ABSTRACT
BACKGROUND: Juvenile granulosa cell tumors (JGCT) of the ovary are rare. They usually present in children and adolescents. About 90% are diagnosed in early stage (FIGO I) with a favorable prognosis. More advanced stages (FIGO II-IV) usually have a poor clinical outcome. CASE: We report a case of long-term survival of a teenager with Stage III JGCT treated with aggressive debulking and thorough staging, but conservative surgery relative to the uterus, contralateral uninvolved ovary, and fallopian tube, plus combination chemotherapy. Her tumor recurred twice, 18 months and 17 years later, for which she had 2 additional surgeries and more chemotherapy. Our patient achieved 2 pregnancies and had 3 children. SUMMARY AND CONCLUSIONS: With fertility sparing surgery, patients may be able to achieve pregnancies and children.
Subject(s)
Abdominal Neoplasms/surgery , Fertility Preservation , Granulosa Cell Tumor/therapy , Liver Neoplasms/surgery , Organ Sparing Treatments , Splenic Neoplasms/surgery , Abdominal Neoplasms/secondary , Adolescent , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carboplatin/administration & dosage , Cytoreduction Surgical Procedures , Diaphragm , Etoposide/administration & dosage , Female , Granulosa Cell Tumor/pathology , Humans , Liver Neoplasms/secondary , Omentum , Recurrence , Splenic Neoplasms/secondaryABSTRACT
OBJECTIVE: To evaluate preoperative levels of CA-125 for the prediction of advanced stages of uterine cancer. STUDY DESIGN: Retrospective chart review of 141 women with endometrial cancer who were treated by a single gynecologic oncologist at a community teaching hospital in North Carolina between November 1994 and September 2002. RESULTS: Ninety-three of 106 patients (87.7%) with surgical stage I or II endometrial cancer had normal preoperative CA-125 levels. Ten of 11 (91%) women with stage IV endometrial cancer had elevated preoperative CA-125 levels. High CA-125 levels and positive lymph vascular space invasion correlated most strongly with advanced stage (p < 0.01). Similar trends in correlation of CA-125 levels were seen with the highest grade and the deepest myometrial invasion. The sensitivity and specificity of a CA-125 cutoff level of 35 U/mL were 63% and 88%, respectively, with a positive predictive value of 61% and negative predictive value of 89%. CONCLUSION: Measurement of preoperative CA-125 is a clinically useful test in endometrial cancer patients. CA-125 appears to be a significant independent predictor of the extrauterine spread of disease and is a better predictor of disease than depth of invasion or grade. This evidence complements a growing body of literature that supports the strong relationship between CA-125 level and stage of disease. A CA-125 level should be included as part of the preoperative workup for all patients with endometrial cancer.
