Granulosa Cell Tumor



Granulosa Cell Tumor


Steven S. Shen, MD, PhD

Mahul B. Amin, MD

Jae Y. Ro, MD, PhD










A GCT shows a well-circumscribed, homogeneous, tan-white nodule. The tumor is small and like many sex cord stromal tumors, does not extensively involve the testis. Hemorrhage and necrosis are lacking.






A GCT shows typical Call-Exner bodies image characterized by central eosinophilic material and palisading tumor cells resulting in a rosette appearance. The tumor cells have scant cytoplasm.


TERMINOLOGY


Abbreviations



  • Granulosa cell tumor (GCT)


Definitions



  • Sex cord stromal tumor of testis occurring in adults and resembling its counterpart of ovarian granulosa cell tumor


CLINICAL ISSUES


Epidemiology



  • Incidence



    • Extremely rare; fewer than 2 dozen cases have been documented


  • Age



    • Range: 16-76 years (mean: 44 years)


    • Juvenile GCT occurs in 1st few months of life


Presentation



  • Painless testicular mass


  • May be associated with gynecomastia (about 25%)


Treatment



  • Surgical approaches



    • Curable by surgical resection in most cases


    • May be managed by partial orchiectomy


Prognosis



  • Most have indolent clinical course but have malignant potential


  • Metastasis has been reported (20% of cases)


  • Long-term follow-up is recommended for all patients


MACROSCOPIC FEATURES


General Features



  • Well-circumscribed, sometimes encapsulated, homogeneous yellow to gray firm mass


  • ± small cysts


  • Hemorrhage or necrosis is unusual


Size



  • Range: 2-10 cm (average: 5 cm)


MICROSCOPIC PATHOLOGY


Histologic Features



  • Growth patterns: Microfollicular (most common), solid, trabecular, insular, macrofollicular, gyriform, or cystic


  • Presence of Call-Exner bodies (eosinophilic material surrounded by palisading granulosa cells)


  • Relatively uniform round or ovoid cells (carrot-shaped) with scant, lightly staining cytoplasm


  • Elongated or angular nuclei with grooves (coffee bean-shaped) with 1 or 2 peripherally located nucleoli


  • Focal cytologic atypia and rare mitoses; mitoses may be high with varying degree of nuclear pleomorphism


  • May intermingle with seminiferous tubules and infiltrate tunica albuginea


  • Some show focal theca cell differentiation or have smooth muscle or osteoid differentiation


  • Rare hemorrhage, necrosis, or angiolymphatic invasion


  • Features seen more often in tumors with malignant outcome: Large size (> 7 cm), frequent mitoses (> 4/10 HPFs), hemorrhage, necrosis, lymphovascular invasion


Predominant Pattern/Injury Type



  • Solid and microfollicular

Jul 7, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Granulosa Cell Tumor
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