Granulosa Cell Tumor

A granulosa cell tumor (GCT) is a rare type of ovarian tumor. Healthcare providers may also call them granulosa theca cell tumors.

CGTs are usually cancerous (malignant). But most GCTs grow slowly. Treatment outcomes are excellent when providers diagnose these tumors early, which occurs in 9 out of 10 cases.

What are granulosa cells?

Granulosa cells are a type of cell in your ovaries that make estrogen and progesterone. These hormones are necessary for egg cells to mature and for ovulation.

Granulosa cells also produce other hormones and peptides, including anti-Müllerian hormone (AMH).

About 7 in 10 granulosa cell tumors release excess hormones, especially estrogen.

Types of granulosa cell tumors

There are two distinct types of granulosa cell tumors:

• Adult GCTs: Adult GCTs typically develop during perimenopause or postmenopause. They’re the most common type. They may recur (come back) more than 20 years after diagnosis.
• Juvenile GCTs: Juvenile GCTs typically develop in females under the age of 30, including in girls who haven’t started puberty. They represent only 5% of all GCT cases. A juvenile GCT can be more likely than an adult GCT to recur within a few years of treatment. They can be more aggressive if they’re diagnosed after they’ve spread outside your ovary (metastasized).

The cells of these tumor types also look different under a microscope.

Symptoms of GCTs

Symptoms of granulosa cell tumors include:

• A mass (bulge) in your lower abdomen that you can feel
• Abdominal pain
• Abnormal uterine bleeding or postmenopausal bleeding
• Early (precocious) puberty in girls
• Irregular periods or no periods
• Swollen belly (abdominal distension)
• Tender or sore breasts

Symptoms of granulosa cell tumors mainly result from high estrogen and the tumor’s size.

You know your body best. See a healthcare provider as soon as possible if you have changes like these.

Granulosa cell tumor causes

A mutation (change) in the FOXL2 gene causes more than 95% of adult GCTs. This gene normally functions to help granulosa cells develop as they should. Researchers don’t know why the mutation happens.

Juvenile GCTs are associated with genetic changes as well. They include trisomy of chromosome 12 (three copies instead of two) and deletion in chromosome 6q (part of the chromosome is missing).

There’s nothing you can do to prevent these gene changes and GCTs.

Complications of this condition

Granulosa cell tumor complications include:

• Bleeding within the tumor (intratumoral hemorrhage)
• Torsion (twisting) of your ovary and fallopian tubes (adnexal mass)
• Tumor rupture

These complications cause sudden, severe abdominal pain. Go to the emergency room (ER) if you experience this.

GCTs that release excess hormones can cause infertility and endometrial cancer.

How doctors diagnose granulosa cell tumors

Typically, healthcare providers use imaging tests to diagnose granulosa cell tumors. You may have a:

• CT scan
• Pelvic ultrasound
• MRI

Your provider may also use blood tests, like tumor markers. They may do blood tests to check your hormone levels as well.

How are granulosa cell tumors treated?

Surgery is the first treatment for a granulosa cell tumor. Your surgeon will remove the tumor while keeping healthy tissue intact. Typically, your provider will recommend getting a hysterectomy (removal of your uterus) at the same time.

If you plan on having biological children, your provider may recommend ovarian removal (oophorectomy) without removing your uterus. Your healthy ovary can remain in this case.

Most often, there’s no need for additional treatment in the case of granulosa cell cancer. But if the tumor comes back, your provider may recommend another surgery and possibly these treatments:

• Chemotherapy
• Hormone therapy
• Radiation therapy

Staging

During surgery, your surgeon will check to see if the tumor has spread. Healthcare providers use a process called staging to describe if and how much the cancer has spread:

• Stage I (1) GCTs haven’t spread outside your ovaries.
• Stage II to IV (2 to 4) GCTs have spread (metastasized) to other parts of your body.

What can I expect if I have a granulosa cell tumor?

The prognosis (outlook) for granulosa cell tumors depends on whether the tumor has spread at the time of diagnosis.

In most cases, the outlook is very good. As many as 9 in 10 GCTs are diagnosed while they’re only in your ovary. Surgery can cure GCTs, especially when surgeons remove them early.

After tumor removal, you’ll need regular follow-up with your healthcare provider for many years. This is because GCTs can come back several years later. Your provider will examine you to ensure the tumor hasn’t returned. You may have:

• Blood tests to look for markers of possible cancer recurrence
• Pelvic exams

If the tumor recurs, it’s fatal in 8 out of 10 cases. This is why regular follow-up is essential.