Granulosa cell tumours of the ovary: Demographics, survival and the management of advanced disease

Savage, Philip; Constenla, D.; Fisher, Cyril; Shepherd, John H.; Barton, Desmond P.J.; Blake, P.; Gore, M.

doi:10.1016/s0936-6555(98)80008-3

Cited by 104 publications

(73 citation statements)

References 15 publications

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“…In the series by Savage et al [56] 4 of 8 patients treated with radiation (for incompletely resected advanced disease) achieved a CR and three had DFI of at least 4 years.…”

Section: Radiotherapymentioning

confidence: 97%

Recent Advances in Granulosa Cell Tumor Ovary: A Review

Kottarathil

Antony

Nair

et al. 2012

Indian J Surg Oncol

105

108

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Granulosa cell tumors constitute less than 5 % of all ovarian tumors. Unlike epithelial ovarian tumors, they occur in a younger age group, are usually detected in an early stage and often have features of hyperestrogenism. The presenting symptoms are usually nonspecific with abdominal pain or distension. They follow an indolent course and are characterized by a long natural history. Mutation of FOXL2 (402C->G) seen in 97 % of adult GCT may be pathognomonic for adult GCT. Only stage of the disease has been consistently shown in various studies to affect survival of patients with GCT. The initial management of patients, for whom fertility is not an issue, is total abdominal hysterectomy, bilateral salpingo-oophorectomy and removal of all gross disease. Nodal dissection is not a significant factor for survival and is not recommended in surgical staging of GCT. Fertility preserving surgery with unilateral salpingooophorectomy is feasible in young patients with stage Ia GCT. Patients with early stage disease (stage I and II) have a very good prognosis with 5 year DFS and OS of 89 % and 99 % respectively and these groups of patients usually don't require any postoperative treatment. Patients with stage Ic disease associated with poor prognostic factors like large tumor size or high mitotic index and stage II, have a higher chance of relapse, and may benefit with postoperative treatment but role of chemotherapy is still debatable. In advanced stage disease (stage III and IV) the 5 year DFS and OS disease was 72 % and 80 % respectively hence the option of postoperative treatment with 6 cycles of BEP should be considered in this group. Recently paclitaxel is being investigated as an effective tool in GCT. The efficacy of radiation in GCT is not well defined but in optimally debulked cases postoperative radiation is a viable option. Due to high chance of recurrence even years after apparent clinical cure of the primary tumor, lifelong follow up with clinical examination and tumor markers like inhibin B is recommended. About 25 % GCT develop recurrence and the median time to recur is usually 4-5 years. Most recurrences are intraperitoneal and usually a complete debulking of the disease is feasible even in the recurrent setting. Postoperative chemotherapy (platinum based) is usually given after surgery more so in cases with widespread disease or after suboptimal cytoreduction. Recurrent chemoresistant, progressive non-responding GCT or patients with high surgical risk are ideal candidates for targeted therapy.

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“…In the series by Savage et al [56] 4 of 8 patients treated with radiation (for incompletely resected advanced disease) achieved a CR and three had DFI of at least 4 years.…”

Section: Radiotherapymentioning

confidence: 97%

Recent Advances in Granulosa Cell Tumor Ovary: A Review

Kottarathil

Antony

Nair

et al. 2012

Indian J Surg Oncol

105

108

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“…Literatüre bakıldığında overin GHT tanısı genellikle postmenopozal dönemde ve özellikle 50-55 yaş arasında konulmakta iken bizim çalışmamızda en sık premenopozal dönemdeki hastalarda gözlenmiştir (8). Tanı anındaki hastanın yaşı önemli bir prognostik faktör olup 40 yaşından küçük olan hastaların prognozunun 40 yaşından büyük olan hastalara kıyasla daha iyi olduğu bildirilmiştir (9 takip süresinin kısa olması ve çalışmanın az hasta sayısı içermesi ile ilgili olduğu düşünülmüştür.…”

Section: Discussionunclassified

Ovarian granulosa cell tumours: A Single Center Experience

Kalkan¹,

Turgut²,

Almalı³

et al. 2017

Van Med J

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GirişTüm over malignensileri içinde seks kord stromal tümörlerin oranı %5-8'dir (1). Seks kord stromal over tümörlerinin yaklaşık %70'ni oluşturan granüloza hücreli tümörler her 100.000 kadının 0.4-1.7'sinde görülür (2). Granüloza hücreli over tümörleri seks kordlarından ve over stroma veya mezenkiminden köken alırlar. Tümörün başlangıç yaşı ve histolojik özelliklerine göre bu tümör adult ÖZET Amaç: Granüloza hücreli tümörler (GHT), overin epitelyal tümörlerine kıyasla nadir görülen daha iyi prognozlu düşük gradeli ve seks kord stromal kaynaklı tümörleridir. Tüm over kanserlerinin yaklaşık %5-8'ini oluştururlar. Biz bu çalışmada, kliniğimizde overin granüloza hücreli tümörü tanısıyla takip edilmiş olan hastaların klinik ve patolojik özeliklerini araştırdık. Results: FIGO staging is used for clinical staging of patients. The median age of patients was 45 (21-62). Of patients, while 14 of them were adult type subtype and the other two of them were juvenile subtype. In the macroscopic examination, the average tumor size 7 cm (2-20 cm). In all of the patients % 68 was premenopausal. The most common symptom was abdominal mass. In this study, the rate of mitosis phase, cellular atypia situations beyond surgery was evaluated in terms of other important prognostic factors. Endometrial proliferation was not detected in none of our patients. Adjuvant chemotherapy was given to 3 of them. Recurrence or metastasis was not observed during the follow-up period. Conclusion:The prognosis of ovarian granulosa cell tumors are quite good and they have very low risk of tumor recurrence. Treatment decisions should be taken by a multidisciplinary team. Patients themselves should be included in the decision-making process with regarding type of treatment

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“…Metastatic disease at presentation is rare and more commonly develops years after initial treatment. Radiotherapy: Adjuvant radiotherapy and targeted radiotherapy for oligometastatic but inoperable recurrent disease has been investigated (45,46). A retrospective study of 103 patients of whom 31 received adjuvant radiotherapy, suggested a survival advantage from this treatment (47).…”

Section: Treatment Surgerymentioning

confidence: 99%

“…The majority of patients with stage I disease have an excellent prognosis and will not require adjuvant treatment following surgical resection (46). However, for patients with poor prognosis factors such as large tumour size, high mitotic activity-index or ruptured tumours, adjuvant chemotherapy is commonly considered.…”

Section: Treatment Surgerymentioning

confidence: 99%

“…However, for patients with poor prognosis factors such as large tumour size, high mitotic activity-index or ruptured tumours, adjuvant chemotherapy is commonly considered. BEP is the most accepted regimen in this setting (16), as well as for recurrent disease that is refractory to hormone therapy (46,49). The potential activity of taxanes has been studied in this disease (50) and the combination of carboplatin and paclitaxel, is not unreasonable.…”

Section: Treatment Surgerymentioning

confidence: 99%

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