Molecularly Defined Adult Granulosa Cell Tumor of the Ovary: The Clinical Phenotype.
The histopathologic features of adult granulosa cell tumors (AGCTs) are relatively nonspecific, resulting in misdiagnosis of other cancers as AGCT, a problem that has not been well characterized. FOXL2 mutation testing was used to stratify 336 AGCTs from three European centers into three categories: 1) FOXL2 mutant molecularly defined AGCT (MD-AGCT) (n = 256 of 336), 2) FOXL2 wild-type AGCT (n = 17 of 336), 3) misdiagnosed other tumor types (n = 63 of 336). All statistical tests were two-sided. The overall and disease-specific survival of the misdiagnosed cases was lower than in the MD-AGCTs (P < .001). The misdiagnosed cases accounted for 71.9% of disease-specific deaths within five years. In the population-based cohort, overall survival of MD-AGCT patients was not different from age-matched, population-based controls. Even though 35.2% of all the MD-AGCT patients in our study experienced a relapse, AGCT is usually an indolent disease. The historical, premolecular data underpinning our clinical understanding of AGCT was likely skewed by inclusion of misdiagnosed cases, and future management strategies should reflect the potential for surgical cure and long survival even after relapse.
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM).
Melissa K
MK
McConechy
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM).
Anniina
A
Färkkilä
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM).
Hugo M
HM
Horlings
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM).
Aline
A
Talhouk
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM).
Leila
L
Unkila-Kallio
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM).
Hannah S
HS
van Meurs
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM).
Winnie
W
Yang
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM).
Nirit
N
Rozenberg
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM).
Noora
N
Andersson
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM).
Katharina
K
Zaby
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM).
Saara
S
Bryk
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM).
Ralf
R
Bützow
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM).
Johannes B G
JB
Halfwerk
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM).
Gerrit K J
GK
Hooijer
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM).
Marc J
MJ
van de Vijver
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM).
Marrije R
MR
Buist
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM).
Gemma G
GG
Kenter
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM).
Sara Y
SY
Brucker
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM).
Bernhard
B
Krämer
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM).
Annette
A
Staebler
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM).
Maaike C G
MC
Bleeker
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM).
Markku
M
Heikinheimo
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM).
Stefan
S
Kommoss
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM).
C
C
Blake Gilks
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM).
Mikko
M
Anttonen
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM) dhuntsma@bccancer.bc.ca anniina.farkkila@helsinki.fi.
David G
DG
Huntsman
D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000175:diagnosis* / Q000401:mortality; D004252:DNA Mutational Analysis; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D005260:Female; D005387:Finland; D000074842:Forkhead Box Protein L2; D051858:Forkhead Transcription Factors / Q000235:genetics*; D005858:Germany; D006106:Granulosa Cell Tumor / Q000175:diagnosis* / Q000235:genetics* / Q000401:mortality / Q000628:therapy; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000235:genetics*; D009426:Netherlands; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000235:genetics* / Q000401:mortality / Q000628:therapy; D010641:Phenotype; D012189:Retrospective Studies; D015996:Survival Rate
C421604:FOXL2 protein, human; D000074842:Forkhead Box Protein L2; D051858:Forkhead Transcription Factors