Ovary tumor
Sex cord stromal tumors
Granulosa cell tumor - adult

Authors: Shahrzad Ehdaivand, M.D. (see Authors page)

Revised: 10 October 2018, last major update December 2012

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PubMed search: Ovarian granulosa cell tumor
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Cite this page: Ehdaivand, S. Granulosa cell tumor - adult. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/ovarytumorgctadult.html. Accessed January 18th, 2019.
Definition / general
  • Differentiation towards follicular granulosa cells
  • Usually women age 15+ years; 75% associated with hyperestrogenism, causes precocious puberty in children, metrorrhagia (bleeding between periods), endometrial hyperplasia / carcinoma (usually well differentiated and superficial) and breast fibrocystic changes in adults
  • Endometrial hyperplasia regresses after tumor excision
  • 10 year survival > 90%; tends to recur locally, up to 20 years later
  • 5 - 25% risk of malignancy, cannot predict from histology
Prognostic factors
  • Stage, size, tumor rupture and nuclear atypia
Case reports
Gross description
  • > 95% unilateral and confined to ovary
  • Encapsulated with smooth lobulated surface, gray or yellow, solid or cystic with straw colored or mucoid fluid
  • May resemble cystadenoma; androgenic tumors tend to be large
Gross images

Images hosted on PathOut server:

Various images

Solid and cystic tumor

Images hosted on other servers:

Various images

Microscopic (histologic) description
  • Small, bland, cuboidal to polygonal cells in various patterns, including Call-Exner bodies (small follicle-like structures filled with acidophilic material), macrofollicular, trabecular, solid and insular patterns
  • Cells may be luteinized (plump with ample cytoplasm), particularly during pregnancy; may have theca cell component
  • Cells have coffee bean nuclei with folds / grooves; may see floret giant cells, indicative of degeneration
  • Rarely focal hepatic cell differentiation (large cells with abundant eosinophilic, slightly granular cytoplasm)
  • Central round nuclei with single prominent nucleoli
  • Often bile pigment in canaliculi between large cells (Am J Surg Pathol 1999;23:1089, Am J Surg Pathol 1993;17:85), pseudopapillary pattern (Am J Surg Pathol 2008;32:581)
Microscopic (histologic) images

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Images hosted on PathOut server:

Case of the Week #96:

Various images


Contributed by Dr. Sharon Bihlmeyer:

Low power

High power




Other images:

Diffuse pattern

Trabecular pattern

Insular pattern

Microfollicular pattern

Microfollicular pattern

Watered-silk (moire-silk) pattern

Gyriform pattern

Cystic tumor

Luteinized tumor

Grooved nuclei

Uniform and pale nuclei

Enlarged, hyperchromatic, bizarre nuclei

Theca cells

Reticulin stain

Images hosted on other servers:

Primitive follicles

Various patterns

Inhibin: fig 1, CD99: fig 4

Cytokeratin 20 and vimentin

Cytology description
Positive stains
Negative stains
  • EMA
Microscopic (histologic) description
  • Monosomy 22 (~40%), trisomy 12 (~30%), +14 (~30%), monosomy X (~10%), monosomy 17 (5%), although most tumors (80%) are diploid or near-diploid (Mod Pathol 2002;15:951)
Electron microscopy description
  • Abundant intermediate filaments, desmosomes

Granulosa cell tumor
Differential diagnosis