Defining the Relationship Between Ovarian Adult Granulosa Cell Tumors and Synchronous Endometrial Pathology: Does Ovarian Tumour Size Correlate With Endometrial Cancer?

Abstract Objective: The main feature of adult granulosa cell tumours (AGCT) is their capacity to secrete hormones, with nearly all of them capable of synthesizing oestradiol. Endometrial pathology is caused granulosa cell-produced oestrogen. The primary goal of this study is to identify synchronised endometrial pathologies, particularly endometrial cancer, in AGCT patients who had undergone a hysterectomy. The secondary objective is to define the factors related to synchronised endometrial cancer in AGCT. Materials and Methods : The study cohort comprised retrospectively of 316 AGCT patients from ten tertiary gynaecological oncology centres. AGCT surgery consisted of bilateral salpingo-oophorectomy, hysterectomy, peritoneal cytology, omentectomy and the excision of any suspicious lesion. Endometrial hyperplasia was categorised as simple hyperplasia without atypia, complex hyperplasia without atypia, complex hyperplasia with atypia or endometrial intraepithelial neoplasia (EIN). The median tumour size value was used to define the relationship between tumour size and endometrial cancer. The relationship between each value and endometrial cancer was evaluated. Results: EIN or hyperplasia with complex atypia was detected in 7.7% of patients and endometrial cancer in 3.2% of patients. The relationship between tumour size and endometrial cancer was evaluated by taking the tumour size as a cut-off value of 150 mm. Four patients with a tumour size of ≤150 mm (3.2%), and four patients with a tumour size >150 mm (12.1%) had endometrial cancer. ( p =0.036). Tumour size was statistically significant in relation to endometrial cancer in menopausal AGCT patients. Conclusion: Our present study determined that 7.3% of patients had complex hyperplasia with atypia or EIN, and 3.1% of patients had endometrial carcinoma. During the menopausal period, endometrial cancer risk was 4.5%. The study revealed that the likelihood of developing endometrial cancer increased to 12% from 3.2% when the size of the tumour was >150 mm in menopausal patients.