Clinical Research
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Nadir over granüloza tümörleri: Retrospektif bir analiz

Year 2024, Volume: 16 Issue: 2, 35 - 41, 31.08.2024
https://doi.org/10.35514/mtd.2024.109

Abstract

Amaç: Overin granüloza hücre tümörleri (GHT), seks kord-stromal tümörlerinin belirli bir alt tipi olup, tüm over kanserlerinin yaklaşık %5-8'ini oluşturur. Daha yaygın olan over epitelyal tümörlerinden farklı olarak, GHT'ler benzersiz kökenleri, klinik davranışları ve prognoz sonuçları ile dikkat çeker. Genellikle düşük dereceli maligniteler olarak nitelendirilen bu tümörler, sıklıkla olumlu bir prognoz ile seyreder. Buna rağmen, klinik sunum, tedaviye yanıt ve uzun vadeli sonuçlar hastalar arasında önemli ölçüde değişiklik gösterebilir. Bu çalışma, daha büyük bir kohorttan seçilen 17 hastada teşhis edilen GHT'lerin klinik ve patolojik özelliklerini derinlemesine incelemeyi amaçlamaktadır. Tanı anındaki yaş, semptomatoloji, radyolojik ve cerrahi bulgular ile takip verileri gibi demografik ve klinik değişkenlerin analizi yoluyla, prognozu etkileyebilecek ve tedavi stratejilerini bilgilendirebilecek modelleri ortaya çıkarmayı hedeflemektedir. Nihai amaç, GHT'lerin daha iyi anlaşılmasını sağlamak, hasta yönetimini geliştirmek ve jinekolojik onkoloji alanındaki süregelen tartışmalara katkıda bulunmaktır.
Materyal ve Metod: Bu geniş kapsamlı retrospektif çalışma, Ocak 2017 ile Şubat 2023 tarihleri arasında İstanbul Eğitim ve Araştırma Hastanesi'nde tedavi gören 596 hastanın klinik verilerini inceledi. Bu geniş kohorttan, over granüloza hücre tümörü teşhisi konan 17 hasta özellikle belirlendi. Veri çıkarma, tanı anındaki yaş, menopoz durumu, başlangıç semptomları, detaylı radyolojik bulgular, sunumda serum CA-125 seviyeleri ve tanı anındaki FIGO evresi gibi bu 17 vaka ile ilgili önemli detaylara odaklandı. Cerrahi raporlar, yapılan cerrahi müdahalelerin türünü belgelemek için incelendi; prosedürlerin tek taraflı salpingo-ooferektomi ile sınırlı olup olmadığı veya total abdominal histerektomi ve bilateral salpingo-ooferektomi gibi daha kapsamlı cerrahileri içerip içermediği not edildi. Kemoterapi veya radyasyon gibi herhangi bir adjuvan terapinin varlığı da kaydedildi. Takip verileri, nüks oranlarını ve herhangi bir uzun vadeli komplikasyonu izlemek üzere sistematik olarak toplandı.
Sonuçlar: Hastaların yaşı 39 ile 64 arasında değişmekte olup, ortanca yaş 47 ve ortalama yaş 50.41'dir. Tanı anında %52.9'u premenopozal durumdaydı. En yaygın başlangıç semptomları sırasıyla abdominal kitle (%82.4), dismenore (%29.4), abdominal ağrı (%17.6) ve servikal lenfadenopati (%70.6) idi. Radyolojik görüntüleme, hastaların %41.17'sinde kistik kitleler ve %17.64'ünde karışık kistik-solid bileşenler gösterdi. Ortalama tümör boyutu 7 cm idi (aralık 2-20 cm). Endometriyal proliferasyon gözlenmedi ve takip döneminde nüks veya metastaz vakası olmadı. Klinik evreleme için FIGO evrelemesi kullanıldı. Hastaların %47.1'inde serum tümör işaretçisi CA-125 seviyeleri yükselmiş bulundu; bu işaretçi, sıklıkla over patolojisi ile ilişkilendirilir.
Sonuç: Over granüloza hücre tümörleri, çok düşük nüks riski ile olumlu bir prognoza sahiptir. Bu çalışma, tedavide multidisipliner bir yaklaşımın önemini vurgulamakta ve karar verme sürecinde hastanın katılımının gerekliliğine dikkat çekmektedir. Cerrahi müdahale kritik olmaya devam etmekte olup, cerrahi tipi ve kapsamı bireysel klinik senaryolara göre şekillendirilmelidir. Bu tümörlerin patofizyolojisini daha iyi anlamak ve hasta sonuçlarını iyileştirmek için sürekli araştırma gereklidir. Erken tanı ve uygun yönetim, nüksleri önlemek ve uzun vadeli sağlığı sağlamak için anahtardır.

Ethical Statement

The study protocol was reviewed and approved by the Ethics Committee of Istanbul Training and Research Hospital, as confirmed by the decision of the meeting held on 29.02.2024, under resolution number 2024-03. The study was conducted in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.

References

  • 1. Gershenson DM. Management of early ovarian cancer: germ cell and sex cord-stromal tumors. Gynecologic oncology.1994;55(3):562-572.
  • 2. Carcangiu ML, Kurman RJ, Carcangiu ML, Herrington CS. WHO classification of tumours of female reproductive organs. International Agency for Research on Cancer. 2014.
  • 3. Pectasides D, Pectasides E, Psyrri A. Granulosa cell tumor of the ovary. Cancer treatment reviews. 2008;34(1):1-12.
  • 4. Gittleman AM, Price AP, Coren C, Akhtar M, Donovan V, Katz DS. Radiology–pathology conference: juvenile granulosa cell tumor. Clinical imaging.2003;27(4):221-224.
  • 5. Fox H, Agrawal K, Langley FA. A clinicopathologic study of 92 cases of granulosa cell tumor of the ovary with special reference to the factors influencing prognosis. Cancer. 1975;35(1):231-241.
  • 6. Geetha P, Nair MK. Granulosa cell tumours of the ovary. Australian and New Zealand Journal of Obstetrics and Gynaecology. 2010;50(3):216-220.
  • 7. Li J, Chu R, Chen Z, Meng J, Yao S, Song K, et al. Progress in the management of ovarian granulosa cell tumor: A review. Acta Obstetricia et Gynecologica Scandinavica. 2021;100(10):1771-1778.
  • 8. Dridi M, Chraiet N, Batti R, Ayadi M, Mokrani A, Meddeb K, et al. Granulosa cell tumor of the ovary: a retrospective study of 31 cases and a review of the literature. Int J Surg Oncol. 2018;2018:4547892.
  • 9. Seagle BLL, Ann P, Butler S, Shahabi S. Ovarian granulosa cell tumor: a National Cancer Database study. Gynecologic oncology. 2017;146(2):285-291.
  • 10. Sekkate S, Kairouani M, Serji B, Tazi A, Mrabti H, Boutayeb S, et al. Ovarian granulosa cell tumors: a retrospective study of 27 cases and a review of the literature. World journal of surgical oncology. 2013;11:1-6.
  • 11. Khosla D, Dimri K, Pandey AK, Mahajan R, Trehan R. Ovarian granulosa cell tumor: clinical features, treatment, outcome, and prognostic factors. North American journal of medical sciences. 2014;6(3):133.

Rare ovarian granulosa tumors: A retrospective analysis

Year 2024, Volume: 16 Issue: 2, 35 - 41, 31.08.2024
https://doi.org/10.35514/mtd.2024.109

Abstract

Objective: Granulosa cell tumors (GCTs) of the ovary, a specific subtype of sex cord-stromal tumors, comprise approximately 5-8% of all ovarian cancers. Unlike the more prevalent ovarian epithelial tumors, GCTs are noted for their unique origin, clinical behavior, and prognostic outcomes. Characterized generally as low-grade malignancies, they often present with a favorable prognosis. Despite this, the clinical presentation, response to treatment, and long-term outcomes can vary significantly among patients. This study aims to provide an in-depth examination of the clinical and pathological features of ovarian granulosa cell tumors in a select group of 17 patients diagnosed with GCTs from a larger cohort of 596 individuals evaluated at our institution. By analyzing demographic and clinical variables such as age at diagnosis, symptomatology, radiological and surgical findings, and follow-up data, this study seeks to uncover patterns that could influence prognosis and inform therapeutic strategies. Ultimately, the objective is to deepen understanding of GCTs, enhance patient management, and contribute to the ongoing discourse in the field of gynecologic oncology.
Materials and Methods: This extensive retrospective study initially reviewed the clinical data of 596 patients treated at Istanbul Training and Research Hospital between January 2017 and February 2023. From this broader cohort, 17 patients were specifically diagnosed with ovarian granulosa cell tumors. The data extraction focused on relevant details from these 17 cases, including age at diagnosis, menopausal status, initial symptoms, detailed radiological findings, serum CA-125 levels at presentation, and FIGO stage at diagnosis. Surgical reports were reviewed to document the type of surgical interventions performed, noting whether procedures were limited to unilateral salpingo-oophorectomy or included more extensive surgeries such as total abdominal hysterectomy and bilateral salpingo-oophorectomy. The presence of any adjuvant therapies, such as chemotherapy or radiation, was also recorded. Follow-up data were systematically collected to monitor outcomes including recurrence rates and any long-term complications.
Results: Patients ranged in age from 39 to 64 years, with a median age of 47 and a mean age of 50.41. About 52.9% were premenopausal at diagnosis. The most common presenting symptoms included abdominal mass (82.4%), dysmenorrhea (29.4%), abdominal pain (17.6%), and cervical lymphadenopathy (70.6%). Radiological imaging showed cystic masses in 41.17% of patients and mixed cystic-solid components in 17.64%. The average tumor size was 7 cm (range 2-20 cm). No endometrial proliferation was noted, and there were no instances of recurrence or metastasis during the follow-up period. FIGO staging was utilized for clinical staging. Elevated levels of the serum tumor marker CA-125 were observed in 47.1% of the patients, indicating a significant presence of this biomarker, which is often associated with ovarian pathology.
Conclusion: Ovarian granulosa cell tumors exhibit a favorable prognosis with a very low risk of recurrence. This study underscores the importance of a multidisciplinary approach in treatment, emphasizing the need for patient involvement in decision-making. Surgical intervention remains crucial, with the type and extent of surgery tailored to individual clinical scenarios. Continued research is necessary to further understand the pathophysiology of these tumors and improve patient outcomes. Early detection and appropriate management are key to preventing recurrences and ensuring long-term health.

References

  • 1. Gershenson DM. Management of early ovarian cancer: germ cell and sex cord-stromal tumors. Gynecologic oncology.1994;55(3):562-572.
  • 2. Carcangiu ML, Kurman RJ, Carcangiu ML, Herrington CS. WHO classification of tumours of female reproductive organs. International Agency for Research on Cancer. 2014.
  • 3. Pectasides D, Pectasides E, Psyrri A. Granulosa cell tumor of the ovary. Cancer treatment reviews. 2008;34(1):1-12.
  • 4. Gittleman AM, Price AP, Coren C, Akhtar M, Donovan V, Katz DS. Radiology–pathology conference: juvenile granulosa cell tumor. Clinical imaging.2003;27(4):221-224.
  • 5. Fox H, Agrawal K, Langley FA. A clinicopathologic study of 92 cases of granulosa cell tumor of the ovary with special reference to the factors influencing prognosis. Cancer. 1975;35(1):231-241.
  • 6. Geetha P, Nair MK. Granulosa cell tumours of the ovary. Australian and New Zealand Journal of Obstetrics and Gynaecology. 2010;50(3):216-220.
  • 7. Li J, Chu R, Chen Z, Meng J, Yao S, Song K, et al. Progress in the management of ovarian granulosa cell tumor: A review. Acta Obstetricia et Gynecologica Scandinavica. 2021;100(10):1771-1778.
  • 8. Dridi M, Chraiet N, Batti R, Ayadi M, Mokrani A, Meddeb K, et al. Granulosa cell tumor of the ovary: a retrospective study of 31 cases and a review of the literature. Int J Surg Oncol. 2018;2018:4547892.
  • 9. Seagle BLL, Ann P, Butler S, Shahabi S. Ovarian granulosa cell tumor: a National Cancer Database study. Gynecologic oncology. 2017;146(2):285-291.
  • 10. Sekkate S, Kairouani M, Serji B, Tazi A, Mrabti H, Boutayeb S, et al. Ovarian granulosa cell tumors: a retrospective study of 27 cases and a review of the literature. World journal of surgical oncology. 2013;11:1-6.
  • 11. Khosla D, Dimri K, Pandey AK, Mahajan R, Trehan R. Ovarian granulosa cell tumor: clinical features, treatment, outcome, and prognostic factors. North American journal of medical sciences. 2014;6(3):133.
There are 11 citations in total.

Details

Primary Language English
Subjects Clinical Sciences (Other)
Journal Section Research Article
Authors

Ayse Konac 0000-0002-9119-3332

H. Serpil Bozkurt This is me 0009-0002-5502-6825

Publication Date August 31, 2024
Submission Date May 6, 2024
Acceptance Date August 8, 2024
Published in Issue Year 2024 Volume: 16 Issue: 2

Cite

Vancouver Konac A, Bozkurt HS. Rare ovarian granulosa tumors: A retrospective analysis. Maltepe tıp derg. 2024;16(2):35-41.