Diagnostic utility of Mullerian inhibiting substance determination in patients with primary and recurrent granulosa cell tumors

Objectives. In this study we evaluated changes in serum Mullerian inhibitin g substance (MIS) concentration in a large number of patients with granulos a cell tumors (GCT) to determine whether MIS is elevated at the time of pre sentation and whether MIS is an index of successful surgical resection and management of recurrences, Methods. We retrospectively reviewed MIS levels from 17 subjects prior to t umor resection and studied serial MIS samples from 56 subjects following in itial tumor resection, Clinical follow-up information was available for 36 of those with postoperative MIS values, Serum MIS was measured by an ELISA. MIS values were compared to a combination of normative values previously e stablished in our laboratory and from more recently obtained samples from o lder pre- and postmenopausal women, using this assay. Results. Serum MIS was elevated pre-operatively in 6 of 8 (75%) subjects wi th juvenile GCTs and in 7 of 9 (78%) of those with adult GCTs relative to a ge-matched controls (76% for both types combined), Post-operative clinical correlation was available for 36 patients. There was no clinical recurrence in 21 subjects with normal or undetectable postoperative values, and incom pletely resectable tumor or recurrence was identified in 6 of 15 patients w ith elevated postoperative values. Conclusions, The results of this study demonstrate that postoperative serum MIS concentrations may be used to evaluate the completeness of tumor remov al following initial surgery and that serial MIS determinations may allow t he detection of recurrences. (C) 1999 Academic Press.