Granulosa Cell Tumour of the Ovary: a Descriptive Cohort Study in Kenyatta National Hospital

Abstract

Background: Granulosa cell tumour (GCT) of the ovary is a rare neoplasm accounting for about 2% - 5% of primary ovarian neoplasms. The major functions of granulosa cells include the synthesis of sex steroids and various peptides required for folliculogenesis and ovulation. GCTs are a relatively homogenous group of tumors, categorised into two clear-cut subtypes, Juvenile GCT and Adult GCT. As stated by the World cancer report of 2020, there were approximately 12,000 cases of GCT worldwide. Although lower incidences of GCT are reported in Asian and African countries compared to Europe and North America, this has been partly attributed to under surveillance. In Kenya, there is lack of data on the characteristics of patients diagnosed with GCT. Research objective: The broad objective was to evaluate the clinical characteristics, histological features and survival of patients managed for GCT of the ovary in KNH. Study setting: The study took place in KNH - Health Information/ Records department as the patient’s records were reviewed retrospectively. Study design: This was a descriptive retrospective cohort study. Sample size: A total of 44 patients’ records with a histological diagnosis of GCT were reviewed. Methodology: Patients records of women with histologically confirmed GCT of the ovary, managed in KNH from 2020 retrospectively were retrieved until the sample size was achieved or unless any logistical issues were encountered. Data was collected using a pre-developed and appraised data abstraction form. Phone calls were used to determine the patient’s well-being and to acquire any critical missing data. Results: The mean age of patients with a diagnosis of GCT from this study was 49.3 (SD 19.6) years, while the overall median age was 52.5 (IQR 33.5 – 61.5) years. The median age for AGCT (n=21) was 54.0 (IQR 42.0 – 63.0) while that for JGCT (n=5) was 17 (IQR 16.0 – 22.0) years. The youngest patient observed was 7yrs, while the oldest was 81yrs. The most common presenting symptom was abdominal pain & abdominal swelling. The most common symptom among those above 50yrs was post-menopausal bleeding. The most common sign was a palpable pelvic mass. Stage 1 disease was the most common stage at diagnosis. The most common histological subtype was AGCT with over 40% registered as GCT otherwise unspecified on histology. The estimated overall survival rate was 91% at 2-years & 81% at 5-years. Patients with early-stage disease (stage I and II) had a very good prognosis at 100% while patients with advanced stage disease (stage III & IV) had a poor prognosis with an overall survival at 25%. Conclusion: Despite the small number of patients in this study, we concluded that the majority of patients with GCT presented with abdominal pain, abdominal swelling and post-menopausal bleeding. The most common histological subtype was AGCT. Finally, we came to the conclusion that the survival of GCT patients managed in KNH is generally favourable due to presentation with early-stage disease while the few patients observed with poorer survival were noted to have presented with advanced stage disease.