DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20175037
Published: 2017-10-28

Single tertiary care centre experience of ovarian granulosa cell tumour in Chennai, India: a retrospective analysis

Deenadayalan T., S. Lakshmi Narasimhan, K. Kalaichelvi, B. Ramkumar, Kanchana Madurai Padmanabhan

Abstract


Background: Granulosa cell tumours of ovary are rare sex-cord stromal tumours characterized by long natural history and favourable prognosis. The present study was done to evaluate the clinical presentation, treatment, outcome, and prognostic factors for patients diagnosed as granulosa cell tumours.

Methods: A Retrospective study of Granulosa cell tumour of the ovary was done for a period of five years from January 2011 to December 2015 at a tertiary care centre, Institute of Obstetrics and Gynaecology, Madras Medical College, Chennai. The clinical data and the treatment details were retrieved from the records of medical oncology department and the data were analysed.

Results: Twenty five patients were diagnosed as granulose cell tumours of ovary during the study period. The median patient age was 48 years. The most common clinical presentation at diagnosis was vaginal bleeding (76%) followed by abdominal pain (40%). Mean tumor size was 9.6cm. The majority of patients were diagnosed in FIGO stage Ia (84%, n = 21). Thirteen patients (52%) underwent complete staging laparotomy. Twenty three patients (92%) had Adult Granulosa cell tumour. Two patients (8%)had juvenile Granulosa cell tumour. After surgery, all patients were put on observation except two patients who received adjuvant chemotherapy (EP: Etoposide, Cisplatin). The median followup period was 48 months. Five patients (20%) had recurrence; The average time to relapse was 29.6 months. Patients who had tumour size more than 9.7cm had more recurrence events (Hazard Ratio(HR):1.058), but their association is not significant (P value-0.839). The association between menopausal status, torsion of tumour mass, tumour stage with recurrence rate were not significant. The estimated mean overall survival was 84.8 months. Following univariate Cox regression modeling, survival appeared to be independent of age range, post operative residual tumour and the FIGO stage.

Conclusions: Granulosa cell tumours of ovary are rare, often diagnosed in early stage. Patients who had tumour size of more than 9.7cm had more recurrence events. A prolonged post therapeutic follow-up is necessary to pick up the late relapses.


Keywords


Chemotherapy, Granulosa cell tumour, Juvenile granulosa cell tumour, Metastasis, Recurrence

Full Text:

PDF

References


Seagle BL, Ann P, Butler S, Shahabi S. Ovarian granulosa cell tumor: A National Cancer Database study. Gynecol Oncol. 2017 Aug;146(2):285-291.

Calaminus G, Wessalowski R, Harms GD, Öbel U. Juvenile granulosa cell tumors of the ovary in children and adolescents: results from 33 patients registered in a prospective cooperative study; Gynecol Oncol. 1997;65:447-452.

Segal R, DePetrillo AD, Thomas G. Clinical review of adult granulosa cell tumors of the ovary. Gynecol Oncol. 1995;56:338-344.

Khosla D, Dimri K, Pandey AK, Mahajan R, Trehan R. Ovarian granulosa cell tumor: Clinical features, treatment, outcome, and prognostic factors. N Am J Med Sci. 2014 Mar;6(3):133-8.

Pautier P, Lhommé C, Culine S, Duvillard P, Michel G, Bidart JM et al. Adult granulosa-cell tumor of the ovary: a rétrospective study of 45 cases. Int J Gynecol Cancer. 1997;7:58-65.

Shim SH, Lee SJ, Kim DY, Kim J, Kim SN, Kang SB et al. A long-term follow-up study of 91 cases with ovarian granulosa cell tumors. Anticancer Res. 2014 Feb 1;34(2):1001-10.

Sekkate S, Kairouani M, Serji B, Tazi A, Mrabti H, Boutayeb S, Errihani H. Ovarian granulosa cell tumors: a retrospective study of 27 cases and a review of the literature. World J Surg Oncol. 2013 Jun 18;11(1):142.

D'angelo E, Mozos A, Nakayama D, Espinosa I, Catasus L, Munoz J et al. Prognostic significance of FOXL2 mutation and mRNA expression in adult and juvenile granulosa cell tumors of the ovary. Modern Pathol. 2011 Oct 1;24(10):1360.

Gershenson DM. Sex cord-stromal tumors of the ovary: Granulosa-stromal cell tumors. UpToDate. Avaialble at https://www.uptodate.com/contents/sex-cord-stromal-tumors-of-the-ovary-granulosa-celltumors?source=search_resultandsearch=granulosa%20cell%20tumorandselectedTitle=1~150

NCCN Guidelines for Patients® | Ovarian Cancer. Available at www.nccn.org/patients/guidelines/ovarian/index.html

van Meurs HS, Buist MR, Westermann AM, Sonke GS, Kenter GG, van der Velden J. Effectiveness of chemotherapy in measurable granulosa cell tumors: a retrospective study and review of literature. Intl J Gynecol Cancer. 2014 Mar 1;24(3):496-505.

G Mangili, J Ottolina, A Gadducci. Long-term follow-up is crucial after treatment for granulosa cell tumours of the ovary. Br J Cancer. 2013;109:29-34.

Koutroumpa I, Thomakos N, Sotiropoulou M, Trachana SP, Haidopoulos D, Zagouri F et al. Clinicopathological prognostic factors for recurrence in adult granulosa cell tumor of the ovary. Gynecol Oncol. 2014 Jun 1;133:84.

Kottarathil VD, Antony MA, Nair IR, Pavithran K. Recent advances in granulosa cell tumor ovary: a review. Indian J Surg Oncol. 2013 Mar 1;4(1):37-47.

Malmstrom H, Hogberg T, Risberg B, Simonsen E. Granulosa cell tumors of the ovary: prognostic factors and outcome. Gynecol Oncol. 1994;52:50-55.

Ayhan A, Salman MC, Velipasaoglu M, Sakinci M, Yuce K. Prognostic factors in adult granulosa cell tumors of the ovary: a retrospective analysis of 80 cases. J Gynecol Oncol. 2009;20:158-163.

Sehouli J, Drescher FS, Mustea A, Elling D, Friedmann W, Kühn W et al. Granulosa cell tumor of the ovary: 10 years follow-up data of 65 patients. Anticancer Res. 2004;24:1223-9.