Granulosa cell tumour, adult type

by Jason Wasserman MD PhD FRCPC
October 17, 2022


What is an adult-type granulosa cell tumour?

An adult-type granulosa cell tumour is a rare and slow-growing type of ovarian cancer. The tumour starts from specialized granulosa cells normally found in the ovary. Adult-type granulosa cell tumour is part of a group of ovarian tumours called sex cord-stromal tumours.

What causes an adult-type granulosa cell tumour?

Almost all adult-type granulosa cell tumours contain a mutation involving the FOXL2 gene. However, at present, doctors do not know what causes this mutation to occur.

What are the symptoms of an adult-type granulosa cell tumour?

Some adult-type granulosa cell tumours will produce hormones such as estrogen which can result in symptoms such as abnormal vaginal bleeding and breast tenderness. Androgen-producing tumours may result in symptoms such as increased body hair growth and voice changes. Small tumours and those that do not produce any hormones may not cause any symptoms and may only be discovered when pelvic imaging is performed for another reason.

Can an adult-type granulosa cell tumour spread to other parts of the body?

Although rare, the tumour cells in an adult-type granulosa cell tumour can spread to other parts of the body.

How is the diagnosis of adult-type granulosa cell tumour made?

For most women, the diagnosis of adult-type granulosa cell tumour of the ovary is only made when the entire tumour has been surgically removed and sent to a pathologist for examination.

Adult type granulosa cell tumour
Adult-type granulosa cell tumour.

What is an intraoperative consultation (frozen section)?

An intraoperative consultation is an opportunity for your surgeon and pathologist to examine the tumour, lymph nodes, or other tissue samples at the time of surgery. During this consultation, a frozen section may be performed where the tissue is quickly examined under the microscope. The purpose of an intraoperative consultation and frozen section is to provide your surgeon with information that will help guide decisions made at the time of surgery.

Were tumour cells seen on the surface of the ovary or fallopian tube?

The tumour cells in an adult-type granulosa cell tumour can spread from the ovary to another nearby organ such as the fallopian tube or the ovary on the other side of the body. If tumour cells are seen on the surface of the fallopian tube or ovary, it suggests that they have spread there from the tumour. The spread of cells from the tumour to another body site is called metastasis. This information is important because a tumour that has spread or metastasized from one organ to another is given a higher tumour (T) stage.

Why is it important if the tumour was received intact or ruptured?

All ovarian tumours are examined to see if there are any holes or tears in the outer (capsular) surface of the ovary. The capsular surface is described as intact if no holes or tears are identified. The capsular surface is described as ruptured if it contains any large holes or tears. If the ovary or tumour is received in multiple pieces, it may not be possible for your pathologist to tell if the capsular surface has ruptured or not. This information is important because a capsular surface that ruptures inside the body may spill tumour cells into the abdominal cavity. A ruptured capsule is associated with a worse prognosis and is used to determine the tumour (T) stage.

Has the tumour spread to other organs or tissues in the pelvis or abdomen?

Small samples of tissue are commonly removed in a procedure called a biopsy to see if tumour cells have spread outside of the ovary. These biopsies, which are often from a tissue in the pelvis and abdomen called the peritoneum, are sent to your pathologist to see if the tumour has spread or metastasized. The omentum is an abdominal organ that is a common site of tumour spread or metastasis. This organ is often entirely removed and examined by your pathologist. Other organs (such as the bladder, small intestine, or large intestine) are not typically removed and sent for pathological examination unless they are directly attached to the tumour or the tumour spreading to these organs is seen by your surgeon. In these cases, your pathologist will examine each organ under the microscope to see if there are any cancer cells attached to those organs. The presence of tumour cells in other organs is used to determine the tumour (T) stage and distant metastatic disease (M) stage.

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