Abstract
Sex cord–stromal tumors (SCSTs) account for approximately 10% of all malignant ovarian neoplasms. The low incidence, the histological heterogeneity, and the variable biologic behavior, makes their optimal management difficult. SCSTs constitute a heterogeneous group of tumors and according to the World Health Organization, they are classified into these categories: pure stromal tumors, pure sex cord tumors (i.e. granulosa cell tumor) and mixed sex cordstromal tumors (Sertoli-Leydig cell tumors).
Histologically, these tumors are considered malignant neoplasms; their natural history, however, is indolent with a very favorable long-term prognosis. Treatment principles have generally based on small series and borrowed from clinical management of epithelial tumors. Adequate knowledge of these neoplasms is imperative to the appropriate diagnosis, choice of surgical treatment and adjuvant therapy.
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References
Gatta G, van der Zwan JM, et al. Rare cancers are not so rare: the rare cancer burden in Europe. Eur J Cancer. 2011;47:2493–511.
Slade I, Bacchelli C, Davies H, et al. DICER1 syndrome: clarifying the diagnosis, clinical features and management implications of a pleiotropic tumour predisposition syndrome. J Med Genet. 2011;48(4):273–8.
Young RH, Dickersin GR, Scully RE. Juvenile granulosa cell tumor of the ovary: a clinicopathological analysis of 125 cases. Am J Surg Pathol. 1984;8:575–96.
Zaloudek C, Norris HJ. Granulosa tumors of the ovary in children: a clinical and pathologic study of 32 cases. Am J Surg Pathol. 1982;6:503–12.
Colombo N, Parma G, Zanagnolo V, Insinga A. Management of ovarian stromal cell tumors. J Clin Oncol. 2007;25(20):2944–51.
Rodgers RJ, Irving-Rodgers HF, Van Wezel IL, et al. Dynamics of the membrana granulosa during expansion of the ovarian follicular antrum. Mol Cell Endocrinol. 2001;171:41–8.
Benayoun BA, Anttonen M, te L’Ho D, et al. Adult ovarian granulosa cell tumor transcriptomics: prevalence of FOXL2 target genes misregulation gives insights into the pathogenic mechanism of the p.Cys134Trp somatic mutation. Oncogene. 2013;30:2739–46.
Cheng JC, Klausen C, Leung PC. Overexpression of wild-type but not C134W mutant FOXL2 enhances GnRH-induced cell apoptosis by increasing GnRH receptor expression in human granulosa cell tumors. PLoS One. 2013;8(1):e55099.
Anttonen M, Pihlajoki M, Andersson N, et al. FOXL2, GATA4, and SMAD3 cooperatively modulate gene expression, cell viability and apoptosis in ovarian granulosa cell tumour cells. PLoS One. 2014;9:e85545.
Kommoss S, Gilks CB, Penzel R, et al. A current perspective on the pathological assessment of FOXL2 in adult-type granulosa cell tumours of the ovary. Histopathology. 2014;64:380–8.
D’Angelo E, Mozos A, Nakayama D, et al. Prognostic significance of FOXL2 mutation and mRNA expression in adult and juvenile granulosa cell tumors of the ovary. Mod Pathol. 2011;24(10):1360–7.
Chang HM, Cheng JC, Taylor E, et al. Oocyte-derived BMP15 but not GDF9 down-regulates connexin43 expression and decreases gap junction intercellular communication activity in immortalized human granulosa cells. Mol Hum Reprod. 2014;20:373–83.
Schultz KA, Pacheco MC, Yang J, et al. Ovarian sex cord-stromal tumors, pleuropulmonary blastoma and DICER1 mutations: a report from the International Pleuropulmonary Blastoma Registry. Gynecol Oncol. 2011;122(2):246–50.
Heravi-Moussavi A, Anglesio MS, Cheng SW, et al. Recurrent somatic DICER1 mutations in non-epithelial ovarian cancers. N Engl J Med. 2012;366(3):234–42.
Connolly DC, Katabuchi H, Cliby WA, et al. Somatic mutations in the STK11/LKB1 gene are uncommon in rare gynecological tumor types associated with Peutz-Jeghers syndrome. Am J Pathol. 2000;156:339–45.
Rabban JT, Zaloudek CJ. A practical approach to immunohistochemical diagnosis of ovarian germ cell tumours and sex cord-stromal tumours. Histopathology. 2013;62(1):71–88.
Cronje HS, Niemand I, Bam RH, Woodruff JD. Review of the granulosa-theca cell tumors from the emil Novak ovarian tumor registry. Am J Obstet Gynecol. 1999;180(2 Pt 1):323–7.
Baker PM, Oliva E. Immunohistochemistry as a tool in the differential diagnosis of ovarian tumors: an update. Int J Gynecol Pathol. 2004;24:39–55.
Prat J, Young RH, Scully RE. Ovarian Sertoli-Leydig cell tumor with heterologous elements II, cartilage and skeletal muscles: a clinicopathologic analysis of twelve cases. Cancer. 1982;50:2465–75.
Mooney EE, Nogales FF, Tavassoli FA. Hepatocytic differentiation in retiform Sertoli-Leydig cell tumors: distinguishing a heterologous element from leydig cells. Hum Pathol. 1999;30:611–7.
Ray-Coquard I, Brown J, Harter P, et al. Gynecologic Cancer InterGroup (GCIG) consensus review for ovarian sex cord stromal tumors. Int J Gynecol Cancer. 2014;24(9 Suppl 3):S42–7.
Oliva E, Alvarez T, Young RH. Sertoli cell tumors of the ovary: a clinicopathologic and immunohistochemical study of 54 cases. Am J Surg Pathol. 2005;29(2):143–56.
Litta P, Saccardi C, Conte L, Codroma A, Angioni S, Mioni R. Sertoli-Leydig cell tumors: current status of surgical management: literature review and proposal of treatment. Gynecol Endocrinol. 2013;29(5):412–7.
Chen L, Tunnell CD, De Petris G. Sertoli-Leydig cell tumor with heterologous element: a case report and a review of the literature. Int J Clin Exp Pathol. 2014;7(3):1176–81.
Hildebrandt RH, Rouse RV, Longacre TA. Value of inhibin in the identification of granulosa cell tumors of the ovary. Hum Pathol. 1997;28:1387–95.
Lappöhn RE, Burger HG, Bouma J, Bangah M, Krans M, de Bruijn HW. Inhibin as a marker for granulosa-cell tumors. N Engl J Med. 1989;321:790–3.
Lane AH, Lee MM, Fuller Jr AF, et al. Diagnostic utility of mullerian inhibiting substance determination in patients with primary and recurrent granulosa cell tumors. Gynecol Oncol. 1999;73:51–5.
Geerts I, Vergote I, Neven P, Billen J. The role of inhibins B and antimullerian hormone for diagnosis and follow-up of granulosa cell tumors. Int J Gynecol Cancer. 2009;19:847–55.
Van Holsbeke C, Domali E, Holland TK, et al. Imaging of gynecological disease (3): clinical and ultrasound characteristics of granulosa cell tumors of the ovary. Ultrasound Obstet Gynecol. 2008;31(4):450–6.
Caoduro C, Ungureanu CM, Singeorzan CM, et al. Granulosa cell tumor of the ovary with high FDG uptake. Clin Nucl Med. 2013;38(7):553–6.
Raj G, Proietto A, Jaaback K. Positron emission tomography and granulosa cell tumor recurrence: a report of 2 cases. Int J Gynecol Cancer. 2009;19(9):1542–4.
Garcia AA, Morrow CP. Stromal tumors of the ovary. In: Raghavan D, Brecher M, Johnson DH, et al., editors. Textbook of uncommon cancer. 2nd ed. New York: Wiley; 1999.
Schumer ST, Cannistra SA. Granulosa cell tumor of the ovary. J Clin Oncol. 2003;21:1180–9.
Shim SH, Kim DY, Lee SW, et al. Laparoscopic management of early-stage malignant non-epithelial ovarian tumors: surgical and survival outcomes. Int J Gynecol Cancer. 2013;23(2):249–55.
Evans AT, Gaffey TA, Malkasian GDJ, et al. Clinicopathologic review of 118 granulosa and 82 theca cell tumors. Obstet Gynecol. 1980;55:231–8.
Zanagnolo V, Pasinetti B, Sartori E. Clinical review of 63 cases of sex cord stromal tumors. Eur J Gynecol Oncol. 2004;25:431–8.
Zhang M, Cheung MK, Shin JY, et al. Prognostic factors responsible for survival in sex cord stromal tumors of the ovary: an analysis of 376 women. Gynecol Oncol. 2007;104(2):396–400. Epub 2006 Oct 9.
Mahdi H, Swensen RE, Hanna R. Prognostic impact of lymphadenectomy in clinically early stage malignant germ cell tumour of the ovary. Br J Cancer. 2011;105(4):493.
Brown J, Sood AK, Deavers MT, et al. Patterns of metastasis in sex cord-stromal tumors of the ovary: can routine staging lymphadenectomy be omitted? Gynecol Oncol. 2009;113(1):86–90.
Abu-Rustum NR, Restivo A, Ivy J, et al. Retroperitoneal nodal metastasis in primary and recurrent granulosa cell tumors of the ovary. Gynecol Oncol. 2006;103:31–4.
Ranganath R, Sridevi V, Shirley SS, et al. Clinical and pathologic prognostic factors in adult granulose cell tumors of the ovary. Int J Gynecol Cancer. 2008;18(5):929–33.
Schneider DT, Calaminus G, Wessalowski R, et al. Ovarian sex cord-stromal tumors in children and adolescents. J Clin Oncol. 2003;21:2357–63.
Homesley HD, Bundy BN, Hurteau JA, et al. Bleomycin, etoposide, and cisplatin combination therapy of ovarian granulosa cell tumors and other stromal malignancies: a Gynecologic Oncology Group study. Gynecol Oncol. 1999;72:131–7.
Gershenson DM. Current advances in the management of malignant germ cell and sex cord stromal tumors of the ovary. Gynecol Oncol. 2012;125:515–7.
Mangili G, Sigismondi C, Frigerio L, et al. Recurrent granulosa cell tumors (GCTs) of the ovary: a MITO-9 retrospective study. Gynecol Oncol. 2013;130:38–42.
Zambetti M, Escobedo A, Pilotti S, et al. Cisplatinum/vinblastine/bleomycin combination chemotherapy in advanced or recurrent granulosa cell tumors of the ovary. Gynecol Oncol. 1990;36:317–20.
Jacobs HJ, Deppe G, Cohen CJ. Combination chemotherapy of ovarian granulosa cell tumor with cisplatinum and doxorubicin. Gynecol Oncol. 1982;14:294.
Pecorelli S, Wagenaar HC, Vergote IB, et al. Cisplatin, vinblastine, and bleomycin combination chemotherapy in recurrent or advanced granulose cell tumor of the ovary: an EORTC Gynecologic Cancer Cooperative Group study. Eur J Cancer. 1999;35:1331–7.
Gershenson DM, Morris M, Burke TW, et al. Treatment of poor-prognosis sex cord-stromal tumors of the ovary with the combination of bleomycin, etoposide and cisplatin. Obstet Gynecol. 1996;87:527–31.
Wolf JK, Brown J. Management of stromal tumors of the ovary. ASCO. 2008;2008 Educational Book.
Gershenson DM, Copeland LJ, Kavanagh JJ, et al. Treatment of metastatic stromal tumors of the ovary with cisplatin, doxorubicin and cyclophosphamide. Obstet Gynecol. 1987;70:765–9.
Colombo N, Sessa C, Landoni F, et al. Cisplatin, vinblastine, and bleomycin combination chemotherapy in metastatic granulosa cell tumor of the ovary. Obstet Gynecol. 1986;67:265–8.
Tresukosol D, Kudelka AP, Edwards CL, et al. Recurrent ovarian granulosa cell tumor: a case report of a dramatic response to taxol. Int J Gynecol Cancer. 1995;5:156–9.
Brown J, Shvartsman HS, Deavers MT, et al. The activity of taxanes compared with bleomycin, etoposide and cisplatin in the treatment of sex cord stromal ovarian tumors. Gynecol Oncol. 2005;97:489–96.
Paclitaxel and carboplatin or bleomycin sulfate, etoposide phosphate, and cisplatin in treating patients with advanced or recurrent sex cord-ovarian stromal tumors. Available at: www.clinicaltrials.gov/ct2/show/NCT01042522.
Tao X, Sood AK, Deavers MT, et al. Anti-angiogenesis therapy with bevacizumab for patients with ovarian granulosa cell tumors. Gynecol Oncol. 2009;114:431–6.
Brown J, Brady WE, Schink J, et al. Efficacy and safety of bevacizumab in recurrent sex cord stromal ovarian tumours. Cancer. 2014;120(3):344–51.
Wolf JK, Mullen J, Eifel PJ, et al. Radiation treatment of advanced or recurrent granulosa cell tumor of the ovary. Gynecol Oncol. 1999;73:35–41.
Korach J, Perri T, Beiner M, et al. Promising effect of aromatase inhibitors on recurrent granulosa cell tumors. Int J Gynecol Cancer. 2009;19:830–3.
Garrett A, Quinn MA. Hormonal therapies and gynecological cancers. Best Pract Res Clin Obstet Gynaecol. 2008;22:407–21.
Freeman SA, Modesitt SC. Anastrozole therapy in recurrent ovarian adult granulose cell tumors: a report of 2 cases. Gynecol Oncol. 2006;103:755–8.
Hardy RD, Bell JG, Nicely CJ, et al. Hormonal treatment of a recurrent granulosa cell tumor of the ovary: case report and review of the literature. Gynecol Oncol. 2005;96:865–9.
Briasoulis E, Karavasilis V, Pavlidis N. Megestrol activity in recurrent adult type granulosa cell tumour of the ovary. Ann Oncol. 1997;8:811–2.
Fishman A, Kudelka AP, Tresukosol D, et al. Leuprolide acetate for treating refractory or persistent ovarian granulosa cell tumor. J Reprod Med. 1996;41:393–6.
Hs VM, van Lonkhuijzen LR, Limpens J, et al. Hormone therapy in ovarian granulosa cell tumors: a systematic review. Gynecol Oncol. 2014;134(1):196–205.
Sommeijer DW, Sjoquist KM, Friedlander M. Hormonal treatment in recurrent and metastatic gynaecological cancers: a review of the current literature. Curr Oncol Rep. 2013;15(6):541–8.
Lee IH, Choi CH, Hong DG, Song JY, Kim YJ, Kim KT. Clinicopathologic characteristics of granulosa cell tumors of the ovary: a multicenter retrospective study. J Gynecol Oncol. 2011;22:188–95.
Shah SP, Köbel M, Senz J, et al. Mutation of FOXL2 in granulosa-cell tumors of the ovary. N Engl J Med. 2009;360:2719–29.
Sun HD, Lin H, Jao MS, Wang KL, et al. A long-term follow-up study of 176 cases with adult-type ovarian granulosa cell tumors. Gynecol Oncol. 2012;24:244–9.
Park JY, Jin KL, Kim DY, et al. Surgical staging and adjuvant chemotherapy in the management of patients with adult granulosa cell tumors of the ovary. Gynecol Oncol. 2012;125:80–6.
Chan JK, Zhang M, Kaleb V, et al. Prognostic factors responsible for survival in sex cord stromal tumors of the ovary a multivariate analysis. Gynecol Oncol. 2005;96:204–9.
Ayhan A, Salman MC, Velipasaoglu M, et al. Prognostic factors in adult granulosa cell tumors of the ovary: a retrospective analysis of 80 cases. J Gynecol Oncol. 2009;20:158–63.
Koukourakis GV, Kouloulias VE, Koukourakis MJ, et al. Granulosa cell tumor of the ovary: tumor review. Integr Cancer Ther. 2008;7:204–15.
Stewart CJ, Doherty D, Guppy R, et al. b-Catenin and E-cadherin expression in stage I adult-type granulosa cell tumour of the ovary: correlation with tumour morphology and clinical outcome. Histopathology. 2013;62:257–66.
Young RH, Scully RE. Sex cord-stromal, steroid cell, and other ovarian tumor with endocrine, paracrine, and paraneoplastic manifestation. In: Blaustein’s pathology of the female genital tract. 5th ed. New York: Springer; 2002.
Young RH, Scully RE. Ovarian Sertoli-Leydig cell tumors: a clinicopathological analysis of 207 cases. Am J Surg Pathol. 1985;9:543.
Hines JF, Khalifa MA, Moore JL, et al. Recurrent granulosa cell tumor of the ovary 37 years after initial diagnosis: a case report and review of the literature. Gynecol Oncol. 1996;60:484–8.
Fujimoto T, Sakuragi N, Okuyama K, et al. Histopathologic prognostic factors of adult granulose cell tumors of the ovary. Acta Obstet Gynecol Scand. 2001;80:1069–74.
Lauszus FF, Peterson AC, Greisen J, et al. Granulosa cell tumor of the ovary: a population based study of 37 women with stage I disease. Gynecol Oncol. 2001;81:456–60.
Miller BE, Barron BA, Wan JY, et al. Prognostic factors in adult granulosa cell tumors of the ovary. Cancer. 1997;79:1951–5.
Färkkilä A, Koskela S, Bryk S, et al. The clinical utility of serum anti-MĂ¼llerian hormone in the follow-up of ovarian adult-type granulosa cell tumors-a comparative study with inhibin B. Int J Cancer. 2015;137(7):1661–71.
Colombo N, Peiretti M, Garbi A, et al. ; ESMO Guidelines Working Group. Non-epithelial ovarian cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2012;23(Suppl 7):vii20–6.
Burger HG, Fuller PJ, Chu S, et al. The inhibins and ovarian cancer. Mol Cell Endocrinol. 2001;180:145–8.
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Garbi, A., Achilarre, M.T., Colombo, N. (2017). Ovarian Sex Cord Tumors. In: Pujade-Lauraine, E., Ray-Coquard, I., LĂ©curu, F. (eds) Ovarian Cancers. Springer, Cham. https://doi.org/10.1007/978-3-319-32110-3_19
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