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Resumen
Los tumores de células de la granulosa ovárica deladulto son interesantes, debido a su comportamientoimpredecible y a su capacidad de producir hormonas, que puede originar alteraciones en otros órganos delaparato genital. El curso clínico de los tumores de células de la granulosa ovárica se caracteriza por su curso indolente, que tiende a la recurrencia tardía.
Presentamos el caso de una paciente de 82 añoscon un gran tumor primario de células de la granulosa, complicado con shock hipovolémico causado porepisodio metrorrágico y sangrado de metástasis pleurales.
En este artículo se discuten el caso y la bibliografíarelativa a las características clínicas y epidemiologíade estos tumores, así como su diagnóstico, pronósticoy modalidades terapéuticas.
Abstract
Adult ovarian granulosa cell tumours (OCGT) are interesting due to their unpredictable behaviour and capacity to produce hormones, which may cause alterations in other organs of the genital tract. The clinical course of ovarian granulosa cell tumours is charecterized by its slow course, and tendency to late recurrence.
We present the case of an 82 year old woman with a large primary granulosa cell tumour, complicated by hypovolaemic shock caused by a metrorrhagic episode and bleeding from pleural metastases.
This case, and the literature relevant to the clinical characteristics and epidemiology of these tumours is discussed in this article. Also, their diagnosis, prognosis, and therapeutic characteristics.
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Bibliografía
[1.]
G. Martellotto, S. Frede, S. Ortiz, E. Hliba.
Granulosa cell tumors: structural and ultrastructural analysis.
Rev Fac Cien Med Univ Nac Cordoba, 58 (2001), pp. 117-123
[2.]
I. Van den Berghe, P. Dal Cin, K. De Groef, P. Michielssen, H. Van den Berghe.
Monosomy 22 and trisomy 14 may be early events in the tumorigenesis of adult granulosa cell tumor.
Cancer Genet Cytogenet, 112 (1999), pp. 46-48
[3.]
AT Evans 3rd, T.A. Gaffey, GD Jr Malkasian, J.F. Annegers.
Clinicopathologic review of 118 granulosa and 82 theca cell tumors.
Obstet Gynecol, 55 (1980), pp. 231-238
[4.]
G. Ohel, H. Kaneti, J.G. Schenker.
Granulosa cell tumors in Is-rael: a study of 172 cases.
Gynecol Oncol, 15 (1983), pp. 278-286
[5.]
I.S. Chua, K.T. Tan, S.K. Lim-Tan, T.H. Ho.
A clinical review of granulosa cell tumours of the ovary cases in KKH.
Sin-gapore Med J, 42 (2001), pp. 203-207
[6.]
F.F. Lauszus, A.C. Petersen, J. Greisen, A. Jakobsen.
Granulosa cell tumor of the ovary: a population-based study of 37 women with stage I disease.
Gynecol Oncol, 81 (2001), pp. 456-460
[7.]
L. Unkila-Kallio, A. Tiitinen, T. Wahlstrom, P. Lehtovirta, A. Leminen.
Reproductive features in women developing ovarian granulosa cell tumour at a fertile age.
Hum Reprod, 15 (2000), pp. 589-593
[8.]
W. Volders, M. Billen, P. Claes, J. Gelin, Y. Palmers.
Granulosa cell tumor of the ovary.
J Belge Radiol, 81 (1998), pp. 256
[9.]
A.M. Kovrigina, O.A. Anurova, M.A. Shabanov, V.N. Bogatyrev.
Cytomorphological diagnosis of granulosa cell tumor of the ovary.
Klin Lab Diagn, 1 (1998), pp. 37-39
[10.]
K. Krommer, P. Gocze, Z. Garamvolgyi, K. Kovacs, I. Szabo.
Therapeutic results in patients with malignant granulosa cell tumors at the Gynecologic Clinic of the City of Pecs.
Orv Hetil, 140 (1999), pp. 1583-1586
[11.]
N.J. Mulvany, C.B. Riley.
Granulosa cell tumors of unilocular cystic type.
Pathology, 29 (1997), pp. 348-353
[12.]
R.A. Sayegh, R. DeLellis, J. Alroy, R. Lechan, H.G. Ball.
Masculinizing granulosa cell tumor of the ovary in a postmeno-pausal woman. A case report.
J Reprod Med, 44 (1999), pp. 821-825
[13.]
P.A. Poma.
Hemoperitoneum in a postmenopausal woman.
J Natl Med Assoc, 90 (1998), pp. 317-319
[14.]
K.K. Vesco, M.E. Carney.
Granulosa cell tumor of the ovary: extensive late recurrence after initial occult microscopic disease.
Obstet Gynecol, 99 (2002), pp. 888-891
[15.]
J. Gyuris, I. Poller, M. Felber.
Spinal metastasis from ovarian granulosa cell tumor—after 23 years.
Orv Hetil, 135 (1994), pp. 1701-1703
[16.]
J.F. Hines, M.A. Khalifa, J.L. Moore, K.P. Fine, J.M. Lage, W.A. Barnes.
Recurrent granulosa cell tumor of the ovary 37 years after initial diagnosis: a case report and review of the literature.
Gynecol Oncol, 60 (1996), pp. 484-488
[17.]
R.J. Williams, H.M. Kamel, A.N. Jilaihawi, D. Prakash.
Metas-tatic granulosa cell tumour of the diaphragm 15 years after the primary neoplasm.
Eur J Cardiothorac Surg, 19 (2001), pp. 516-518
[18.]
K. Morikawa, H. Hatabu, K. Togashi, M.L. Kataoka, T. Mori, J. Konishi.
Granulosa cell tumor of the ovary: MR findings.
Comput Assist Tomogr, 21 (1997), pp. 1001-1004
[19.]
E. Sfar, Z. Rhimi, S. Boubaker, A. Eloufir, H. Chelli, M. Kharouf, M. Challi.
The anatomoclinical characteristics of granulosa tumors observed at the maternity unit of Rabta-Tunisia. Review of the literature.
J Gynecol Obstet Biol Reprod (Pa-ris, 21 (1992), pp. 37-44
[20.]
D. Baumann, H. Donat, M. Bohme, E. Lenz.
Clinical experiences with treatment of granulosa cell tumors.
Zentralbl Gynakol, 114 (1992), pp. 361-364
[21.]
K.W. Schweppe, F.K. Beller.
Clinical data of granulosa cell tumors.
J Cancer Res Clin Oncol, 104 (1982), pp. 161-169
[22.]
E. Bjorkholm, F. Pettersson.
Granulosa-cell and theca-cell tumors. The clinical picture and long-term outcome for the Radiumhemmet series.
Acta Obstet Gynecol Scand, 59 (1980), pp. 361-365
[23.]
M.J. Costa, P.F. Ames, J. Walls, L.M. Roth.
Inhibin immunohis-tochemistry applied to ovarian neoplasms: a novel, effective, diagnostic tool.
Hum Pathol, 28 (1997), pp. 1247-1254
[24.]
K. Papathanasiou, C. Papageorgiou, D. Tsonoglou.
A case of Meigs’ syndrome with a gigantic granulosa ovarian tumor.
Clin Exp Obstet Gynecol, 25 (1998), pp. 61-63
[25.]
F. Martin, S. Brouche, A. Haidar.
Demons-Meigs’ syndrome.Report of a case with ovarian tumor of the granulosa.
Rev Pneumol Clin, 46 (1990), pp. 123-124
[26.]
E. Bjorkholm, C. Silfversward.
Granulosa- and theca-cell tumors. Incidence and occurrence of second primary tumors.
Acta Radiol Oncol, 19 (1980), pp. 161-167
[27.]
F.F. Lauszus, A.C. Petersen, J. Greisen, A. Jakobsen.
Granulosa cell tumor of the ovary: a population-based study of 37 women with stage I disease.
Gynecol Oncol, 81 (2001), pp. 456-460
[28.]
H. Hiroi, M. Momoeda, N. Yamauchi, Y. Abe, H. Yoshikawa, O. Tsutsumi, et al.
An earlier menopause as clinical manifestation of granulosa-cell tumor: a case report.
J Obstet Gynaecol Res, 26 (2000), pp. 9-12
[29.]
N. Nakashima, R.H. Young, R.E. Scully.
Androgenic granulo-sa cell tumors of the ovary. A clinicopathologic analysis of 17 cases and review of the literature.
Arch Pathol Lab Med, 108 (1984), pp. 786-791
[30.]
J. Jarabak, A. Talerman.
Virilization due to a metastasizing granulosa cell tumor.
Int J Gynecol Pathol, 2 (1983), pp. 316-324
[31.]
S.H. Kim, S.H. Kim.
Granulosa cell tumor of the ovary: common findings and unusual appearances on CT and MR.
J Comput Assist Tomogr, 26 (2002), pp. 756-761
[32.]
I.S. Chua, K.T. Tan, S.K. Lim-Tan, T.H. Ho.
A clinical review of granulosa cell tumours of the ovary cases in KKH.
Sin-gapore Med J, 42 (2001), pp. 203-207
[33.]
S.F. Ko, Y.L. Wan, S.H. Ng, T.Y. Lee, J.W. Lin, W.J. Chen, et al.
Adult ovarian granulosa cell tumors: spectrum of sonograp-hic and CT findings with pathologic correlation.
AJR Am J Roentgenol, 172 (1999), pp. 1227-1233
[34.]
E. Aboud.
Adult granulosa cell tumours of the ovary.
Eur J Gynaecol Oncol, 18 (1997), pp. 520-522
[35.]
E. Aboud.
A review of granulosa cell tumours and thecomas of the ovary.
Arch Gynecol Obstet, 259 (1997), pp. 161-165
[36.]
G.K. Nguyen, J. Redburn.
Aspiration biopsy of granulosa-cell tumor of the ovary: cytologic findings and differential diagnosis.
Diagn Cytopathol, 8 (1992), pp. 253-257
[37.]
E.F. Gaffney, B. Majmudar, G.L. Hertzler, R. Zane, B. Furlong, E. Breding.
Ovarian granulosa cell tumorsimmunohistoche-mical localization of estradiol and ultrastructure, with functional correlations.
Obstet Gynecol, 61 (1983), pp. 311-319
[38.]
E. Ahmed, R.H. Young, R.E. Scully.
Adult granulosa cell tumor of the ovary with foci of hepatic cell differentiation: a report of four cases and comparison with two cases of gra-nulosa cell tumor with Leydig cells.
Am J Surg Pathol, 23 (1999), pp. 1089-1093
[39.]
C.B. Drachenberg, S. Mendenhall, J.C. Papadimitriou.
Adult-type granulosa cell tumor, presenting as extraovarian metastases: ultrastructural diagnosis.
Ultrastruct Pathol, 20 (1996), pp. 231-239
[40.]
D. Mayr, C. Kaltz-Wittmer, S. Arbogast, G. Amann, D.E. Aust, J. Diebold.
Characteristic pattern of genetic aberrations in ovarian granulosa cell tumors.
Mod Pathol, 15 (2002), pp. 951-957
[41.]
M.J. Gaffey, HF Jr Frierson, J.C. Iezzoni, S.E. Mills, P.B. Clement, D.J. Gersell, et al.
Ovarian granulosa cell tumors with bizarre nuclei: an immunohistochemical analysis with fluorescence in situ hybridization documenting trisomy 12 in the bizarre component [corrected].
Mod Pathol, 9 (1996), pp. 308-315
[42.]
G.K. Gorski, L.E. McMorrow, L. Blumstein, D. Faasse, M.H. Do-naldson.
Trisomy 14 in two cases of granulosa cell tumor of the ovary.
Cancer Genet Cytogenet, 60 (1992), pp. 202-205
[43.]
E.E. Duhig, R.L. Riha, B.E. Clarke.
Test and teach. An unusual tumour presenting in the lungs. Metastatic adult granulosa cell tumour of the ovary, microfollicular pattterns.
Pathology, 34 (2002), pp. 78-81
[44.]
M. Suzuki, M. Ohwada, Y. Saga, K. Ochiai, I. Sato.
DNA replication error is frequent in ovarian granulosa cell tumors.
Cancer Genet Cytogenet, 122 (2000), pp. 55-58
[45.]
J.B. Gebhart, P.C. Roche, G.L. Keeney, T.G. Lesnick, K.C. Podratz.
Assessment of inhibin and p53 in granulosa cell tumors of the ovary.
Gynecol Oncol, 77 (2000), pp. 232-236
[46.]
S.L. Ala-Fossi, J. Maenpaa, R. Aine, P. Koivisto, A.M. Koivisto, R. Punnonen.
Prognostic significance of p53 expression in ovarian granulosa cell tumors.
Gynecol Oncol, 66 (1997), pp. 475-479
[47.]
H.D. Homesley, B.N. Bundy, J.A. Hurteau, L.M. Roth.
Bleomycin, etoposide, and cisplatin combination therapy of ovarian gra-nulosa cell tumors and other stromal malignancies: a gyneco-logic oncology group study.
Gynecol Oncol, 72 (1999), pp. 131-137
[48.]
S.L. Ala-Fossi, R. Aine, R. Punnonen, J. Maenpaa.
Is potential to produce inhibins related to prognosis in ovarian granulo-sa cell tumors?.
Eur J Gynaecol Oncol, 21 (2000), pp. 187-189
[49.]
M. Iwahashi, M. Ikoma, T. Otani, A. Ooshima, R. Nakano.
Increased serum concentrations of type IV collagen and lami-nin associated with granulosa cell tumour of the ovary.
J Clin Pathol, 50 (1997), pp. 77-79
[50.]
R. Sharony, R. Aviram, A. Fishman, I. Cohen, M. Altaras, Y. Beyth, et al.
Granulosa cell tumors of the ovary: do they have any unique ultrasonographic and color Doppler flow features?.
Int J Gynecol Cancer, 11 (2001), pp. 229-233
[51.]
B.K. Hong, C.J. Jeng, S.H. Huang, Y.C. Yang, K.G. Wang.
Sono-graphic and clinical findings of granulosa cell tumor.
Zhonghua Yi Xue Za Zhi (Taipei, 57 (1996), pp. 214-218
[52.]
D.G. Varma, I.H. Thorneycroft, S. Digefu, S.M. Eberly, LG Jr. Smith.
Magnetic resonance imaging of adult ovarian granu-losa cell tumor. Case report.
Clin Imaging, 14 (1990), pp. 55-58
[53.]
A. Vodovnik.
Bladder-washing cytology of metastatic ovarian granulosa cell tumor.
Diagn Cytopathol, 26 (2002), pp. 387-388
[54.]
D.M. Robertson, N. Cahir, H.G. Burger, P. Mamers, N. Groome.
Inhibin forms in serum from postmenopausal women with ovarian cancers.
Clin Endocrinol (Oxf, 50 (1999), pp. 381-386
[55.]
H.G. Burger, D.M. Robertson, N. Cahir, P. Mamers, D.L. Healy, T. Jobling, et al.
Characterization of inhibin immunoreacti-vity in post-menopausal women with ovarian tumours.
Clin Endocrinol (Oxf, 44 (1996), pp. 413-418
[56.]
D.L. Healy, H.G. Burger, P. Mamers, T. Jobling, M. Bangah, M. Quinn, et al.
Elevated serum inhibin concentrations in postmenopausal women with ovarian tumors.
N Engl J Med, 329 (1993), pp. 1539-1542
[57.]
T. Jobling, P. Mamers, D.L. Healy, V. MacLachlan, H.G. Burger, M. Quinn, et al.
A prospective study of inhibin in granulosa cell tumors of the ovary.
Gynecol Oncol, 55 (1994), pp. 285-289
[58.]
B.R. Witt, G.C. Wolf, C.J. Wainwright, I.H. Thorneycroft.
Endocrine function of granulosa cell tumors in vivo.
Gynecol Obstet Invest, 33 (1992), pp. 59-64
[59.]
D.M. Robertson, T. Stephenson, E. Pruysers, P. McCloud, A. Tsi-gos, N. Groome, et al.
Characterization of inhibin forms and their measurement by an inhibin alpha-subunit ELISA in serum from postmenopausal women with ovarian cancer.
J Clin Endocrinol Metab, 87 (2002), pp. 816-824
[60.]
R.A. Rey, C. Lhomme, I. Marcillac, N. Lahlou, P. Duvillard, N. Josso, et al.
Antimullerian hormone as a serum marker of granulosa cell tumors of the ovary: comparative study with serum alpha-inhibin and estradiol.
Am J Obstet Gynecol, 174 (1996), pp. 958-965
[61.]
A.V. Sluijmer, M.J. Heineman, J.L. Evers, F.H. De Jong.
Peripheral vein, ovarian vein and ovarian tissue levels of inhibin in a postmenopausal patient with a granulosa cell tumour.
Acta Endocrinol (Copenh, 129 (1993), pp. 311-314
[62.]
T. Noguchi, J. Kitawaki, T. Tamura, T. Kim, H. Kanno, T. Yama-moto, et al.
Relationship between aromatase activity and steroid receptor levels in ovarian tumors from postmenopau-sal women.
J Steroid Biochem Mol Biol, 44 (1993), pp. 657-660
[63.]
C.I. Friedman, J.D. Iams, F.W. Schweizer, M.H. Kim.
Hormonal screening of hyperestrogenic, elderly, obese females for a granulosa cell tumor.
J Reprod Med, 26 (1981), pp. 268-271
[64.]
S.T. Schumer, S.A. Cannistra.
Granulosa cell tumor of the ovary.
J Clin Oncol, 21 (2003), pp. 1180-1189
[65.]
H. Malmstrom, T. Hogberg, B. Risberg, E. Simonsen.
Granulosa cell tumors of the ovary: prognostic factors and outcome.
Gynecol Oncol, 52 (1994), pp. 50-55
[66.]
M. Bidzinski, R. Krynicki, B. Lindner, P. Sobiczewski, G. Panek, W. Wierzba, et al.
Granulosa cell tumor – The assessment of some clinical and therapeutic parameters as prognostic factors.
Ginekol Pol, 72 (2001), pp. 1449-1454
[67.]
R. Fontanelli, B. Stefanon, F. Raspagliesi, R. Kenda, G. Tomasic, G. Spatti, et al.
Adult granulosa cell tumor of the ovary: a clinic pathologic study of 35 cases.
Tumori, 84 (1998), pp. 60-64
[68.]
T. Fujimoto, N. Sakugari, K. Okuyama, T. Fujino, K. Yamashita, S. Yamashiro, et al.
Histopathological pronostic factors of adult granulosa cell tumors of the ovary. Acta Obstet.
Gy-necol Scand, 80 (2001), pp. 1069-1074
[69.]
L. Wu, W. Zhang, L. Li.
Prognostic factors in granulosa cell tumor of the ovary.
Zhonghua Fu Chan Ke Za Zhi, 35 (2000), pp. 673-676
[70.]
M.J. Costa, J. Walls, P. Ames, L.M. Roth.
Transformation in recurrent ovarian granulosa cell tumors: Ki67 (MIB-1) and p53 immunohistochemistry demonstrates a possible molecular basis for the poor histopathologic prediction of clinical behavior.
Hum Pathol, 27 (1996), pp. 274-281
[71.]
B.E. Miller, B.A. Barron, J.Y. Wan, J.E. Delmore, E.G. Silva, D.M. Gershenson.
Prognostic factors in adult granulosa cell tumor of the ovary.
Cancer, 79 (1997), pp. 1951-1955
[72.]
K.S. Suh, S.G. Silverberg, J.G. Rhame, D.S. Wilkinson.
Granulosa cell tumor of the ovary. Histopathologic and flow cyto-metric analysis with clinical correlation.
Arch Pathol Lab Med, 114 (1990), pp. 496-501
[73.]
A. Scharl, M. Vierbuchen, M. Kusche, A. Bolte.
Clinical aspects and prognosis of granulosa cell tumors of the ovary.
Geburtshilfe Frauenheilkd, 48 (1988), pp. 567-573
[74.]
J. Wabersich, M. Fracas, S. Mazzer, M. Marchetti, G. Altavilla.
The value of the prognostic factors in ovarian granulosa cell tumors.
Eur J Gynaecol Oncol, 19 (1998), pp. 69-72
[75.]
P.J. Klemi, H. Joensuu, T. Salmi.
Prognostic value of flow cy-tometric DNA content analysis in granulosa cell tumor of the ovary.
Cancer, 65 (1990), pp. 1189-1193
[76.]
R. Haba, H. Miki, S. Kobayashi, M. Ohmori.
Combined analysis of flow cytometry and morphometry of ovarian granulosa cell tumor.
Cancer, 72 (1993), pp. 3258-3262
[77.]
B. Piura, D. Nemet, I. Yanai-Inbar, Y. Cohen, M. Glezerman.
Granulosa cell tumor of the ovary: a study of 18 cases.
J Surg Oncol, 55 (1994), pp. 71-77
[78.]
A. Ayhan, Z.S. Tuncer, R. Tuncer, R. Mercan, K. Yuce, A. Granulosa cell tumor of the ovary. Ayhan.
A clinicopathological evaluation of 60 cases.
Eur J Gynaecol Oncol, 15 (1994), pp. 320-324
[79.]
W. Alberti, M. Bamberg, U. Schulz.
Granulosa cell tumor.The results of postoperative irradiation.
Dtsch Med Wo-chenschr, 109 (1984), pp. 750-752
[80.]
W. Bartl, R. Spernol, G. Breitenecker.
The significance of clinical and morphological parameters for the prognosis of granulosa cell tumors of the ovaries.
Geburtshilfe Frauen-heilkd, 44 (1984), pp. 295-299
[81.]
Z. Kietlinska, K. Pietrzak, M. Drabik.
The management of granulosa-cell tumors of the ovary based on long-term follow up.
Eur J Gynaecol Oncol, 14(Suppl (1993), pp. 118-127
[82.]
S. Maleemonkol, V. Chareonium, P. Isariyodom, S. Faichamnan.
Granulosa cell tumor of the ovary.
J Med Assoc Thai, 79 (1996), pp. 648-653
[83.]
K. Uygun, A. Aydiner, P. Saip, Z. Kocak, M. Basaran, M. Dincer, et al.
Clinical parameters and treatment results in recurrent granulosa cell tumor of the ovary.
Gynecol Oncol, 88 (2003), pp. 400-403
[84.]
K. Chatzigeorgiou, S. Economou, G. Zafiriou, G. Minopoulos, K. Manolas, N. Chatzigeorgiou.
Continuous intraoperative intraperitoneal hyperthermic chemoperfusion (CIIPHCP) in the treatment of advanced stage and recurrent granulosa cell tumors. Report of two cases.
Zentralbl Gynakol, 124 (2002), pp. 374-377
[85.]
P. Savage, D. Constenla, C. Fisher, J.H. Shepherd, D.P. Barton, P. Blake, et al.
Granulosa cell tumours of the ovary: demographics, survival and the management of advanced disease.
Clin Oncol (R Coll Radiol, 10 (1998), pp. 242-245
[86.]
I.A. Al-Badawi, P.M. Brasher, P. Ghatage, J.G. Nation, A. Sche-pansky, G.C. Stuart.
Postoperative chemotherapy in advanced ovarian granulosa cell tumors.
Int J Gynecol Cancer, 12 (2002), pp. 119-123
[87.]
F.F. Lauszus, A.C. Petersen, I.M. Stamp, J. Praest.
Granulosa cell tumor. A 30-year material from a central hospital.
Ugeskr Laeger, 155 (1993), pp. 3020-3023
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