Juvenile type granulosa cell tumour

Jason Wasserman MD PhD FRCPC
December 17, 2023


A juvenile type granulosa cell tumour (GCT) is a rare and slow-growing type of ovarian cancer that typically develops in girls and women before 30 years of age. The tumour is composed of immature (primitive) appearing granulosa cells. Mature granulosa cells are normally found in the ovary where they produce the hormone estrogen and support developing egg cells. Juvenile GCTs belong to a category of ovarian tumours called sex-cord stromal tumours.

What causes a juvenile type granulosa cell tumour?

Currently, the cause of juvenile type GCTs remains unknown.

What are the symptoms of a juvenile type granulosa cell tumour?

Some juvenile type GCTs will produce hormones such as estrogen which can result in precocious (early onset) puberty in young girls or menstrual disturbances in adolescents and young women. 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 the tumour cells in a juvenile type granulosa cell tumour spread to other parts of the body?

Although rare, the tumour cells in a juvenile type GCT can spread to other parts of the body.

How is the diagnosis of juvenile type granulosa cell tumour made?

For most girls and young women, the diagnosis of juvenile type GCT of the ovary is only made when the entire tumour has been surgically removed and sent to a pathologist for examination.

What does a juvenile type granulosa cell tumour look like under the microscope?

Under microscopic examination, juvenile type GCT is composed of medium-sized tumour cells with round nuclei and abundant pale or eosinophilic (pink) cytoplasm. The tumour cells are often arranged in large groups described as nodular or diffuse. Unlike the adult type GCT, it is not uncommon to find a large number of mitotic figures (dividing cells) in juvenile GCT.

When immunohistochemistry (IHC) is performed the tumour cells are typically positive for calretinin, inhibin, SF1, CD99, and WT1. Other immunohistochemical markers such as PAX8, cytokeratin 7 (CK7), and EMA are usually negative.

juvenile type granulosa cell tumour

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

The tumour cells in a juvenile type GCT 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 ovary’s outer (capsular) surface. 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. 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 tissue samples 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.

About this article

This article was written by doctors to help you read and understand your pathology report. Contact us if you have any questions about this article or your pathology report. Read this article for a more general introduction to the parts of a typical pathology report.

Other helpful resources

Atlas of Pathology
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