Elsevier

Gynecologic Oncology

Volume 81, Issue 1, April 2001, Pages 113-116
Gynecologic Oncology

Case Report
Management of Recurrent Juvenile Granulosa Cell Tumor of the Ovary

https://doi.org/10.1006/gyno.2000.6098Get rights and content

Abstract

Background. Juvenile granulosa cell tumors of the ovary are a rare form of neoplasm that makes up less than 5% of ovarian tumors in childhood and adolescence. About 90% are diagnosed in stage I with a favorable prognosis. More advanced stages (FIGO stages II–IV) have a poor prognosis.

Case. A patient was initially diagnosed at age 17 with FIGO stage IIIC disease and treated with a right salpingo-oophorectomy, debulking, and staging followed by six cycles of carboplatin and etoposide chemotherapy. Tumor recurrence in the liver and adjacent to the spleen occurred 13 months after completion of primary therapy. Aggressive surgical removal of tumor followed by six cycles of bleomycin and taxol as salvage chemotherapy resulted in 44 months of disease-free survival. On November 27, 2000, she had a cesarean delivery of a 2335-g normal male due to a breech presentation. Exploration revealed no evidence of tumor.

Conclusion. This is the second case report of a patient with advanced juvenile granulosa cell tumor to become pregnant after apparently successful chemotherapy. These results are encouraging, but the best treatment for extensive and recurrent disease has yet to be determined.

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    Combination chemotherapy should be initiated promptly postoperatively. There has been no consistently effective regimen in these patients, although anecdotal cases and small series have reported successes with either regimens of cisplatin, vinblastine, and bleomycin (PVB); methotrexate, actinomycin D, and cyclophosphamide (MAC); cisplatin and doxorubicin; ifosfamide, adriamycin, vincristine, and actinomycin D; carboplatin and etoposide; and carboplatin, bleomycin, and paclitaxel; and bleomycin, etoposide, and cisplatin (BEP)3–8,13,17 For these patients with advanced-stage JGCT or recurrence, the best treatment is yet to be determined; although, the highest activity has been seen with the PVB and BEP regimens. The treatment of recurrent disease with hormonal therapy is an option, but experience is limited.

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