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Other Primary Malignancies Among Women With Adult-Type Ovarian Granulosa Cell Tumors
  1. Saara Bryk, MD, PhD*,,
  2. Eero Pukkala, PhD,§,
  3. Anniina Färkkilä, MD, PhD*,,
  4. Markku Heikinheimo, MD, PhD,
  5. Leila Unkila-Kallio, MD, PhD* and
  6. Annika Riska, MD, PhD*
  1. *Obstetrics and Gynecology, and
  2. Children’s Hospital, University of Helsinki and Helsinki University Hospital;
  3. Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki;
  4. §Faculty of Social Sciences, University of Tampere, Tampere, Finland; and
  5. Department of Pediatrics, Washington University School of Medicine, St Louis Children’s Hospital, St Louis, MO.
  1. Address correspondence and reprint requests to Saara Bryk, MD, PhD, Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, PO Box 140, 00290 Helsinki, Finland. E-mail: saara.bryk{at}


Objective The aim of this study was to determine the incidence of new primary malignancies after adult-type granulosa cell tumor (AGCT) and the incidence of AGCT after breast and uterine cancer using nationwide population-based registry data.

Methods We used the Finnish Cancer Registry to identify all patients diagnosed with AGCT in 1968 to 2013 (n = 986). The number of subsequent primary malignancies among women with AGCT and the number of AGCTs in women with previous breast or uterine cancer were compared with the expected number of cases and expressed as standardized incidence ratios (SIRs).

Results There were 122 cases of subsequent cancers diagnosed at least 6 months after the primary diagnosis of AGCT (SIR, 1.09; 95% confidence interval [CI], 0.91–1.3). In particular, the observed number of cancers of the soft tissue (SIR, 4.13; 95% CI, 1.33–12.8), thyroid (SIR, 3.42; 95% CI, 1.54–7.62), and leukemia (SIR, 2.67; 95% CI, 0.98–5.82) exceeded the number of expected cases. The SIR for breast cancers after AGCT was 1.26 (95% CI, 0.92–1.73), and the SIR for AGCT after breast cancer was 1.59 (95% CI, 1.04–2.29). The risk for subsequent AGCT was more than 2-fold in breast cancer patients younger than 50 years, and over 15 years after primary diagnosis.

Conclusions There is an increased risk for thyroid and soft tissue cancer as well as leukemia after AGCT, which may be associated with late effects of carcinogenic treatments and possibly shared risk factors. After breast cancer, the risk for AGCT was higher, which may indicate a shared hormonal etiology.

  • Granulosa cell tumor
  • Sex cord-stromal tumors
  • Second primary malignancy
  • Second primary cancer
  • Ovarian cancer epidemiology

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  • The authors declare no conflicts of interest.