Adult granulosa cell tumors of the ovary: Tumor dissemination pattern at primary and recurrent situation, surgical outcome

Abstract Objective Granulosa-cell-tumors of the ovary (GCT) constitute a rare group of neoplasms with malignant potential. Due to the rarity of the disease intraoperative tumor-dissemination-patterns are not well defined and are mostly based on retrospective data. Aim of the present study was to des...

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Published in:Gynecologic oncology 2010-11, Vol.119 (2), p.285-290
Main Authors: Fotopoulou, C, Savvatis, K, Braicu, E-I, Brink-Spalink, V, Darb-Esfahani, S, Lichtenegger, W, Sehouli, J
Format: Article
Language:English
Subjects:
Adult
Aged
Female
Granulosa Cell Tumor - pathology
Granulosa Cell Tumor - surgery
Granulosa cell tumors ovary
Hematology, Oncology and Palliative Medicine
Humans
Middle Aged
Neoplasm Recurrence, Local - pathology
Neoplasm Recurrence, Local - surgery
Obstetrics and Gynecology
Ovarian Neoplasms - pathology
Ovarian Neoplasms - surgery
Relapse
Treatment Outcome
Tumor debulking
Tumor pattern
Tumor residuals
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Summary:Abstract Objective Granulosa-cell-tumors of the ovary (GCT) constitute a rare group of neoplasms with malignant potential. Due to the rarity of the disease intraoperative tumor-dissemination-patterns are not well defined and are mostly based on retrospective data. Aim of the present study was to describe surgical and clinical outcome and dissemination pathways in the primary and recurrent situation of the disease. Methods All primary and relapsed GCT-patients, operated between 01/2001 and 02/2010 in our institution were evaluated using a systematic intraoperative documentation-tool (IMO). Surgical outcome, intraoperative tumor-dissemination-pattern and pathological and findings were separately analyzed for the primary and recurrent situation. Results Overall, 45 patients were analyzed; including eighteen patients with primary and 27 patients with recurrent GCT. Tumor-dissemination-patterns differed significantly between primary and recurrent patients, by the latter having significantly higher rates of diffuse peritoneal involvement (15.8% vs. 52%; p = 0.027) and of extraovarian tumor involvement of the middle (15.8% vs. 48.1%; p = 0.05) and upper abdomen (0 vs. 33.3%; p = 0.006). While all primary patients could be operated tumor-free, this was the case for 85.2% of the relapsed patients ( p = 0.13). A multivisceral operative approach with extensive peritonectomy, intestinal or diaphragmatic resection, splenectomy and partial hepatectomy/panceratectomy had to be performed only in recurrent GCT (55.6%). Conclusions Tumor-dissemination-pathways followed in primary and recurrent GCT differ significantly by higher rates of multivisceral tumor involvement in the recurrent situation of the disease. While at primary presentation extrapelvic involvement with peritoneal carcinosis appears only rare, surgical cytoreduction during relapse is more challenging involving a multivisceral approach.
ISSN:0090-8258
1095-6859
DOI:10.1016/j.ygyno.2010.06.031