Elsevier

Gynecologic Oncology

Volume 103, Issue 1, October 2006, Pages 31-34
Gynecologic Oncology

Retroperitoneal nodal metastasis in primary and recurrent granulosa cell tumors of the ovary

https://doi.org/10.1016/j.ygyno.2006.01.050Get rights and content

Abstract

Objective.

To describe the incidence of retroperitoneal pelvic or paraaortic lymph node metastasis in patients with primary and recurrent ovarian granulosa cell tumors.

Methods.

At Memorial Sloan-Kettering Cancer Center, we conducted a retrospective chart review of all patients with ovarian granulosa cell tumors managed as inpatients from January 1991 to July 2005. The initial date of diagnosis ranged from 1971 to 2005.

Results.

We identified 68 patients with a median age of 49 years (mean, 47.5 years; range, 19–78 years). Sixty-four (94%) patients had adult type and 4 (6%) had juvenile granulosa cell tumors. Fifty-three (78%) patients had their initial surgery at another institution and 55 (81%) were incompletely surgically staged at diagnosis due to the absence of pelvic and/or aortic lymph node dissection. Patients were assigned an International Federation of Gynecology and Obstetrics (FIGO) stage that included IA, 39; IC, 15; IIB, 3; IIC, 3; IIIC, 1. In 7 patients, the original stage was not assigned.

Only 16 (24%) patients had a pelvic lymph node sampling and 13 (19%) also had a paraaortic lymph node sampling at primary surgery or at restaging surgery performed shortly following initial diagnosis; however, in these cases, lymph nodes were negative for metastasis. The median number of pelvic lymph nodes removed was 10 (mean, 11.6 nodes; range, 0–36 nodes). The median number of paraaortic lymph nodes removed was 4 (mean, 6 nodes; range, 0–19 nodes). Nine of 15 (60%) of patients managed initially at our institution were surgically staged compared to 4 of 53 (7.5%) who were managed initially elsewhere (P < 0.001).

Thirty-four patients with recurrent granulosa cell tumors were managed during the study, 31 (91%) had adult type granulosa cell tumor, and 3 had juvenile histology. Thirty-three of 34 patients who recurred were incompletely surgically staged at the initial operation. Original “clinical” FIGO stage for patients who recurred included IA, 15; IC, 8; IIB, 1; IIC, 3; IIIC, 1; and in 6 patients, the original stage was not available.

The median disease-free interval to first recurrence was 63 months (mean,69.4 months; range, 4–170 months). First recurrence sites included pelvis, 24/34 (70%); pelvis and abdomen, 3 (9%); retroperitoneum only, 2 (6%); pelvis and retroperitoneum, 2 (6%); pelvis/abdomen/retroperitoneum, 1(3%); abdomen only, 1 (3%); and bone, 1 (3%).

Conclusions.

Complete surgical staging was performed in approximately 1/5 women with ovarian granulosa cell tumors; however, in those initially surgically staged, no nodal metastasis was identified. Clinical stage IA disease was the most common original diagnosis in women who recurred, and approximately 15% of first recurrences appear to involve the retroperitoneum.

Introduction

Granulosa cell tumors are rare neoplasms of the ovary that are similar to other tumors that arise from the ovary and can metastasize, recur, and cause death; however, due to their rarity, limited data are available on patterns of nodal metastasis at initial surgery and sites of disease at recurrence. Currently, there is no specific preoperative diagnostic modality to help identify patients with granulosa cell tumors and facilitate referral to a subspecialist; thus, general gynecologists usually initially explore the majority of cases. Limited data are available on the results of comprehensive surgical staging for this disease and the incidence of lymph node metastasis at the time of initial diagnosis is lacking; however, retroperitoneal pelvic and paraaortic nodal recurrences have been observed with this disease as an isolated event or part of multisite recurrence. We conducted this study to describe the incidence of nodal metastasis in women newly diagnosed with ovarian granulosa cell tumors and describe the incidence of retroperitoneal involvement in patients at first recurrence of this disease.

Section snippets

Materials and methods

Following institutional review board approval, we conducted a retrospective chart review of all patients with ovarian granulosa cell tumors managed as inpatients from January 1990 to July 2005. Patients were identified using the Virginia K. Pierce Gynecology Service database. The initial date of diagnosis ranged from1971 to 2005. We excluded patients who were seen in the outpatient setting for consultation only; this included patients seen for second opinion consults or those who were managed

Results

We identified 68 patients with documented ovarian granulosa cell tumors who were managed as inpatients at our institution during the study period. The median age was 49 years (mean, 47.5 years; range, 19–78 years). Past gynecologic surgical history included 3 patients with prior total abdominal hysterectomy with unilateral salpingo-oophorectomy, 2 with prior total abdominal hysterectomy, and 2 with prior unilateral salpingo-oophorectomy. All these procedures were performed for benign disease.

Discussion

Adult granulosa cell tumors are rare ovarian malignancies that are commonly initially encountered by general gynecologists during management of an ovarian mass. The vast majority of cases are presumed stage I disease, even though complete staging is rarely performed at diagnosis. It is estimated that the majority if women with apparent stage I disease do well and may never seek consultation with or be referred to a gynecologic oncologist until a recurrence is detected at which point a

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