The other peak fre quency corresponds on the prepubertal age. The signs are various, stomach pain, stomach distension linked to mass result and hormonal occasions such as irregular menstruation, intermenstrual bleeding, postmenopausal bleeding or amenorrhea. Even so, for all those cases in which the patient is asymptomatic, the clinical examination is incredibly essential. Endocrine manifestations are noted in 66% from the pa tients. These manifestations are linked to estrogen se cretion with the tumor. This explains why the granulosa cell tumors are fre quently connected with endometrial hyperplasia or to endometrial adenocarcinoma. Thus, endometrial and cervical biopsies are essen tial to define the therapeutic tactic. The juvenile type might be characterized through the pres ence of pseudopuberty, and galactorrhea may comprehensive the clinical pres entation.
The mechanism is just not plainly established. Radiologicaly speaking, the granulosa cell tumor presents like a reliable element with multicystic appearance, by using a median diameter of 12 cm. The imaging appearances from the two varieties of granulosa cells tumors are related. The same clinical hop over to this site and radiological information had been mentioned in the sufferers from our review. The diagnosis is confirmed by histological analyses. The grownup type includes five subtypes, amongst which the most frequent subtype microfollicular is characterized by Phone Exner bodies and cores coffee bean. Inside the juvenile kind, the architecture is often lobu lated, Phone Exner bodies are unusual, along with the indications of luteini zation are regular.
The survival prices at 5 years and 10 years had been reported by Malmstrom et al, 94% and 88%, respectively, for stage I, and reducing to 44% for stage II and III. Wu et al. also reported their success about sur vival for 100 patients with granulosa cell tumors, sur vival prices at five many years and 10 years were 98% and 96%, respectively, for stage I and were 70% and 60%, respect ively, for stage SU11274 II. The recurrence charge is additionally connected to the stage. The results of Ahyans study of 80 patients with granulosa cell tumors, revealed recurrence costs of five. 4%, 21% and 40% for stage I, stage II and stage III, respectively. The prognostic worth of stage was also noted in our review. The key immunohistochemical markers expressed by these cells are vimentin, CD 99 and alpha inhibin. The serum tumor markers are estradiol, inhibin, and anti M?llerian hormone. Cancer antigen 125 is not really correlated to the tumor progression. Kalfa et al. identified a mutation FOXL2 during the vast majority of granulosa cell tumors, notably in grownup form. This FOXL2 could be the subsequent target for use in therapy. Yoo et al. also identified mutations of genes Fas, FLIP and Bcl two associated to alterations of apoptosis.