Histopathological prognostic factors of adult granulosa cell tumors of the ovary

Background. The prognostic factors of adult granulosa cell tumor (AG-CT) have not been well defined. Methods. In 27 AGCT patients, we examined clinical stage, microscopic patterns, mitotic index (MI), and lymph-vascular space invasion (LVSI) to determine whether these factors were related to disease-free survival (DFS) of patients with AG-CT. We also performed immunohistochemical examination for p53. Results. Seventeen cases represented stage I tumors, four stage II, five stage III, and one stage IV Patients with stage I disease had more favorable prognosis than those with stage II to IV disease (p=0.034). There was no relation between the microscopic patterns and the DFS. The MI, which was categorized into less than or equal to3/10high power field (HPF) and greater than or equal to4/10 HPF, was significantly related to patients DFS (p <0.0005). The DFS time for patients with moderate or prominent LVSI was significantly shorter than that for patients with no or minimal LVSI (p <0.0001) By multivariate analysis, MI and LVSI were shown to be independent prognostic factors. Five of seven patients with recurrent tumor had extrapelvic spread; two in the abdominal cavity and three in the liver. Conclusion. The results of this study suggest that prognosis for patients with AGCT depends on the MI and LVSI. During the follow-up period of patients, they need to be examined for distant metastasis including liver.