title: Is the endometrial evaluation routinely required in patients with adult granulosa cell tumors of the ovary?
abstract: OBJECTIVE
  Granulosa cell tumors (GCTs) are the most common estrogen-secreting ovarian tumors; perhaps due to the persistent hyperestrogenism, a wide spectrum of associated endometrial pathologies ranging from endometrial hyperplasia to carcinoma has been documented in patients with GCTs. The aim of this study is to evaluate the incidence of endometrial pathologies in a large series of GCT patients treated in MITO centers.
  
  
  METHODS
  A retrospective multi-institutional review of patients with granulosa cell tumors of the ovary treated or referred to MITO centers was conducted. Descriptive statistics were used to characterize the patient population and to assess the association of GCT and endometrial abnormalities at the time of diagnosis; multivariate regression analysis was also performed to identify independent predictors of endometrial abnormalities.
  
  
  RESULTS
  A total of 150 patients with primary adult GCT was identified. During the preoperative assessment, endometrial pathology was found in 35.9% of symptomatic patients and in 90.9% of asymptomatic women with endometrial thickening at transvaginal ultrasound. At the time of surgery, hyperplasia was documented in 29.2% of patients, whereas endometrial cancer occurred in 7.5% of patients. Almost all of the patients (97.6%) with endometrial hyperplasia were older than 40years. All patients with endometrial cancer were older than 40years and postmenopausal.
  
  
  CONCLUSIONS
  Endometrial carcinoma/atypical hyperplasia were commonly observed in GCT patients >40years; based on these data, endometrial sampling should be performed in symptomatic women at least 40years of age. In asymptomatic women <40years, endometrial sampling is of low yield.
authors.affiliation: Gynecology Department, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Jessica
authors.initials: J
authors.lastname: Ottolina
authors.affiliation: Gynecologic Oncology Department, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Ferrandina
authors.affiliation: Procreative Medicine Department, Pisa University, Pisa, Italy.
authors.forename: Angiolo
authors.initials: A
authors.lastname: Gadducci
authors.affiliation: Obstetrics and Gynecology, Cannizzaro Hospital, Catania, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Scollo
authors.affiliation: Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
authors.forename: Domenica
authors.initials: D
authors.lastname: Lorusso
authors.affiliation: Gynecologic Oncology Department, National Cancer Institute, Aviano, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Giorda
authors.affiliation: Medical Oncology Department, San Giovanni Calibita-Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Breda
authors.affiliation: Gynecologic Oncology Department, National Cancer Institute Regina Elena, Rome, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Savarese
authors.affiliation: Gynecology Department, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Candiani
authors.affiliation: Department of Obstetrics and Gynecology, University "Magna Graecia" of Catanzaro, Catanzaro, Italy.
authors.forename: Fulvio
authors.initials: F
authors.lastname: Zullo
authors.affiliation: Gynecology Department, San Raffaele Scientific Institute, Milan, Italy. Electronic address: mangili.giorgia@hsr.it.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Mangili
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004714:Endometrial Hyperplasia / Q000473:pathology*; D016889:Endometrial Neoplasms / Q000473:pathology*; D005260:Female; D006106:Granulosa Cell Tumor / Q000473:pathology*; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000473:pathology*; D012189:Retrospective Studies
keywords: Endometrial carcinoma; Endometrial hyperplasia; Endometrial sampling; Granulosa cell tumor of the ovary; Hyperestrogenism