Ovarian granulosa cell tumors: retrospective analysis of 18 cases

Background. Granulosa cell tumors (GCTs) are rare neoplasms and they represent about 2 to 5% of all ovarian cancers. They are usually detected at an early stage and have a relatively favorable prognosis. Aim. The aim of this study was to investigate the clinical and pathological characteristics of GCT patients and to identify the prognostic factors. Methods. In a retrospective study, we have analyzed the medical data of 18 patients with newly diagnosed GCTs treated by the Department of Gynecology and Obstetrics in the University Hospital Centre Zagreb in the period from January 2011 until December 2017. We have investigated data for age, parity, symptoms, tumor size, stage of disease, radicality of surgery, pathological characteristics of the tumors (number of mitosis, presence of Call-Exner bodies), application of adjuvant chemotherapy, time to progression of disease and overall survival. Results. Data from 18 cases were obtained. The median age was 55 years. The mean parity was 1,39. The most common clinical manifestations of the disease were abdominal pain (44%) and abdominal distension (44%). The mean tumor size was 11 cm (range 2 – 30 cm). The majority of our patients were stage I (78%, N = 14), while (22%, N = 4) were stage III. 15 patients underwent radical surgery, while in 3 patients fertility-sparing surgery was performed. According to the tumor characteristics, the mitotic count was high (> 10 mitosis/10 HPFs) in 9 cases (50%) and 7 patients had presence of Call-Exner bodies. Four patients received 1–6 cycles of adjuvant chemotherapy. During the follow-up period (median 49 months), 3 patients relapsed and one patient died free of the primary disease, from myocardial infarction. Conclusion. The basis of therapy in GCTs is surgical removal of the disease, and platinum-based adjuvant chemotherapy is recommended for advanced-stage GCTs. A prolonged follow-up period is necessary because they progress slowly and have a specific tendency for late recurrences