title: Juvenile Granulosa Cell Tumor of the Ovary: A Clinicopathologic Study.
abstract: OBJECTIVE
  To report on the clinical characteristics and outcome of pediatric patients with juvenile granulosa cell tumor (JGCT) of the ovary. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: Patients with histopathologically confirmed ovarian JGCT diagnosed between 1990 and 2016 were identified. Data on the clinical presentation, surgical management, oncologic management, laboratory investigation, follow-up, and outcome were collected. Tumors were staged according to the International Federation of Gynecology and Obstetrics criteria.
  
  
  RESULTS
  Eight patients were diagnosed with ovarian JGCT during the study period. The median age at presentation was 3 years (range, 0.7-14 years). Precocious puberty was the presenting symptom in all five prepubertal children; abdominal distension due to mass effect was the presenting symptom in three children older than 9 years of age. In patients who had preoperative serologic testing, estradiol (n = 3) and inhibin (n = 3) levels were elevated. Five patients had stage I disease, and three had stage III. All stage I patients underwent salpingo-oophorectomy as the only treatment. Stage III patients received adjuvant chemotherapy. After a median follow-up of 6.2 years, six patients (75%) were alive without evidence of disease. One stage I patient with germline p53 mutation and phosphatase and tensin homolog mutation, died because of subsequent liposarcoma. One patient with stage IIIB disease developed recurrence detected according to an elevated inhibin serum level, and died due to progressive disease despite receiving multiple chemotherapy regimens.
  
  
  CONCLUSIONS
  Juvenile granulosa cell tumor has a favorable prognosis in patients with stage I disease after surgical resection alone. Adjuvant chemotherapy might be indicated in patients with higher-stage tumors.
authors.affiliation: Department of Pathology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas. Electronic address: hao.wu@bcm.edu.
authors.forename: Hao
authors.initials: H
authors.lastname: Wu
authors.affiliation: Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas.
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Pangas
authors.affiliation: Department of Pathology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
authors.forename: Karen W
authors.initials: KW
authors.lastname: Eldin
authors.affiliation: Department of Pathology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
authors.forename: Kalyani R
authors.initials: KR
authors.lastname: Patel
authors.affiliation: Department of Pathology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
authors.forename: John
authors.initials: J
authors.lastname: Hicks
authors.affiliation: Department of Gynecology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Dietrich
authors.affiliation: Texas Children's Cancer Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
authors.forename: Rajkumar
authors.initials: R
authors.lastname: Venkatramani
mesh_terms: D000293:Adolescent; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D005260:Female; D006106:Granulosa Cell Tumor / Q000150:complications / Q000473:pathology* / Q000628:therapy; D006801:Humans; D007223:Infant; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000150:complications / Q000473:pathology* / Q000628:therapy; D010052:Ovariectomy / Q000379:methods; D011379:Prognosis; D011629:Puberty, Precocious / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D047368:Tumor Burden
keywords: Chemotherapy; Inhibin B; Juvenile granulosa cell tumor; Pathology