The ovaries, according to researchers, are a favorite site for tumors. Granulosa cell tumor of the ovaries (GCOT) is not one disease, but a whole group, they are of non-epithelial origin, belong to the group of stromal. Develop from ovarian follicle granulosa cells that surround the oocyte and form its stroma.
The essence of the problem
The occurrence of formation occurs with hormonal disorders in general or in the ovaries themselves, in which granuloses develop. The group consists of the following pathological formations:
- vesicle adenoma;
- cylinder;
- granular and folliculoid cancer;
- granulosaepithelioma;
- ovarian mesenchymoma.
GKOs account for 1-7% of oncological diseases of the female genital area. The age of patients is 40-60 years. Most often - 50-55 years. But it can develop at other ages.
Help! The specificity of these tumors is their hormonal activity.
Granulosa cell tumorovary is most often manifested by increased production of estrogen and endometrial hyperplasia. This gives negative symptoms. From its very appearance, GKO does not detect malignancy. The onset of oncogenesis in the body can serve as a trigger for malignancy.
Danger of malignancy
Malignancy of a granulosa cell tumor in the epididymis is not easy to detect. But there is always a transitional stage - between good and malignant tumors. Its course determines the chance of malignancy.
Interesting: statistics show that malignancy occurs in every fifth case. Achieving a tumor larger than 5 cm makes the prognosis unfavorable.
Tumor histology
The adult-type granulosa cell tumor itself contains monoform rounded cells, i.e. differentiated. But sometimes the shape can be elongated. They have dark colored nuclei surrounded by a thin layer of cytoplasm.
GKO always contains the so-called. rosettes - a series of small cavities. They have a yellowish color due to the content of lipids, between which there are fibrous structures.
Most often, the surface of tumors is smooth, less often - bumpy. A micropreparation of a malignant granulosa cell tumor of the ovary: in the field of view it is clear that the cells have already lost their monoformity and become polymorphic. Those. abnormal cells vary in size and shape.
On the section of the tumor, areas of softening with cavities of serous or hemorrhagic fluid are visible. Granulosa cell tumor of the ovaryhas an unpleasant property to germinate (invade) into neighboring organs - into the second ovary, uterus, intestines, omentum, liver.
Important! There is no hematogenous and lymphogenous spread of the tumor, which means that there will be no distant metastases here.
The complexity of any metastases is always that it is almost impossible to fight them with surgical methods. Therefore, chemotherapy or radiation becomes an addition to treatment.
Relapses occur anyway. This explains the value of early diagnosis. Granulosa cell carcinoma contains not too atypical cells - another of its features. Therefore, the risk of malignancy is not very high. In addition, tumor growth is slow.
T-bills reasons
It was noted above that it is hormonal imbalances that become the main cause. Moreover, the script descends "from above" - in violation of the pituitary gland. It is he who is responsible for the production of estrogen and progesterone in the appendages.
The exact etiology of GKO has not been established even today. But there are many provocative moments:
- bad heredity;
- low immunity;
- viruses;
- inflammation of the appendages;
- delayed puberty in girls;
- violations of the MC;
- adnexal dysfunction.
GKO classification
Granulosa cell tumor exists in 2 types and 2 types. Each of them has its own characteristics of the course, appearance, consequences andtreatment.
There are 2 types of T-bills according to age categories - teenagers or juveniles and adults. The former occupy only 5%. They appear in puberty and in young women under 30, while the lesion is usually one-sided. 95% - occur after 40 years and belong to the adult form. Teenage tumors range in diameter from 9 to 22 cm.
Juvenile formations never regenerate, after the operation the symptoms disappear and the tumor itself completely disappears. Rarely, but there are relapses, usually in the first 3 years after surgery. The clinic is also favorable.
For reference: 10% of juvenile lesions develop during gestation, but this does not change the prognosis.
The adult GKO appears at 45-60 years of age. An adult-type granulosa cell tumor of the ovary can be clinically expressed in a special youthfulness of patients, this is observed with endometrial hyperplasia. The rest of the symptoms of adult granulosa cell tumor are not so pleasant and the quality of life is very worse.
Types of T-bills
They are also 2 - macrofollicular and luteinized. Macrofollicular - characteristic of a young age. Such a tumor is often large, its large cavities are filled with fluid - serous or bloody.
Luteinized type - granulosa cells vary in size and shape and are clustered. The cytoplasm is well developed and has no nuclei. These cells contain drops of eosinophilic secretion.
Fact! Many studies suggest that juvenile formations appear from gene mutations that arose even in embryogenesis, and it was during the formation of sexualfetal appendages. And an adult type granulosa cell tumor of the ovary is the result of pituitary disorders.
Symptomatic manifestations
The most common disorders of the MC and uterine bleeding. Frequent pain in the lower back and lower abdomen. Different ages have their own symptoms. If the girl has a pathology, early puberty will be noted. Uncharacteristically, the appearance of bleeding from the uterus and during menopause.
Important! The hormonal activity of GKO makes it possible to detect it early. This is noted in 65-75% of cases of diagnosis. An adult granulosa cell tumor of the ovary can produce any sex hormones - estrogens and androgens. Symptoms will vary from this.
Most obvious manifestations
Most common manifestations:
- Pathological fluctuations in MC - in the form of amenorrhea in childbearing age, menorrhagia, uterine bleeding in menopause, bleeding with mucus between cycles.
- In addition, pain in the lower back and lower abdomen.
- Girls have early sexual development in combination with other signs: breast growth and pubic and armpit hair.
- Prevalence of androgens - will give the growth of the clitoris and enlargement of the uterus, the formation of a male figure, hirsutism, activation of the sebaceous glands and hirsutism. With hirsutism, a woman begins to grow a mustache and beard. A gynecological examination will reveal a densely elastic formation in the ovary. Treatment at such an early detection period is always successful.
Tumor complications
In addition to metastasis, there may be a rupture of the capsule of the formation, followed by a clinic of an acute abdomen. In a quarter of cases, GCT can lead to the accumulation of fluid in the abdominal cavity - ascites. It is remarkable that there are no atypical cells in such a liquid with GKO.
Diagnostic measures
It begins with a gynecological examination of the patient in the chair - even then it is possible to determine the seal in the ovary. When analyzing blood for hormones, the level of estradiol is always elevated; in the dynamics of the process, an increase in the oncomarker CA-125 is noted. Urine may also contain estrogens.
Smear cytology for pathological cells and histological examination of the biopsy, pneumogynecography, examination of the uterine cavity with a hysteroscope, transvaginal echography, transabdominal ultrasound or ovarian ultrasonography are carried out (both the latter methods use ultrasound, but the mode of use of the devices is different).
CT - detects a multi-chamber cystic formation, which indicates the malignancy of the process.
Ultrasound remains a valuable method - it detects an early stage of a tumor in the ovaries.
Pneumogynecography or pneumopelviography is a type of X-ray examination, where air is used instead of a contrast agent: nitrous oxide, oxygen, carbon dioxide. Their advantage lies in the rapid resorption in the cavity - from half an hour to 2 hours. Oxygen is delayed up to a day. In addition, it has bactericidal and analgesic properties. The method is used in girls and women who have not lived sexually. It provides information about the external contours of the uterus and appendages, adhesive processes here, cicatricial changes in the vagina, the presence of formations in the ovaries, and hermaphroditism.
To diagnose relapses in GCOS, the definition of such a marker as inhibins is used. With menopause, it practically does not happen. But when a tumor appears, it continues to be produced.
Treatment methods
Treatment of granulosa cell tumor is always complex. Here we mean the surgical method (basic), tumor irradiation, hormone therapy and chemotherapy. The operation consists in the complete removal of the affected areas. Much determines the age of the patient and the stage of GCT.
Pangisterectomy is performed in women during menopause. removal of the uterus and appendages, the omentum completely. In women of reproductive age who are planning a pregnancy, surgeons always try to leave one tube and uterus. But the omentum is most often removed with the affected ovary, because it is in it that the tumor likes to germinate.
Metastases may require repeated operations, but the risk of recurrence remains in any case - this is a feature of GKO. To reduce the possibility of their occurrence, chemotherapy and radiation therapy are carried out. For chemotherapy, bleocin, platinum derivatives, etoposide, etc. are used. The selection and course of administration are always individual. Most often, after surgery, they are limited to 3 courses of treatment.
In addition, hormone therapy may also take place. Megestrol and other hormones alsoare selected separately for each patient, there are no templates here.
And another common treatment is radiation therapy. It is indicated for contraindications to chemotherapy. Radio beams destroy the tumor and in 80% of cases it regresses.
All additional methods are used to combat not only relapses, but also metastases. In general, treatment lasts from six months to 2 years.
In 12-55% of cases, HCT occurs, differing in that even with such a full treatment in 12-55% of patients, it gives relapses after a few years - from 9 to 30 years of waiting. This is also indicated by reviews of granulosa cell tumors of the ovary in women of childbearing age. At the 1st stage of the disease, the 5-year survival rate is 95%, in the later stages it is noticeably less. Sometimes up to 70%, or even less.
Warning: It's worth reminding you not to brush aside relapses from radiotherapy and hormones. These are complete treatments.
GKO forecasts
Prognosis of a granulosa cell tumor in the uterine appendages is determined by its stage, the patient's age and general condition. Paradoxically, the effectiveness of treatment for adult tumors in patients aged 50-60 years is more successful than in adolescents. Within 5 years, relapses in such cases occur only in a third of patients.
Juvenile - may return within 3 years of treatment. It should be noted that no surgeon will give you a guarantee that there will be no recurrence. This once again speaks to the importance of early diagnosis.
What do women ask doctors? Their most frequent question is whethergranulosa cell tumor to cancer? The answer is twofold - yes and no. It is determined by the stage of the disease.
As they say, it is not originally "pure cancer". But if a woman does not heed any symptoms and starts the process, she will definitely metastasize and become malignant.
The insidiousness of a granulosa tumor, unlike other neoplasms, is that even 30 years after successful removal, it can return in half of the patients. This is especially true for those women who were left with partially reproductive organs during the operation.
