Ovaries, according to researchers, are a favorite place for tumors. Granulosa cell ovarian tumor (GCOS) is not one disease, but a whole group, they are of non-epithelial origin, belong to the stromal group. They develop from granulosa cells of the ovarian follicle, which surround the oocyte and form its stroma.
Nature of the problem
The occurrence of education 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;
- cylindroma;
- granulosa and folliculoid cancer;
- granulose epithelium;
- ovarian mesenchymoma.
Among oncological diseases of the female genital area, T-bills occupy 1-7%. The age of the sick is 40-60 years. Most often - 50-55 years. But it can develop at other ages.
Reference! The specificity of these tumors is their hormonal activity.
Granulosa cell tumor of the ovary 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.
The danger of malignancy
Malignancy of a granulosa cell tumor in the appendage is not easy to identify. But there is always a transitional stage - between the benign and malignant tumors. Its course and determines the chance of malignancy.
Interesting: statistics show that malignancy occurs in every fifth case. Reaching a tumor larger than 5 cm makes the prognosis unfavorable.
Tumor histology
The adult type granulosa cell tumor itself contains monoform round cells, i.e. differentiated. But sometimes the shape may be elongated. They have dark colored nuclei surrounded by a thin layer of cytoplasm.
GKO always contains the so-called sockets - a number 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 the tumors is smooth, less often - tuberous. 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. atypical cells have different sizes and shapes.
On the incision of the tumor, softening areas with cavities of serous or hemorrhagic fluid are visible. Granulosa cell tumor of the ovary has an unpleasant property to germinate (invade) in neighboring organs - in the second ovary, uterus, intestines, omentum, liver.
Important! There is no hematogenous and lymphogenous spread of the tumor, which means there will be no distant metastases.
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 the treatment.
Relapses occur in this case anyway. Hence, the value of an early diagnosis is clear. Granulosa cell cancer does not contain very atypical cells - another of its features. Therefore, the risk of malignancy is not very high. In addition, tumor growth is slow.
Causes of T-bills
It was noted above that it is hormonal imbalances that become the main cause. Moreover, the script descends "from above" - with violations of the pituitary gland. It is he who is responsible for the production of estrogen and progestogen in the appendages.
The exact etiology of T-bills has not been established today. But there are many provocative moments:
- bad heredity;
- low immunity;
- viruses;
- inflammation of the appendages;
- delayed maturation in girls;
- violations of the MC;
- appendage dysfunctions.
GKO classification
Granulosa cell tumor exists in 2 types and 2 types. Each of them has its own characteristics of the course, appearance, consequences and treatment.
There are 2 types of GKO age categories - adolescent or juvenile and adult. The former occupy only 5%. They appear in puberty and in young women up to 30, while the lesion is usually one-sided. 95% - occur after 40 years and belong to the adult species. Teenage tumors in diameter range from 9 to 22 cm.
Juvenile formations are never reborn, after the operation the symptoms disappear and the tumor itself completely. Rarely, but there are relapses, usually in the first 3 years after surgery. The clinic is also favorable.
For reference: 10% of juvenile formations develop during gestation, but this does not change the prognosis.
The adult form of T-bills appears in 45-60 years. Granulosa cell tumor of an ovary of an adult type can clinically be expressed in the special youthfulness of patients, this is observed with endometrial hyperplasia. The remaining symptoms of an adult granulosa cell tumor are not so pleasant and the quality of life is very poor.
Types of T-bills
There are also 2 of them - macrofollicular and luteinized. Macrofollicular - characteristic of a young age. Such a tumor is often large, its large cavities are filled with a fluid - serous or bloody.
Luteinized type - granulosa cells are different in size and shape and are grouped. The cytoplasm is well developed and has no nuclei. Such cells contain drops of eosinophilic secretion.
Fact! Many studies suggest that juvenile formations arise from gene mutations that arose as early as embryogenesis, and precisely during the formation of the genital appendages of the fetus. A granulosa cell tumor of an ovary of an adult type is the result of pituitary disorders.
Symptomatic manifestations
Most often, there are violations 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. The appearance of bleeding from the uterus and during menopause is also uncharacteristic.
Important! The hormonal activity of T-bills makes it possible to detect it early. This is noted in 65-75% of cases of diagnosis. Granulosa cell tumor of an adult ovary can produce any sex hormones - estrogens and androgens. Symptoms of this will change.
The most obvious manifestations
The most common manifestations:
- Pathological fluctuations in MC are in the form of amenorrhea at the fertile age, menorrhagia, uterine bleeding in menopause, the allocation of bloody secretions with mucus between cycles.
- In addition, pain in the lower back and lower abdomen.
- In girls - early sexual development in combination with other signs: the growth of the breast and hair growth of the pubis and armpits.
- The prevalence of androgens - will give clitoris growth and an increase in the uterus, the formation of a male figure, hirsutism, activation of the sebaceous glands and hirsutism. With hirsutism, a woman's mustache and beard begin to grow. A gynecological examination will reveal a tight-elastic formation in the ovary. Treatment at such an early detection period is always successful.
Tumor Complications
In addition to metastasis, rupture of the capsule formation with subsequent clinical presentation of the acute abdomen may be noted. In a quarter of cases, GKO can lead to the accumulation of fluid in the abdominal cavity - ascites. What is distinctive is that at GKO there are no atypical cells in such a liquid.
Diagnostic measures
It begins with a gynecological examination of the patient in the chair - even then it is possible to determine the compaction in the ovary. When analyzing blood for hormones, the level of estradiol is always elevated; In the dynamics of the process, the growth of the tumor marker CA-125 is noted. Urine may also contain estrogens.
Cytology of the smear for pathological cells and histological examination of the biopsy, pneumogynecography, examination of the uterine cavity with a hysteroscope, transvaginal ultrasound, transabdominal ultrasound or ovarian ultrasonography (both of the latter methods use ultrasound, but the mode of use of the devices is different) is performed.
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 the tumor in the ovaries.
Pneumogynecography or pneumopelviography is a type of X-ray examination, where instead of a contrasting substance, air is used: nitrous oxide, oxygen, carbon dioxide. Their advantage is the rapid absorption 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 did not live sexually. It gives information about the external contours of the uterus and appendages, adhesions here, cicatricial changes in the vagina, the presence of formations in the ovaries, hermaphroditism.
For the diagnosis of relapses with GCOS, the definition of a marker such as inhibins is used. With menopause, it practically does not happen. But when a tumor appears, it continues to be produced.
Treatment methods
The treatment of granulosa cell tumor is always only complex. This refers to the surgical method (primary), 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 GKO.
In women during menopause, a panhisterectomy is performed, i.e. removal of the uterus and appendages, omentum completely. In women of reproductive age 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 relapse persists in any case - this is a feature of T-bills. To reduce the likelihood of their occurrences, chemotherapy and radiation therapy are performed. Bleocin, platinum derivatives, etoposide, etc. are used for chemotherapy. 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 occur. Megestrol and other hormones are also selected separately for each patient, there are no templates here.
And another frequent 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, GKO occurs, it differs in that even with such a full-fledged treatment in 12-55% of patients, it gives relapses after several years - from 9 to 30 years of waiting. This is also indicated by reviews of granulosa cell tumor of the ovary in women of childbearing age. At the 1st stage of the disease, 5-year survival is 95%, in the later stages it is noticeably less. Sometimes up to 70%, or even less.
Attention: it is worth recalling that there is no need to brush off relapses from radiation therapy and hormones because of These are complete treatment methods.
GKO forecasts
The prognosis of a granulosa cell tumor in the appendages of the uterus is determined by its stage, age of the patient, and general condition. Paradoxically, the effectiveness of treatment in adult tumors in patients aged 50-60 years is more successful than in adolescent ones. Within 5 years, relapse in such cases occurs only in a third of patients.
Juvenile - may return within 3 years after treatment. It should be noted that no surgeon will give you a guarantee that there will be no relapse. This once again speaks of the importance of early diagnosis.
What do women ask doctors? Their most common question is whether a granulosa cell tumor is a cancer? The answer is twofold - yes and no. It is determined by the stage of the disease.
As they say, it is not "pure cancer" from the very beginning. But if a woman does not heed any symptoms and starts the process, she metastasizes and malignantly.
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 had partially reproductive organs left during surgery.