Luteinized Adult Granulosa Cell Tumor—A Series of 9 Cases

Abstract

Most adult granulosa cell tumors (AGCTs) consist of small-to-medium cells with scanty cytoplasm imparting a "small blue cell" appearance. We report 9 cases of luteinized AGCT, whose appearance differs from typical AGCT by the presence of abundant eosinophilic cytoplasm in at least 50% of tumor cells. These tumors were identified in patients aged between 37 and 80 years, all but 1 of whom were postmenopausal. The tumors ranged in size from 4.4 to 14 cm, usually had a yellow cut surface, were unilateral in 7 cases, bilateral in 1 case, and presented as a pelvic mass posthysterectomy in 1 case. Endometrial proliferative changes were present in 7 of 7 (100%) of the postmenopausal patients, a higher percentage than that reported in typical AGCT. The luteinized component occupied 50% to 90% of the tumors that were examined. Morphologic differences from typical AGCT were the luteinization of cytoplasm, relative lack of nuclear grooves, the presence of prominent nucleoli, and a myxoid stroma. The luteinized areas, especially when widespread, resulted in consideration of a wide range of other primary and metastatic ovarian neoplasms containing oxyphilic cells. Immunohistochemistry was useful in confirming a sex cord-stromal tumor, but of no value in the distinction from other neoplasms in the same category. Pathologists should be aware of the existence of luteinized AGCT, an uncommon variant of AGCT, to avoid an erroneous diagnosis.

Adult Granulosa Cell Tumour With Heterologous Adipocytic Differentiation: Report of a Unique Case

“…The tumor we report contained areas of typical AGCT and areas with more abundant eosinophilic cytoplasm, in keeping with a component of luteinized AGCT (14,15). Due to the presence of cells with abundant eosinophilic cytoplasm rather than the typical scant cytoplasm of most AGCT, luteinized AGCT may be mistaken for a variety of other sex cord-stromal tumors, including thecoma, steroid cell tumor and juvenile granulosa cell tumor as well as AGCT with a prominent fibrothecomatous component.…”

“…The presence of these different architectural patterns may be a clue to diagnosis but may also result in consideration of a variety of other neoplasms. Morphologic "variants" of AGCT which may result in problems in diagnosis include luteinized variants, diffuse variants with a spindle cell morphology, predominantly cystic variants, thecoma-like variants, variants with "high-grade" transformation and tumors with a prominent fibrothecomatous component (previously referred to as granulosa-theca cell tumor) (12)(13)(14)(15)(16). As discussed previously, AGCTs may also contain heterologous elements, which in the published literature have been confined to mucinous epithelium and hepatocytes (4-8).…”

Follicle Cysts of the Ovary: A Report of 30 Cases of a Common Benign Lesion Emphasizing its Unusual Clinical and Pathologic Aspects

“…The presence of nuclear grooves is a reliable diagnostic trait of adult granulosa cell tumors, with our follicle cysts uniformly lacking this feature. A caveat is in the setting of luteinized granulosa cell tumors where nuclear grooves may become inconspicuous, though extensive sampling usually results in the identification of nonluteinized granulosa cells (5,10). Atypia is generally rare in granulosa cell tumors of both forms, but when present, can be bizarre (11,12); such bizarre nuclei were not found in our follicle cysts.…”

Sex Cord-Stromal Tumors of the Ovary: An Update and Review. Part II — Pure Sex Cord and Sex Cord-Stromal Tumors

“…The neoplastic granulosa cells themselves may rarely become luteinized, displaying moderate to abundant eosinophilic cytoplasm and even vacuolization. 21,22 This appearance may be extensive, and nuclear grooves may be less prominent, making the diagnosis challenging. 22 Luteinization may also be extensive in pregnancy.…”

“…21,22 This appearance may be extensive, and nuclear grooves may be less prominent, making the diagnosis challenging. 22 Luteinization may also be extensive in pregnancy.…”