Imaging of gynecological disease (3): clinical and ultrasound characteristics of granulosa cell tumors of the ovary

Ultrasound Obstet Gynecol. 2008 Apr;31(4):450-6. doi: 10.1002/uog.5279.


Objectives: To describe the clinical and ultrasound characteristics of granulosa cell tumors (GCTs) of the ovary, and to define the ultrasound appearance of GCTs based on pattern recognition.

Methods: Databases of four gynecological ultrasound centers were searched to identify patients with histologically proven GCTs who had undergone a standard preoperative ultrasound examination.

Results: A total of 23 women with confirmed GCT were identified. Twelve (52%) women were postmenopausal, nine (39%) were of fertile age and two (9%) were prepubertal. Clinical symptoms were abdominal distension (7/23, 30%), pain (5/23, 22%) and irregular vaginal bleeding (6/23, 26%). Seven patients (30%) were asymptomatic. Endometrial pathology was found in 54% (7/13) of the patients from whom endometrial biopsies were taken. On ultrasound scan 12/23 (52%) masses were multilocular-solid, 9/23 (39%) were purely solid, one mass (4%) was unilocular-solid and one mass was multilocular (4%). Multilocular and multilocular-solid cysts typically contained large numbers of small locules (> 10). The echogenicity of the cyst content was most often mixed (6/16, 38%) or low level (7/16, 44%). Papillary projections were found in only four women (17%). The GCTs were large tumors with a median largest diameter of 102 (range, 37-242) mm and manifested moderate or high color content at color Doppler examination (color score 3 in 13/23 tumors (57%); color score 4 in 8/23 tumors (35%)).

Conclusions: At ultrasound examination, most GCTs are large multilocular-solid masses with a large number of locules, or solid tumors with heterogeneous echogenicity of the solid tissue. Hemorrhagic components are common and increased vascularity is demonstrated at color/power Doppler ultrasound examination. The hyperestrogenic state that is created by the tumor often causes endometrial pathology with bleeding problems as a typical associated symptom.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child
  • Child, Preschool
  • Databases, Factual
  • Female
  • Granulosa Cell Tumor / complications
  • Granulosa Cell Tumor / diagnostic imaging*
  • Humans
  • Menorrhagia / diagnostic imaging
  • Menorrhagia / etiology
  • Middle Aged
  • Pain / diagnostic imaging
  • Pain / etiology
  • Retrospective Studies
  • Ultrasonography, Doppler, Color / methods*
  • Uterine Hemorrhage / diagnostic imaging
  • Uterine Hemorrhage / etiology
  • Uterine Neoplasms / complications
  • Uterine Neoplasms / diagnostic imaging*