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GnRH agonist therapy in a patient with recurrent ovarian granulosa cell tumors.

Kim HJ, Lee SC, Bae SB, Kwon KW, Kim CK, Lee NS, Lee KT, Won JH, Hong DS, Park HS - J. Korean Med. Sci. (2009)

Bottom Line: After two courses of systemic combination chemotherapy, with paclitaxel and carboplatin, the masses in the abdomen and pelvic cavity increased, and debulking surgery also failed because of peritoneal dissemination with severe adhesion.This partial response had been maintained for more than 8 months as of the last follow-up visit.Owing to its long and indolent course and the low metabolic rate of the tumors, advanced or recurrent granulosa cell tumor (GCT) requires treatment options beyond chemotherapy, surgery, and radiotherapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Korea.

ABSTRACT
A 65-yr-old woman presented 17 yr status post-hysterectomy with bilateral ovarian salpingo-oophorectomy, attributable to ovarian cancer. She was admitted to our hospital, with multiple cystic liver masses and multiple large seeded masses in her abdomen and pelvic cavity. Histological examination of the pelvic masses demonstrated granulosa cell tumors. After two courses of systemic combination chemotherapy, with paclitaxel and carboplatin, the masses in the abdomen and pelvic cavity increased, and debulking surgery also failed because of peritoneal dissemination with severe adhesion. Finally, she underwent palliative radiotherapy for only the pelvic masses obstructing the urinary and GI tracts, and monthly hormonal therapy with a gonadotrophin-releasing hormone agonist; leuprorelin 3.75 mg IM. Subsequently, multiple masses beyond the range of the radiation as well as those within the radiotherapy field partially decreased. This partial response had been maintained for more than 8 months as of the last follow-up visit. Owing to its long and indolent course and the low metabolic rate of the tumors, advanced or recurrent granulosa cell tumor (GCT) requires treatment options beyond chemotherapy, surgery, and radiotherapy. Hormonal agents may provide another treatment option for advanced or recurrent GCT in those who are not candidates for surgery, chemotherapy, or radiotherapy.

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Related in: MedlinePlus

Images before and after treatments. (A) A CT scan performed before systemic chemotherapy shows multiple metastatic masses in the abdomen and pelvis. (B) A PET scan performed before systemic chemotherapy shows multiple hypometabolic masses in the abdomen and pelvis. (C) A CT scan performed before radiotherapy and hormonal therapy shows multiple metastatic masses with increased size in the abdomen and pelvis. (D) A CT scan performed after radiotherapy and hormonal therapy shows a partial response to this therapy. The insert shows a radiotherapy planning radiography.
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Figure 1: Images before and after treatments. (A) A CT scan performed before systemic chemotherapy shows multiple metastatic masses in the abdomen and pelvis. (B) A PET scan performed before systemic chemotherapy shows multiple hypometabolic masses in the abdomen and pelvis. (C) A CT scan performed before radiotherapy and hormonal therapy shows multiple metastatic masses with increased size in the abdomen and pelvis. (D) A CT scan performed after radiotherapy and hormonal therapy shows a partial response to this therapy. The insert shows a radiotherapy planning radiography.

Mentions: A 65-yr-old multiparous woman presented 17 yr status post-hysterectomy with bilateral ovarian salpingo-oophorectomy, attributable to ovarian cancer. She had not received adjuvant therapy because of intolerance and she had not undergone regular follow-up monitoring. After 7 yr, she visited another hospital for abdominal pain, and she found that she had relapsed, developing multiple liver masses with granulosa cell tumors, and underwent three cycles of transarterial chemotherapy with cisplatin (100 mg/m2) without systemic chemotherapy. The response to transarterial chemotherapy was not fully determined. We could not get additional information regarding her medical information, because of limitations at the other institute and the long time gap. Ten years after the transarterial chemotherapy, without any regular follow-up monitoring, she was admitted via our emergency room because of abdominal pain and hematuria. She presented with multiple cystic liver masses, multiple large seeded masses in the abdomen and pelvic cavity, and hydronephrosis of her left kidney (Fig. 1A). The masses were recognized as hypometabolic by positron emission tomography-computed tomography (PET-CT) (Fig. 1B). Histological examination of the pelvic masses demonstrated granulosa cell tumors that were negative for estrogen receptor (ER), positive for progesterone receptor (PR), and positive for inhibin (Fig. 2).


GnRH agonist therapy in a patient with recurrent ovarian granulosa cell tumors.

Kim HJ, Lee SC, Bae SB, Kwon KW, Kim CK, Lee NS, Lee KT, Won JH, Hong DS, Park HS - J. Korean Med. Sci. (2009)

Images before and after treatments. (A) A CT scan performed before systemic chemotherapy shows multiple metastatic masses in the abdomen and pelvis. (B) A PET scan performed before systemic chemotherapy shows multiple hypometabolic masses in the abdomen and pelvis. (C) A CT scan performed before radiotherapy and hormonal therapy shows multiple metastatic masses with increased size in the abdomen and pelvis. (D) A CT scan performed after radiotherapy and hormonal therapy shows a partial response to this therapy. The insert shows a radiotherapy planning radiography.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2698208&req=5

Figure 1: Images before and after treatments. (A) A CT scan performed before systemic chemotherapy shows multiple metastatic masses in the abdomen and pelvis. (B) A PET scan performed before systemic chemotherapy shows multiple hypometabolic masses in the abdomen and pelvis. (C) A CT scan performed before radiotherapy and hormonal therapy shows multiple metastatic masses with increased size in the abdomen and pelvis. (D) A CT scan performed after radiotherapy and hormonal therapy shows a partial response to this therapy. The insert shows a radiotherapy planning radiography.
Mentions: A 65-yr-old multiparous woman presented 17 yr status post-hysterectomy with bilateral ovarian salpingo-oophorectomy, attributable to ovarian cancer. She had not received adjuvant therapy because of intolerance and she had not undergone regular follow-up monitoring. After 7 yr, she visited another hospital for abdominal pain, and she found that she had relapsed, developing multiple liver masses with granulosa cell tumors, and underwent three cycles of transarterial chemotherapy with cisplatin (100 mg/m2) without systemic chemotherapy. The response to transarterial chemotherapy was not fully determined. We could not get additional information regarding her medical information, because of limitations at the other institute and the long time gap. Ten years after the transarterial chemotherapy, without any regular follow-up monitoring, she was admitted via our emergency room because of abdominal pain and hematuria. She presented with multiple cystic liver masses, multiple large seeded masses in the abdomen and pelvic cavity, and hydronephrosis of her left kidney (Fig. 1A). The masses were recognized as hypometabolic by positron emission tomography-computed tomography (PET-CT) (Fig. 1B). Histological examination of the pelvic masses demonstrated granulosa cell tumors that were negative for estrogen receptor (ER), positive for progesterone receptor (PR), and positive for inhibin (Fig. 2).

Bottom Line: After two courses of systemic combination chemotherapy, with paclitaxel and carboplatin, the masses in the abdomen and pelvic cavity increased, and debulking surgery also failed because of peritoneal dissemination with severe adhesion.This partial response had been maintained for more than 8 months as of the last follow-up visit.Owing to its long and indolent course and the low metabolic rate of the tumors, advanced or recurrent granulosa cell tumor (GCT) requires treatment options beyond chemotherapy, surgery, and radiotherapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Korea.

ABSTRACT
A 65-yr-old woman presented 17 yr status post-hysterectomy with bilateral ovarian salpingo-oophorectomy, attributable to ovarian cancer. She was admitted to our hospital, with multiple cystic liver masses and multiple large seeded masses in her abdomen and pelvic cavity. Histological examination of the pelvic masses demonstrated granulosa cell tumors. After two courses of systemic combination chemotherapy, with paclitaxel and carboplatin, the masses in the abdomen and pelvic cavity increased, and debulking surgery also failed because of peritoneal dissemination with severe adhesion. Finally, she underwent palliative radiotherapy for only the pelvic masses obstructing the urinary and GI tracts, and monthly hormonal therapy with a gonadotrophin-releasing hormone agonist; leuprorelin 3.75 mg IM. Subsequently, multiple masses beyond the range of the radiation as well as those within the radiotherapy field partially decreased. This partial response had been maintained for more than 8 months as of the last follow-up visit. Owing to its long and indolent course and the low metabolic rate of the tumors, advanced or recurrent granulosa cell tumor (GCT) requires treatment options beyond chemotherapy, surgery, and radiotherapy. Hormonal agents may provide another treatment option for advanced or recurrent GCT in those who are not candidates for surgery, chemotherapy, or radiotherapy.

Show MeSH
Related in: MedlinePlus