Ovarian Granulosa Cell Tumors: Cystic Presentation of Six Cases

The World Health Organization classifies ovarian granulosa cell tumors as sex cord stromal tumors pure sex cord and both, adult granulosa and juvenile granulosa cell tumors are described. Usually, they appear as solid or cystic solid tumors and less commonly the tumors are entirely cystic, which results in scarce literature published on this presentation. Juvenile type presents histologically a lobulated appearance Call-Exner bodies are infrequent, luteinization is common, and it is usual to observe follicles containing eosinophilic or basophilic secretions. Adult type typically shows a proliferation of uniform cells with vesicular nuclei that show typical grooves. It is important to take into account the entirely cystic presentation to avoid wrong diagnoses such as ovarian follicular cyst. From the pathological point of view there are no overwhelming data that could clearly differentiate a cystic granulosa cell tumor from a follicular cyst. However, some authors have described macroscopic and microscopic findings that should be taken into account to perform the differential diagnostic between these entities. Six cystic granulosa cell tumor cases from the period 1973–2017 from our Pathology Department were studied, and they included three adult granulosa cell tumors and three juvenile granulosa cell tumors. We analyzed clinical presentation and histological features like patterns, nuclear atypia, epithelium-stroma relationship, mitotic index, and presence of necrosis in order to establish whether there is a correlation among these parameters and clinical behavior.