A 20-year-old female was diagnosed with granulosa cell tumor of the ovary. Which of the following biomarkers would be most useful for diagnosis and follow-up of the patient?
Ans. b. Inhibin (Ref: Robbins 9/e p1032-1033, 8/e p1050)Elevated tissue and serum levels of inhibin, a product of granulosa cells, are associated with granulosa cell tumors. This biomarker may be useful for identifying granulosa and other sex cord-stromal tumors, and for monitoring patients being treated for these neoplasms.Granulosa Cell TumourGenerally occurs before puberty and after 40 yearsTumour secretes estrogens, which cause precocious sexual development in girls or increase the risk for endometrial hyperplasia and carcinoma in women.Less commonly granulosa ceil tumours can secrete androgens and produce masculinization.Pathology:Low grade malignancyAlmost always unilateralEncapsulated tumours and have smooth surfaceMicroscopy: Coffee bean nucleus and Call-Exner bodiesQMC type of ovarian tumor that is composed of cells that stain positively with inhibinQ.Metastasis is peculiar in case of granulosa cell tumor, it first involves opposite ovary followed by metastasis in lumbar region.Clinical Features:MC symptoms: Menometrorrhagia and post-menopausal bleedingDiagnosis:Granulosa cell tumor secrete inhibin (useful marker)Treatment:Children and women of reproductive age: Unilateral salpino-oophorectomyPost-menopausal: TAH + BSO"Tumor cells in Sertoli-Leydig tumors (Androblastomas) may stain positively with inhibin, but Call-Exner bodies are not present. Sertoli-Leydig tumors also may secrete androgens and produce virilization in women."
Neuron-specific enolase
Inhibin
CA 19-9
CA 50
Tumor Markers