Juvenile Granulosa Cell Tumour of Ovary in Young Females- A Clinico-pathological Evaluation of 11 Patients

Abstract

Introduction: Ovarian sex cord-stromal tumours, including Granulosa Cell Tumours (GCTs), are a group of neoplasm that occurs rarely, especially in children. Only 0.1% of all ovarian tumours and 4-5% of GCTs occur in children. They commonly present as precocious puberty especially in prepubertal girls. Aim: To analyse the clinico-pathological features along with the laboratory findings of ovarian mass. Materials and Methods: A prospective study in tertiary care teaching institutions was carried out during a three year study period starting from April 2017 to March 2020. The study was carried out in tertiary care teaching institutions i.e., VCSGG Medical Sciences and Research Institute, Srinagar Garhwal, PauriGarhwal, Doon Medical College, Dehradun and Rohilkhand Medical College, Bareilly. A total of 11 cases of Juvenile Granulosa Cell Tumour (JGCT) among girls in the age group of 5-13 years who presented with precocious puberty were included in the present study. The results were analysed especially the clinico-laboratory parameters including histopathology and Immunohistochemistry (IHC) findings. All the patients underwent resection of the ovarian mass and were subjected to histopathological examination. Microscopy and IHC was compatible with the diagnosis of juvenile GCT in all the 11 cases. Results: Majority of the patients with GCTs of the ovary presented in the early stage. Of the 11 cases included, only one patient was aged 13 years; seven were in the age group of 5-8 years and three in the 9-12 years of age group. The laboratory profile in all showed an elevated Estradiol level, low Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH) levels. Among the thyroid profile only the Triiodothyronine (T3) levels were raised while Thyroid Stimulating Hormone (TSH) and Thyroxine (T4) levels were within normal limits. All cases were histopathologically proved and confirmed using IHC markers. Surgery is the primary treatment modality for GCTs. Conclusion: Histopathology along with specific IHC is important in the diagnosis of JGCT. A careful search provides good insight of the tumour and its final outcome. Diagnosing JGCT especially in the early stage is important as they carry a favourable prognosis when treated in the initial phase.

Keywords

• girls
• inhibin
• sex-cord stromal