GRANULOSA CELL TUMOR OF THE OVARIES: A RARE BUT INSIDIOUS DIAGNOSIS

“A granulosa cell tumor of the ovary is a rare malignant tumor that may remain asymptomatic for a long time and can recur even decades after removal. However, despite being malignant, it is not highly aggressive, and the prognosis is often favorable,” says Heda Maltzagova, an oncologist from the gynecological department of the N. Lopatkin Scientific Research Institute of Urology and Interventional Radiology – branch of the Federal State Budgetary Institution of the “National Medical Research Radiological Centre” of the Ministry of Health of the Russian Federation.

Our Patient’s Story

In 2000, a 40-year-old woman was first diagnosed with an ovarian cyst. At her local hospital, both ovaries were removed. After histological examination, the diagnosis came as a surprise to both the doctors and the patient: granulosa cell tumor. A second surgery was performed, during which the uterus was removed, leaving only the cervix and the omentum.

For many years, the patient underwent regular check-ups. However, in 2017, an ultrasound revealed a large tumor in the pelvis measuring 9 cm. It was removed, but just a year later, the disease returned, as indicated by a rising tumor marker.

In 2018, the patient sought treatment at the P. Hertsen Moscow Oncology Research Institute – branch of the Federal State Budgetary Institution of the “National Medical Research Radiological Centre” of the Ministry of Health of the Russian Federation. After examinations, she was prescribed hormone therapy, a crucial part of granulosa cell tumor treatment.

In December 2020, she underwent surgery led by the Chief Oncologist of the Russian Ministry of Health, Academician Andrey Kaprin. The surgery involved the removal of the pelvic tumor, cervix, lymph nodes, and appendix, followed by six cycles of chemotherapy. For the next four years, she remained under medical supervision.

However, in January 2024, her tumor marker levels rose again, and in December of the same year, a recurrence was detected. In early 2025, the patient underwent another surgery performed by a team of surgeons from the N. Lopatkin SRI of Urology and Interventional Radiology, led by Academician Kaprin. All recurrent tumors in the pelvis were successfully removed.

Why Does This Tumor Behave This Way?

“The unique characteristic of granulosa cell tumors of the ovary is their potential to recur long after the initial diagnosis—anywhere from 10 to 30 years later,” explains Heda Maltzagova. This makes these tumors difficult to predict. Additionally, each subsequent recurrence tends to be more aggressive, requiring a multidisciplinary approach to treatment.

Is There Hope for Our Patient?

Despite the recurrent nature of the disease, the patient has a favorable prognosis, given the extent of the surgery—all visible tumor sites were removed.

“Considering the long course of the disease—more than 20 years—the patient remains under strict dynamic observation. Granulosa cell tumors require careful management, and thanks to modern treatment methods, we can keep the situation under control,” emphasizes Heda Maltzagova.