Granulosa Cell Tumors: Symptoms and Treatment 

Granulosa cell tumours (GCTs) represent a rare subset of ovarian neoplasms derived from sex-cord stromal tissue. These tumours are predominantly observed in adult women, albeit with occurrences in juvenile cases. A nuanced understanding of GCTs, including their aetiology, symptomatology, diagnostic protocols, and treatment modalities, is imperative for effective management and patient care.

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What Are Granulosa Cell Tumors?

Granulosa cell tumours are classified under the umbrella of sex-cord stromal tumours, accounting for approximately 2-5% of all ovarian cancers. They are characterized by their slow growth and potential for late relapse, making long-term monitoring crucial.

Causes of Granulosa Cell Tumor

The precise etiology of granulosa cell tumours remains elusive. However, research suggests a multifactorial origin involving genetic predispositions and hormonal influences. Mutations in the FOXL2 gene have been frequently associated with adult-type GCTs, indicating a possible genetic underpinning. Additionally, hormonal fluctuations during the reproductive years may contribute to tumorigenesis, although definitive causal links remain unconfirmed.

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Granulosa Cell Tumor Symptoms

The clinical presentation of granulosa cell tumours can vary significantly based on the tumour's size, location, and extent of hormonal activity. Commonly reported symptoms include:

In some cases, the tumour may be asymptomatic and discovered incidentally during routine imaging or surgical procedures.

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Diagnosis of Granulosa Cell Tumor

Accurate diagnosis of granulosa cell tumours necessitates a combination of clinical evaluation, imaging, and histopathological analysis.

Imaging Techniques

Transvaginal ultrasound often serves as the initial imaging modality, offering detailed visualization of ovarian structures. In cases where further delineation is required, magnetic resonance imaging (MRI) or computed tomography (CT) scans may be employed to evaluate tumour extent and potential metastasis.

Histopathological Examination

Definitive diagnosis hinges on histological examination following surgical biopsy or resection. Characteristic features observed under microscopy include Call-Exner bodies and coffee bean nuclei, which are indicative of granulosa cell tumours.

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Treatment Options for Granulosa Cell Tumor

The therapeutic approach to granulosa cell tumours is predominantly surgical, supplemented by adjuvant therapies in cases of advanced disease or recurrence.

Surgical Treatment for Granulosa Cell Tumor

Surgical intervention is the cornerstone of treatment, with the primary aim of complete tumour excision. The extent of surgery is tailored to the individual patient based on factors such as age, tumour stage, and desire for fertility preservation. Common procedures include:

Adjuvant Therapies

In instances where complete surgical resection is not feasible, or in cases of recurrence, adjuvant therapies such as chemotherapy or radiotherapy may be considered. However, the efficacy of these treatments in granulosa cell tumours is not well-established, necessitating further clinical research.

Management of Granulosa Cell Tumor

Long-term management of granulosa cell tumours involves vigilant follow-up due to the propensity for late recurrence. Regular monitoring through imaging and serum marker assessments, such as inhibin levels, is critical in detecting recurrences at an early, treatable stage.

Prognosis and Survival Rates

The prognosis for granulosa cell tumours is generally favourable, with an overall survival rate exceeding 90% in early-stage disease. However, the risk of recurrence persists, underscoring the importance of ongoing surveillance.