Indian Journal of Surgical Oncology

, Volume 4, Issue 1, pp 37–47 | Cite as

Recent Advances in Granulosa Cell Tumor Ovary: A Review

  • Vijaykumar Dehannathparambil Kottarathil
  • Michelle Aline Antony
  • Indu R. Nair
  • Keechilat Pavithran
Review Article


Granulosa cell tumors constitute less than 5 % of all ovarian tumors. Unlike epithelial ovarian tumors, they occur in a younger age group, are usually detected in an early stage and often have features of hyperestrogenism. The presenting symptoms are usually nonspecific with abdominal pain or distension. They follow an indolent course and are characterized by a long natural history. Mutation of FOXL2 (402C->G) seen in 97 % of adult GCT may be pathognomonic for adult GCT. Only stage of the disease has been consistently shown in various studies to affect survival of patients with GCT. The initial management of patients, for whom fertility is not an issue, is total abdominal hysterectomy, bilateral salpingo-oophorectomy and removal of all gross disease. Nodal dissection is not a significant factor for survival and is not recommended in surgical staging of GCT. Fertility preserving surgery with unilateral salpingo-oophorectomy is feasible in young patients with stage Ia GCT. Patients with early stage disease (stage I and II) have a very good prognosis with 5 year DFS and OS of 89 % and 99 % respectively and these groups of patients usually don’t require any postoperative treatment. Patients with stage Ic disease associated with poor prognostic factors like large tumor size or high mitotic index and stage II, have a higher chance of relapse, and may benefit with postoperative treatment but role of chemotherapy is still debatable. In advanced stage disease (stage III and IV) the 5 year DFS and OS disease was 72 % and 80 % respectively hence the option of postoperative treatment with 6 cycles of BEP should be considered in this group. Recently paclitaxel is being investigated as an effective tool in GCT. The efficacy of radiation in GCT is not well defined but in optimally debulked cases postoperative radiation is a viable option. Due to high chance of recurrence even years after apparent clinical cure of the primary tumor, lifelong follow up with clinical examination and tumor markers like inhibin B is recommended. About 25 % GCT develop recurrence and the median time to recur is usually 4–5 years. Most recurrences are intraperitoneal and usually a complete debulking of the disease is feasible even in the recurrent setting. Postoperative chemotherapy (platinum based) is usually given after surgery more so in cases with widespread disease or after suboptimal cytoreduction. Recurrent chemoresistant, progressive non-responding GCT or patients with high surgical risk are ideal candidates for targeted therapy.


Granulosa cell tumor Inhibin B 


  1. 1.
    Ranganath R, Sridevi V, Shirley SS, Shantha V (2008) Clinical and pathologic prognostic factors in adult granulose cell tumors of the ovary. Int J Gynecol Cancer 18:929–933PubMedCrossRefGoogle Scholar
  2. 2.
    Vimla N, Kumar L, Kumar S, Vijayaraghavan M, Bhatla N, Roopa H (2005) Granulosa cell tumors of the ovary: factors affecting prognosis. Indian J Med Pediatr Oncol 26:12–20Google Scholar
  3. 3.
    Mehta H, Trivedi P, Parikh B, Shukla K (2005) Clinicopathological prognostic factors of adult granulosa cell tumors of the ovary—a study of 37 cases. Indian J Pathol Microbiol 48:439–443PubMedGoogle Scholar
  4. 4.
    Zhang M, Cheung MK, Shin JY, Kapp DS, Husain A, Teng NN, Berek JS, Osann K, Chan JK (2007) Prognostic factors responsible for survival in sex cord stromal tumors of the ovary: an analysis of 376 women. Gynecol Oncol 104:396–400PubMedCrossRefGoogle Scholar
  5. 5.
    Lee IH, Choi CH, Hong DG, Song JY, Kim YJ, Kim KT (2011) Clinicopathologic characteristics of granulosa cell tumors of the ovary: a multicenter retrospective study. J Gynecol Oncol 22:188–195PubMedCrossRefGoogle Scholar
  6. 6.
    Shah SP, Köbel M, Senz J, Morin RD, Clarke BA, Wiegand KC, Leung G, Zayed A, Mehl E, Kalloger SE, Sun M, Giuliany R, Yorida E, Jones S, Varhol R, Swenerton KD, Miller D, Clement PB, Crane C, Madore J, Provencher D, Leung P, DeFazio A, Khattra J, Turashvili G et al (2009) Mutation of FOXL2 in granulosa-cell tumors of the ovary. N Engl J Med 360:2719–2729PubMedCrossRefGoogle Scholar
  7. 7.
    Jamieson S, Fuller PJ (2012) Molecular pathogenesis of granulosa cell tumors of the ovary. Endocr Rev 33:109–144PubMedCrossRefGoogle Scholar
  8. 8.
    Jakob A, Geiger R, Hirsch FW (2002) Successful treatment of a patient with a granulosa/theca cell tumor of the ovary with STI571 (Gleevec). Proc Am Soc Clin Oncol 21:24b, Abstract 1904Google Scholar
  9. 9.
    Tao X, Sood AK, Deavers MT, Schmeler KM, Nick AM, Coleman RL, Milojevic L, Gershenson DM, Brown J (2009) Anti-angiogenesis therapy with bevacizumab for patients with ovarian granulosa cell tumors. Gynecol Oncol 114:431–436PubMedCrossRefGoogle Scholar
  10. 10.
    Kesterson JP, Mhawech-Fauceglia P, Lele S (2008) The use of bevacizumab in refractory ovarian granulosa-cell carcinoma with symptomatic relief of ascites: a case report. Gynecol Oncol 111:527–529PubMedCrossRefGoogle Scholar
  11. 11.
    Barrena Medel NI, Herzog TJ, Wright JD, Lewin SN (2010) Neoadjuvant bevacizumab in a granulosa cell tumor of the ovary: a case report. Anticancer Res 30:4767–4768PubMedGoogle Scholar
  12. 12.
    Farinola MA, Gown AM, Judson K, Ronnett BM, Barry TS, Movahedi-Lankarani S, Vang R (2007) Estrogen receptor and progesterone receptor expression in ovarian adult granulosa cell tumors and Sertoli-Leydig cell tumors. Int J Gynecol Pathol 26:375–382PubMedCrossRefGoogle Scholar
  13. 13.
    Chu S, Alexiadis M, Fuller PJ (2009) Proteasome inhibition by bortezomib decreases proliferation and increases apoptosis in ovarian granulosa cell tumors. Reprod Sci 16:397–407PubMedCrossRefGoogle Scholar
  14. 14.
    Kruyt FA (2008) TRAIL and cancer therapy. Cancer Lett 263:14–25PubMedCrossRefGoogle Scholar
  15. 15.
    Woods DC, Liu HK, Nishi Y, Yanase T, Johnson AL (2008) Inhibition of proteasome activity sensitizes human granulose tumor cells to TRAIL-induced cell death. Cancer Lett 260:20–27PubMedCrossRefGoogle Scholar
  16. 16.
    Lappöhn RE, Burger HG, Bouma J, Bangah M, Krans M, de Bruijn HW (1989) Inhibin as a marker for granulosa-cell tumors. N Engl J Med 321:790–793PubMedCrossRefGoogle Scholar
  17. 17.
    Petraglia F, Luisi S, Pautier P, Sabourin JC, Rey R, Lhomme C, Bidart JM (1998) Inhibin B is the major form of inhibin/activin family secreted by granulosa cell tumors. J Clin Endocrinol Metab 83:1029–1032PubMedCrossRefGoogle Scholar
  18. 18.
    Mom CH, Engelen MJ, Willemse PH, Gietema JA, ten Hoor KA, de Vries EG, van der Zee AG (2007) Granulosa cell tumors of the ovary: the clinical value of serum inhibin A and B levels in a large single center cohort. Gynecol Oncol 105:365–372PubMedCrossRefGoogle Scholar
  19. 19.
    Healy DL, Burger HG, Mamers P, Jobling T, Bangah M, Quinn M, Grant P, Day AJ, Rome R, Campbell JJ (1993) Elevated serum inhibin concentrations in postmenopausal women with ovarian tumors. N Engl J Med 329:1539–1542PubMedCrossRefGoogle Scholar
  20. 20.
    Ala-Fossi SL, Aine R, Punnonen R, Mäenpää J (2000) Is potential to produce inhibins related to prognosis in ovarian granulosa cell tumors? Eur J Gynaecol Oncol 21:187–189PubMedGoogle Scholar
  21. 21.
    Koukourakis GV, Kouloulias VE, Koukourakis MJ, Zacharias GA, Papadimitriou C, Mystakidou K et al (2008) Granulosa cell tumor of the ovary: tumor review. Integr Cancer Ther 7:204–215PubMedCrossRefGoogle Scholar
  22. 22.
    Long WQ, Ranchin V, Pautier P, Belville C, Denizot P, Cailla H, Lhommé C, Picard JY, Bidart JM, Rey R (2000) Detection of minimal levels of serum anti-Mullerian hormone during follow-up of patients with ovarian granulose cell tumor by means of a highly sensitive enzyme-linked immunosorbent assay. J Clin Endocrinol Metab 85:540–544PubMedCrossRefGoogle Scholar
  23. 23.
    Chang HL, Pahlavan N, Halpern EF, MacLaughlin DT (2009) Serum Mullerian inhibiting substance/anti-Mullerian hormone levels in patients with adult granulosa cell tumors directly correlate with aggregate tumor mass as determined by pathology or radiology. Gynecol Oncol 114:57–60PubMedCrossRefGoogle Scholar
  24. 24.
    Anttonen M, Unkila-Kallio L, Leminen A, Butzow R, Heikinheimo M (2005) High GATA-4 expression associates with aggressive behavior, whereas low anti-Mullerian hormone expression associates with growth potential of ovarian granulosa cell tumors. J Clin Endocrinol Metab 90:6529–6535PubMedCrossRefGoogle Scholar
  25. 25.
    Geerts I, Vergote I, Neven P, Billen J (2009) The role of inhibins B and antimullerian hormone for diagnosis and follow-up of granulosa cell tumors. Int J Gynecol Cancer 19:847–855PubMedCrossRefGoogle Scholar
  26. 26.
    Schumer ST, Cannistra SA (2003) Granulosa cell tumor of the ovary. J Clin Oncol 21:1180–1189PubMedCrossRefGoogle Scholar
  27. 27.
    Zhao C, Vinh TN, McManus K, Dabbs D, Barner R, Vang R (2009) Identification of the most sensitive and robust immunohistochemical markers in different categories of ovarian sex cord-stromal tumors. Am J Surg Pathol 33:354–356PubMedCrossRefGoogle Scholar
  28. 28.
    Hauspy J, Beiner ME, Harley I, Rosen B, Murphy J, Chapman W, Le LW, Fyles A, Levin W (2011) Role of adjuvant radiotherapy in granulosa cell tumors of the ovary. Int J Radiat Oncol Biol Phys 79:770–774PubMedCrossRefGoogle Scholar
  29. 29.
    Van der Vorst MJ, Bleeker MC, Boven E (2010) Unusual presentation of Granulosa cell tumour of the ovary. J Clin Oncol 28:e554–e556PubMedCrossRefGoogle Scholar
  30. 30.
    Ko SF, Wan YL, Ng SH, Lee TY, Lin JW, Chen WJ, Kung FT, Tsai CC (1999) Adult ovarian granulosa cell tumors: spectrum of sonographic and CT findings with pathologic correlation. AJR Am J Roentgenol 72:1227–1233Google Scholar
  31. 31.
    Kim SH, Kim SH (2002) Granulosa cell tumor of the ovary: common findings and unusual appearances on CT and MR. J Comput Assist Tomogr 26:756–761PubMedCrossRefGoogle Scholar
  32. 32.
    Chan JK, Zhang M, Kaleb V, Loizzi V, Benjamin J, Vasilev S, Osann K, DiSaia PJ (2005) Prognostic factors responsible for survival in sex cord stromal tumors of the ovary—a multivariate analysis. Gynecol Oncol 96:204–209PubMedCrossRefGoogle Scholar
  33. 33.
    Ayhan A, Salman MC, Velipasaoglu M, Sakinci M, Yuce K (2009) Prognostic factors in adult granulosa cell tumors of the ovary: a retrospective analysis of 80 cases. J Gynecol Oncol 20:158–163PubMedCrossRefGoogle Scholar
  34. 34.
    Sun HD, Lin H, Jao MS, Wang KL, Liou WS, Hung YC, Chiang YC, Lu CH, Lai HC, Yu MH (2012) A long-term follow-up study of 176 cases with adult-type ovarian granulosa cell tumors. Gynecol Oncol 24:244–249CrossRefGoogle Scholar
  35. 35.
    Auranen A, Sundström J, Ijäs J, Grénman S (2007) Prognostic factors of ovarian granulosa cell tumor: a study of 35 patients and review of the literature. Int J Gynecol Cancer 17:1011–1018PubMedCrossRefGoogle Scholar
  36. 36.
    Pectasides D, Papaxoinis G, Fountzilas G, Aravantinos G, Pectasides E, Mouratidou D et al (2008) Adult granulosa cell tumors of the ovary: a clinicopathological study of 34 patients by the Hellenic Cooperative Oncology Group (HeCOG). Anticancer Res 28:1421–1428PubMedGoogle Scholar
  37. 37.
    Sehouli J, Drescher FS, Mustea A, Elling D, Friedmann W, Kühn W, Nehmzow M, Opri F, Klare P, Dietel M, Lichtenegger W (2004) Granulosa cell tumor of the ovary: 10 years follow-up data of 65 patients. Anticancer Res 24:1223–1229Google Scholar
  38. 38.
    Uygun K, Aydiner A, Saip P, Basaran M, Tas F, Kocak Z, Dincer M, Topuz E (2003) Granulosa cell tumor of the ovary retrospective analysis of 45 Cases. Am J Clin Oncol 26:517–521PubMedCrossRefGoogle Scholar
  39. 39.
    Park JY, Jin KL, Kim DY, Kim JH, Kim YM, Kim KR, Kim YT, Nam JH (2012) Surgical staging and adjuvant chemotherapy in the management of patients with adult granulosa cell tumors of the ovary. Gynecol Oncol 125:80–86PubMedCrossRefGoogle Scholar
  40. 40.
    Kyrönlahti A, Rämö M, Tamminen M, Unkila-Kallio L, Butzow R, Leminen A, Nemer M, Rahman N, Huhtaniemi I, Heikinheimo M, Anttonen M (2008) GATA-4 regulates Bcl-2 expression in ovarian granulosa cell tumors. Endocrinology 149:5635–5642PubMedCrossRefGoogle Scholar
  41. 41.
    Thrall MM, Paley P, Pizer E, Garcia R, Goff BA (2011) Patterns of spread and recurrence of sex cord—stromal tumors of the ovary. Gynecol Oncol 122:242–245PubMedCrossRefGoogle Scholar
  42. 42.
    Brown J, Sood AK, Deavers MT, Milojevic L, Gershenson DM (2009) Gynecol Oncol 113:86–90PubMedCrossRefGoogle Scholar
  43. 43.
    Fotopolou C, Savvatis K, Braicu EI, Brink-Spalink V, Darb-Esfahani S (2010) Adult granulosa cell tumors of the ovary: tumor dissemination patern at primary and recurrent situation, surgical outcome. Gynecol Oncol 119:285–290CrossRefGoogle Scholar
  44. 44.
    Abu-Rustum NR, Restivo A, Ivy J, Soslow R, Sabbatini P, Sonoda Y, Barakat RR, Chi DS (2006) Retroperitoneal nodal metastasis in primary and recurrent granulosa cell tumors of the ovary. Gynecol Oncol 103:31–34PubMedCrossRefGoogle Scholar
  45. 45.
    Gershenson DM, Copeland LJ, Kavanagh JJ, Stringer CA, Saul PB, Wharton JT (1987) Treatment of metastatic stromal tumors of the ovary with cisplatin, doxorubicin, and cyclophosphamide. Obstet Gynecol 70:765–769PubMedGoogle Scholar
  46. 46.
    Pectasides D, Alevizakos N, Athanassiou AE (1992) Cisplatin-containing regimen in advanced or recurrent granulosa cell tumours of the ovary. Ann Oncol 3:316–318PubMedGoogle Scholar
  47. 47.
    Uygun K, Aydiner A, Saip P, Kocak Z, Basaran M, Dincer M, Topuz E (2003) Clinical parameters and treatment results in recurrent granulosa cell tumor of the ovary. Gynecol Oncol 88:400–403PubMedCrossRefGoogle Scholar
  48. 48.
    Colombo N, Sessa C, Landoni F, Sartori E, Pecorelli S, Mangioni C (1986) Cisplatin, vinblastine, and bleomycin combination chemotherapy in metastatic granulosa cell tumor of the ovary. Obstet Gynecol 67:265–268PubMedCrossRefGoogle Scholar
  49. 49.
    Zambetti M, Escobedo A, Pilotti S, De Palo G (1990) cisplatinum/vinblastine/bleomycin combination chemotherapy in advanced or recurrent granulosa cell tumors of the ovary. Gynecol Oncol 36:317–320PubMedCrossRefGoogle Scholar
  50. 50.
    Pecorelli S, Wagenaar HC, Vergote IB, Curran D, Beex LVA, Witshaw E et al (1999) Cisplatin (P), vinblastine (V) and bleomycin (B) combination chemotherapy in recurrent or advanced granulosa (-theca) cell tumours of the ovary. An EORTC Gynaecological Cancer Cooperative Group Study. Eur J Cancer 35:1331–1337PubMedCrossRefGoogle Scholar
  51. 51.
    Gershenson DM, Morris M, Burke TW, Levenback C, Matthews CM, Wharton JT (1996) Treatment of poor prognosis sex cord-stromal tumors of the ovary with the combination of bleomycin, etoposide, and cisplatin. Obstet Gynecol 87:527–531PubMedCrossRefGoogle Scholar
  52. 52.
    Homesley HD, Bundy BN, Hurteau JA, Roth LM (1999) Bleomycin, etoposide, and cisplatin combination therapy of ovarian granulosa cell tumors and other stromal malignancies: a Gynecologic Oncology Group study. Gynecol Oncol 72:131–137PubMedCrossRefGoogle Scholar
  53. 53.
    Pautier P, Gutierrez-Bonnaire M, Rey A, Sillet-Bach I, Chevreau C, Kerbrat P, Morice P, Duvillard P, Lhommé C (2008) Combination of bleomycin, etoposide, and cisplatin for the treatment of advanced ovarian granulosa cell tumors. Int J Gynecol Cancer 18:446–452PubMedCrossRefGoogle Scholar
  54. 54.
    Brown J, Shvartsman HS, Deavers MT et al (2003) The activity of taxanes compared with bleomycin, etoposide and cisplatin in the treatment of sex cord-stromal ovarian tumors. Gynecol Oncol 97:489–496CrossRefGoogle Scholar
  55. 55.
    Pankratz E, Boyes DA, White GW, Galliford BW, Fairey RN, Benedet JL (1978) Granulosa cell tumors. A clinical review of 61 cases. Obstet Gynecol 52:718–723PubMedGoogle Scholar
  56. 56.
    Savage P, Constenla D, Fisher C, Shepherd JH, Barton DP, Blake P, Gore ME (1998) Granulosa cell tumours of the ovary: demographics, survival and the management of advanced disease. Clin Oncol (R Coll Radiol) 10:242–245CrossRefGoogle Scholar
  57. 57.
    Wolf JK, Mullen J, Eifel PJ et al (1999) Radiation treatment of advanced or recurrent granulosa cell tumor of the ovary. Gynecol Oncol 73:35–41PubMedCrossRefGoogle Scholar
  58. 58.
    East N, Alobaid A, Goffin F, Ouallouche K, Gauthier P (2005) Granulosa cell tumour: a recurrence 40 years after initial diagnosis. J Obstet Gynaecol Cancer 27:363–364Google Scholar
  59. 59.
    Crew KD, Cohen MH, Smith DH, Tiersten AD, Feirt NM, Hershman DL (2005) Long natural history of recurrent granulosa cell tumor of the ovary 23 years after initial diagnosis: a case report and review of the literature. Gynecol Oncol 96:235–240PubMedCrossRefGoogle Scholar
  60. 60.
    Lordan JT, Jones RL, Karanjia ND, Butler-Manuel S (2007) Debulking hepatectomy for an unusual case of a grade 1 stage 1 granulosa cell tumour of the ovary with late metastases. Oncology 72:143–144PubMedCrossRefGoogle Scholar
  61. 61.
    Lee IW, Levin W, Chapman W, Goldberg RE, Murphy KJ, Milosevic M (1999) Radiotherapy for the treatment of metastatic granulosa cell tumor in the mediastinum: a case report. Gynecol Oncol 73:455–460PubMedCrossRefGoogle Scholar
  62. 62.
    Choan E, Samant R, Fung M, Fung K, Le T, Hopkins L, Senterman M (2006) Palliative radiotherapy for recurrent granulosa cell tumor of the ovary: a report of 3 cases with radiological evidence of response. Gynecol Oncol 102:406–410CrossRefGoogle Scholar
  63. 63.
    Lee YK, Park NH, Kim JW, Song YS, Kang SB, Lee HP (2008) Characteristics of recurrence in adult-type granulose cell tumor. Int J Gynecol Cancer 18:642–647PubMedCrossRefGoogle Scholar
  64. 64.
    Tresukosol D, Kudelka AP, Edwards CL, Charnsangavej C, Narboni N, Kavanagh JJ (1995) Recurrent ovarian granulosa cell tumor: a case report of a dramatic response to Taxol. Int J Gynecol Oncol 5:156–159CrossRefGoogle Scholar
  65. 65.
    Malik ST, Slevin ML (1991) Medroxyprogesterone acetate (MPA) in advanced granulosa cell tumours of the ovary: a new therapeutic approach? Br J Cancer 63:410–411PubMedCrossRefGoogle Scholar
  66. 66.
    Isaacs R, Forgeson G, Allan S (1992) Progestagens for granulosa cell tumours of the ovary. Br J Cancer 65:140PubMedCrossRefGoogle Scholar
  67. 67.
    Briasoulis E, Karavasilis V, Pavlidis N (1997) Megestrol activity in recurrent adult type granulosa cell tumour of the ovary. Ann Oncol 8:811–812PubMedCrossRefGoogle Scholar
  68. 68.
    Hardy RD, Bell JG, Nicely CJ, Reid GC (2005) Hormonal treatment of a recurrent granulosa cell tumor of the ovary: case report and review of the literature. Gynecol Oncol 96:865–869PubMedCrossRefGoogle Scholar
  69. 69.
    Freeman SA, Modesitt SC (2006) Anastrozole therapy in recurrent ovarian adult granulosa cell tumors: a report of 2 cases. Gynecol Oncol 103:755–758PubMedCrossRefGoogle Scholar
  70. 70.
    Abdul Munem A, Al-Bahrani B, Mehdi I, Kamona A, Nadas AM (2012) Aromatase inhibitors—a viable option for recurrent granulose cell tumour of ovary: overview and case report. J Pak Med Assoc 62:505–507Google Scholar
  71. 71.
    Korach J, Perri T, Beiner M, Davidzon T, Fridman E, Ben-Baruch G (2009) Promising effect of aromatase inhibitors on recurrent granulosa cell tumors. Int J Gynecol Cancer 19:830–833PubMedCrossRefGoogle Scholar
  72. 72.
    AlHilli MM, Long HJ, Podratz KC, Bakkum-Gamez JN (2012) Aromatase inhibitors in the treatment of recurrent ovarian granulosa cell tumors: brief report and review of the literature. J Obstet Gynaecol Res 38:340–344PubMedCrossRefGoogle Scholar
  73. 73.
    Martikainen H, Penttinen J, Huhtaniemi I, Kauppila A (1989) Gonadotropin-releasing hormone agonist analog therapy effective in ovarian granulosa cell malignancy. Gynecol Oncol 35:406–408PubMedCrossRefGoogle Scholar
  74. 74.
    Fishman A, Kudelka AP, Tresukosol D, Edwards CL, Freedman RS, Kaplan AL, Girtanner RE, Kavanagh JJ (1996) Leuprolide acetate for treating refractory or persistent ovarian granulosa cell tumor. J Reprod Med 41:393–396PubMedGoogle Scholar
  75. 75.
    Kim HJ, Lee S-C, Bae SB, Kwon KW, Kim CK, Lee NS et al (2009) GnRH agonist therapy in a patient with recurrent ovarian granulosa cell tumors. J Korean Med Sci 24:535–538PubMedCrossRefGoogle Scholar
  76. 76.
    Schwartz PE, MacLusky N, Sakamoto H, Eisenfeld A (1983) Steroid receptor proteins in nonepithelial malignancies of the ovary. Gynecol Oncol 15:305–315PubMedCrossRefGoogle Scholar
  77. 77.
    Kauppila A, Bangah M, Burger H, Martikainen H (1992) GnRHagonist analog therapy in advanced/recurrent granulose cell tumors: further evidence of a role of inhibin in monitoring response to treatment. Gynecol Endocrinol 6:271–274PubMedCrossRefGoogle Scholar
  78. 78.
    Maxwell GL, Soisson AP, Miles P (1994) Failure of gonadotropin releasing hormone therapy in patients with metastatic ovarian sex cord stromal tumors. Oncology 51:356–359PubMedCrossRefGoogle Scholar
  79. 79.
    Ameryckx L, Fatemi HM, De Sutter P, Amy JJ (2005) GnRH antagonist in the adjuvant treatment of a recurrent ovarian granulosa cell tumor: a case report. Gynecol Oncol 99:764–766PubMedCrossRefGoogle Scholar
  80. 80.
    Adams J (2004) The proteasome: a suitable antineoplastic target. Nat Rev Cancer 4:349–360PubMedCrossRefGoogle Scholar

Copyright information

© Indian Association of Surgical Oncology 2012

Authors and Affiliations

  • Vijaykumar Dehannathparambil Kottarathil
    • 1
    • 2
  • Michelle Aline Antony
    • 3
  • Indu R. Nair
    • 4
  • Keechilat Pavithran
    • 5
  1. 1.Department of Surgical OncologyAmrita Institute of Medical Sciences and Research Centre, Amrita Vishwa VidyapeethamKochiIndia
  2. 2.KochiIndia
  3. 3.Gynecologic Oncology, Department of Surgical OncologyAmrita Institute of Medical Sciences and Research Centre, Amrita Vishwa VidyapeethamKochiIndia
  4. 4.Department of PathologyAmrita Institute of Medical Sciences and Research Centre, Amrita Vishwa VidyapeethamKochiIndia
  5. 5.Department of Medical OncologyAmrita Institute of Medical Sciences and Research Centre, Amrita Vishwa VidyapeethamKochiIndia

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