Review Question - QID 100501

The image depicts a granulosa cell tumor of the ovary. Granulosa cell tumors secrete estrogen, which can result in endometrial hyperplasia.

As seen in the image, granulosa cell tumors contain Call-Exner bodies, small follicles filled with pink eosinophilic fluid. Cells are referred to as "coffee-bean shaped" due to their central groove. In addition to endometrial hyperplasia, granulosa cell tumors may cause uterine bleeding or result in precocious puberty in children. Granulosa cell tumors are a type of sex-cord stromal tumor. Sex-cord stromal tumors comprise 5-10% of all ovarian cancers, and also include theca cell tumors in women.

Roett et al. describe ovarian cancers, which tend to present in women older than 50 years old. Patients often present with nonspecific pelvic or abdominal symptoms. Initial diagnostic tests include transvaginal ultrasonography and serum cancer antigen (CA) 125 measurement; however, these tests are not specific for ovarian cancer. Conventional treatment includes surgical debulking followed by chemotherapy.

Tamura et al. provide a case report of two patients with granuloma cell tumor and review prognosis. About 20-30% of these tumors are malignant. 5-year survival ranges from 95% of those with stage I or II disease to 60% of those with stage III or IV disease. In some patients, relapse may occur 20 to 30 years after initial surgical management of the tumor.

Figure A shows Call-Exner bodies.
Illustration A shows Call-Exner bodies to the right and highlights the coffee-bean shaped cells typical of granulosa cell tumors to the left.

Incorrect answers:
Answer 1: Mature teratomas are not associated with granulosa cell tumors.
Answer 2: CA19-9 is a tumor marker associated with pancreatic cancer.
Answer 4: Because granulosa cell tumors result in a hyperestrogenemic state, vaginal atrophy is an unlikely result.
Answer 5: Pregnancy is not suggested by the presence of Call-Exner bodies on biopsy.