Pictorial assay of the granulosa cell tumor

Objectives: Granulosa cell tumors (GCTs) are rare ovarian neoplasms accounting for approximately 3% of all ovarian malignancies. They are the most commonmalignant sex cord stromal tumor. The differences between the two types (juvenile and adult) are mainly microscopic. GCT is a slow-growing tumor that tends to recur very late. According to textbooks GCT is a large tumor with a smooth or lobulated surface with necrotic or hemorrhagic areas. The majority of the masses are solid; the minority are partially or totally cystic. Little is known about the correlation with preoperative sonographic features and most studies only report on the locularity. The aim of the study was to describe the sonographic features of the GCT. Methods: Patients with a GCT that were preoperatively scanned by a strict protocol were retrospectively included in this analysis. Results: Nineteen patients were included, three with a juvenile- and 16 with an adult-type GCT. Most GCTs were multilocular solid (11/19 (58%)) or solid (7/19 (37%)); one mass was unilocular solid. Some 58% (11/19) of the masses had more than five locules, and 37% (7/19) more than 10 locules. The masses were large with a mean largest diameter of 116 (37 242) mm. Only three tumors had papillary projections. All tumors showed increased vascularization; 95% (18/19) had a color score ≥3. The mean PI was 0.69 (0.7 1.8), the mean RI 0.46 (0.49 0.93) and the mean PSV 21.79 (4 52). Endometrial pathology was suspected only once on ultrasound but found in six of the 11 (54.6%) biopsies. The free fluid was suggestive of a hematoperitoneum in one case and ascites in four cases. In 12/15 masses the subjective impression of the sonologist was a malignant or a germ cell tumor.