarcinoma, and significantly elevated (18-fold) in GCT compared to normal ovary. Despite the coordinate over-expression of both LRH-1 and aromatase in GCT versus normal ovary, their levels did not correlate in individual patients; rather, aromatase expression correlated with that of SF-1. Finally, although both LRH-1 and SF-1 activated aromatase promoter activity in transient transfection studies, gel-shift and chromatin immunoprecipitation data indicated that SF-1, but not LRH-1, bound to the aromatase promoter. We conclude that SF-1 regulates aromatase expression in GCT; over-expression of LRH-1 suggests that this receptor may be involved in the pathogenesis of GCT by mechanisms other than the regulation of aromatase. Its role in this disease therefore warrants further investigation.
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Affiliation(s)
- Ashwini L Chand
- Prince Henry's Institute, PO Box 5152, Clayton, Victoria, Australia
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Adachi T, Sato H, Nakayama S, Shimizu S, Matsui H, Nakabayashi M. Primary amenorrhea due to juvenile granulosa-cell tumor of the ovary: A case report. J Obstet Gynaecol Res 2012; 38:597-600. [DOI: 10.1111/j.1447-0756.2011.01735.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abdel-Gadir A, Francis ND, Oyawoye OO, Chander BP. Secondary amenorrhoea with high inhibin B level caused by parasitic ovarian leiomyoma. Gynecol Endocrinol 2010; 26:93-5. [PMID: 19657814 DOI: 10.3109/09513590903184126] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A 35-year-old patient attended the clinic after 1 year of primary infertility and 9 years secondary amenorrhoea. Her BMI was 21.9 kg/m². Transvaginal scan examination showed a small uterus with 1.7 mm thick endometrium. The left ovary was quiescent and measured 2.9 cm x 61.2 cm x 62.1 cm. 3D images manipulation showed a large (96.9 cm³) solid mass attached to the right ovary. Follicle stimulating hormone (FSH) level was 3.8 IU/l, oestradiol was 57 pmol/l and testosterone was 0.9 nmol/l. She had normal thyroid indices, serum prolactin, 17-hydroxyprogesterone and cortisol levels. Inhibin B and luteinising hormone (LH) blood levels were high at 408 pg/ml and 19.5 IU/l, respectively. The mass was shelled laparoscopically off the right ovary, and proved histologically to be a parasitic leiomyoma. She resumed regular menstruation 1 month after surgery and conceived in her fourth cycle. To the best of our knowledge, this is the first case to be reported relating high inhibin B and luteinising hormone blood levels to an ovarian leiomyoma.
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Affiliation(s)
- Ahmed Abdel-Gadir
- London Female and Male Fertility Centre, Highgate Hospital, London, UK.
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Middlebrook BS, Eldin K, Li X, Shivasankaran S, Pangas SA. Smad1-Smad5 ovarian conditional knockout mice develop a disease profile similar to the juvenile form of human granulosa cell tumors. Endocrinology 2009; 150:5208-17. [PMID: 19819941 PMCID: PMC2819741 DOI: 10.1210/en.2009-0644] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Granulosa cell tumors (GCTs) of the ovary are rare sex cord stromal tumors. Although generally indolent, GCTs recur, and if not diagnosed and treated in early stages, survival rates are significantly shortened. Very little is known regarding GCT etiology. Because of the low incidence of cases and lack of standard diagnostics, mouse models for granulosa cell tumors are a valuable tool for studying GCTs and provide models for developing diagnostic and treatment strategies. We recently developed a novel mouse model of metastatic granulosa cell tumors by genetic deletion of the bone morphogenetic protein signaling transcription factors (SMADs) in granulosa cells of the ovary. Histological and serum hormone analyses reveal that this mouse model most closely resembles the juvenile form of GCT. We further analyzed samples of human juvenile GCT (JGCT) for expression of anti-Müllerian hormone and activation of two major signaling pathways: TGFbeta/SMAD2/3 and wingless-related mouse mammary tumor virus integration site (Wnt)/beta-catenin. The TGFbeta family is active in mouse Smad1-Smad5 double knockout tumors, and here we show that this pathway, but not the beta-catenin pathway, is activated in samples of human JGCT. These data suggest that the SMAD family, possibly through disruption of SMAD1/5 or activation of SMAD2/3 may contribute to the pathogenesis of JGCT in humans.
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