GRANULOSA-CELL TUMORS OF UNILOCULAR CYSTIC TYPE

We reviewed the clinical, pathological and immunohistochemical feature s of six unilocular cystic granulosa cell tumors (UCGs) of the ovary. The mean age of the patients was 46 years and the presenting features included abdominal distension, pain, urinary frequency, dyspareunia an d amenorrhea. The tumors were unilateral, thin walled and consisted of a single large cavity with a smooth internal lining. The mean tumor-d iameter was 10 cm and in all instances the UCGs were of adult histolog ical type. The granulosa cells in six tumors demonstrated immunoreacti vity for vimentin, five neoplasms showed reactivity for both alpha-inh ibin and progesterone-receptor protein and four showed reactivity for smooth muscle actin. All tumors were nonimmunoreactive with antibodies to epithelial membrane antigen, beta-inhibin, estrogen-receptor prote in, testosterone and s100 antigen. Only one of the three patients test ed pre-operatively had an elevated serum inhibin concentration and thi s returned to normal six weeks post-operatively. We conclude that UCGs are distinguished by the infrequency of diagnostic serum tumor marker s and clinically evident endocrine activity. Correct diagnosis is depe ndent on histological examination and the finding of a monotonous popu lation of cells, a trabecular growth pattern, nuclear grooves, low mit otic activity and an immunohistochemical profile compatible with granu losa cell tumors.