Granulosa Cell Tumor: Symptoms, Causes, Treatment

What are the symptoms of a granulosa cell tumor?

Granulosa cell tumors (GCTs) are rare ovarian tumors that can be classified as either adult type or juvenile type, with adult-type GCTs being more common. The symptoms of a granulosa cell tumor can vary depending on the type of tumor, its size, and whether it produces hormones.

1. Menstrual irregularities: One of the most common symptoms of a granulosa cell tumor in adult women is abnormal uterine bleeding, which can include irregular periods, heavy menstrual bleeding (menorrhagia), or postmenopausal bleeding.
2. Pelvic pain: Some women with a granulosa cell tumor may experience pelvic or abdominal pain, which can be dull and constant or sharp and intermittent.
3. Abdominal mass: In some cases, a granulosa cell tumor may grow large enough to be felt as a palpable mass in the abdomen or pelvis.
4. Menopausal symptoms: Granulosa cell tumors can produce estrogen, leading to symptoms of estrogen excess in postmenopausal women, such as hot flashes, vaginal dryness, and breast tenderness.
5. Infertility: In some cases, granulosa cell tumors may be discovered during an evaluation for infertility.
6. Virilization: Juvenile-type GCTs, which are more common in children and adolescents, can produce androgens (male hormones), leading to symptoms of virilization in girls, such as growth of facial hair (hirsutism), deepening of the voice, and enlargement of the clitoris.
7. Other symptoms: Rarely, granulosa cell tumors may cause other symptoms such as nausea, vomiting, constipation, or urinary symptoms if they compress nearby structures.

It’s important to note that the symptoms of a granulosa cell tumor can be nonspecific and can resemble those of other ovarian tumors or gynecological conditions. Therefore, any persistent or concerning symptoms should be evaluated by a healthcare provider for an accurate diagnosis and appropriate management.

What are the causes of a granulosa cell tumor?

The exact cause of granulosa cell tumors (GCTs) is not well understood. Like many types of cancer, GCTs are thought to develop due to a combination of genetic and environmental factors. Some possible factors that may contribute to the development of GCTs include:

1. Genetic mutations: Changes (mutations) in certain genes may play a role in the development of GCTs. For example, mutations in the FOXL2 gene have been associated with adult-type GCTs. However, not all GCTs have identifiable genetic mutations.
2. Hormonal factors: GCTs are hormonally active tumors, meaning they can produce hormones such as estrogen. Hormonal imbalances or changes in estrogen levels may contribute to the development of GCTs, particularly in cases where the tumor is estrogen-producing.
3. Age and reproductive factors: GCTs are more common in women during their reproductive years and around menopause, suggesting that hormonal factors related to the menstrual cycle and menopause may play a role in the development of these tumors.
4. Environmental factors: While specific environmental factors have not been definitively linked to GCTs, exposure to certain chemicals or toxins may potentially increase the risk of developing these tumors.
5. Other conditions: Some conditions, such as certain types of ovarian cysts or tumors, may be associated with an increased risk of developing GCTs, although the exact relationship is not fully understood.

It’s important to note that while these factors may contribute to the development of GCTs, they do not guarantee that a person will develop a granulosa cell tumor. GCTs are rare tumors, and most women with hormonal imbalances or other risk factors do not develop these tumors. Further research is needed to better understand the underlying causes of GCTs.

How is the diagnosis of granulosa cell tumor made?

The diagnosis of a granulosa cell tumor (GCT) is typically made through a combination of imaging tests, blood tests, and biopsy. The following steps are commonly used to diagnose a granulosa cell tumor:

1. Medical history and physical examination: A healthcare provider will take a detailed medical history and perform a physical examination to assess for signs and symptoms of a GCT, such as abdominal or pelvic mass, menstrual irregularities, or signs of hormone excess.
2. Imaging tests: Imaging tests, such as ultrasound, CT scan, or MRI, may be done to visualize the ovaries and assess for the presence of a tumor. These tests can help determine the size, location, and characteristics of the tumor.
3. Blood tests: Blood tests may be done to measure levels of certain hormones, such as estrogen and inhibin, which are often elevated in women with GCTs. These tests can help support the diagnosis of a hormone-producing tumor.
4. Biopsy: A biopsy may be performed to obtain a sample of tissue from the tumor for examination under a microscope. A biopsy is the most definitive way to diagnose a GCT and can help determine the type of tumor and its characteristics.
5. Surgical staging: If a GCT is suspected based on imaging tests and blood tests, surgical staging may be performed to confirm the diagnosis and determine the extent of the disease. During surgical staging, the tumor is removed and sent to a laboratory for further examination.
6. Histological examination: The tissue sample obtained from the biopsy or surgical staging is examined by a pathologist under a microscope to look for characteristic features of a GCT, such as granulosa cell proliferation and the presence of Call-Exner bodies.

Once a diagnosis of a granulosa cell tumor is confirmed, further tests may be done to assess the stage of the disease and determine the appropriate treatment plan.

What is the treatment for a granulosa cell tumor?

The treatment for a granulosa cell tumor (GCT) depends on several factors, including the type of GCT (adult or juvenile), the stage of the tumor, the age and overall health of the patient, and whether the tumor is hormone-producing. Treatment options for GCTs may include:

1. Surgery: The primary treatment for GCTs is surgical removal of the tumor. The extent of surgery depends on the size and location of the tumor, as well as whether the tumor has spread beyond the ovary. In some cases, a unilateral salpingo-oophorectomy (removal of one ovary and fallopian tube) may be sufficient, while in other cases, a total hysterectomy with bilateral salpingo-oophorectomy (removal of both ovaries, fallopian tubes, and uterus) may be necessary, especially for larger or more advanced tumors.
2. Fertility-sparing surgery: In women who wish to preserve their fertility, conservative surgery may be an option. This involves removing only the affected ovary and leaving the uterus and other ovary intact, if possible.
3. Chemotherapy: Chemotherapy may be recommended for women with advanced or recurrent GCTs. The specific chemotherapy regimen depends on the type and stage of the tumor. GCTs are often less responsive to chemotherapy compared to other types of ovarian cancer, but chemotherapy may still be used to help control the disease.
4. Hormone therapy: For women with estrogen-producing GCTs, hormone therapy may be used to help manage symptoms and reduce the risk of recurrence. This may include medications that block the effects of estrogen or reduce estrogen production.
5. Radiation therapy: Radiation therapy is not commonly used for the treatment of GCTs, but it may be considered in some cases, particularly for tumors that are not responsive to other treatments or that have spread to other parts of the body.
6. Follow-up care: After treatment, regular follow-up visits with a healthcare provider are important to monitor for any signs of recurrence and to assess the overall health of the patient. Imaging tests, blood tests, and physical examinations may be done during these visits to monitor for recurrence.

The treatment of GCTs is often individualized based on the specific characteristics of the tumor and the needs of the patient. It’s important for patients to discuss their treatment options with a healthcare provider who specializes in the treatment of ovarian cancer.

What is the survival rate of a granulosa cell tumor?

The survival rate for granulosa cell tumors (GCTs) varies depending on several factors, including the type of GCT (adult or juvenile), the stage of the tumor at the time of diagnosis, and the effectiveness of treatment. Overall, GCTs are considered to have a relatively good prognosis compared to other types of ovarian cancer.

For adult-type GCTs, the 5-year survival rate is generally high, ranging from 80% to 95% for early-stage tumors (stage I and II) and 50% to 70% for advanced-stage tumors (stage III and IV).

For juvenile-type GCTs, which are more common in children and adolescents, the 5-year survival rate is also high, ranging from 80% to 95%.

It’s important to note that these are general statistics and individual outcomes can vary. Factors that can affect prognosis include the size and location of the tumor, the age and overall health of the patient, and how well the tumor responds to treatment.

It’s also important for patients with GCTs to receive care from a healthcare team experienced in the treatment of ovarian cancer, as the management of these tumors can be complex and may require a multidisciplinary approach. Regular follow-up care is also important to monitor for any signs of recurrence and to ensure the best possible outcome.