Ovary tumor
Sex cord stromal tumors
Granulosa cell tumor - juvenile

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

Revised: 25 October 2018, last major update December 2012

Copyright: (c) 2002-2018, PathologyOutlines.com, Inc.

PubMed search: Ovarian granulosa cell tumor juvenile
Cite this page: Ehdaivand, S. Granulosa cell tumor - juvenile. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/ovarytumorgctjuv.html. Accessed November 18th, 2018.
Definition / general
  • 5% of ovarian tumors in children
  • Mean age 13 years, range 0-67 years, 80% occur before age 20 and 97% before age 30
  • Most prepubertal patients present with sexual precocity due to excessive estrogen production; rarely produce androgens (J Endocrinol Invest 2006;29:653); older patients have non-specific abdominal swelling and pain (Am J Surg Pathol 1984;8:575)
  • Rarely associated with enchondromatosis (Ollier’s disease), Mafucci syndrome, abnormal karyotype / ambiguous genitalia (Am J Surg Pathol 1985;9:737)
Case reports
Gross description
  • Usually unilateral, up to 12 cm
  • Multiloculated, cystic and solid tumor with yellow-white solid areas
  • May have hemorrhage and necrosis
Gross images

Images hosted on PathOut server:

Various images

Contributed by Dr. Hanni Gulwani - 3 year old girl with breast enlargement:

Mostly solid tumor with focal cystic change

Microscopic (histologic) description
  • Diffuse or macrofollicular patterns with microcysts containing eosinophilic secretions, tumor cells either have scant cytoplasm or are luteinized (Arch Pathol Lab Med 1989;113:40)
  • Round / oval hyperchromatic nuclei with small nucleoli, irregular nuclear contours
  • No / rare nuclear grooves; high mitotic rate (mean 7/10 HPF)
  • May have hobnail-type cells, pseudopapillary pattern (Am J Surg Pathol 2008;32:581)
Microscopic (histologic) images

Scroll to see all images.

Images hosted on PathOut server:

Solid cellular neoplasm with focal follicle formation

Solid nodules

Papillary pattern

Lumen of follicles stained by mucicarmine

Theca cells

Mitotic figures

Hobnail nuclei

Severe nuclear atypia

Case of Week #59:

Various images

Contributed by Dr. Hanni Gulwani, New Delhi (India) - 3 year old girl with breast enlargement:

Primordial follicles in normal ovary

Poorly formed follicles with mucoid secretions

Well-demarcated tumor with pseudolobular pattern
and compressed normal ovary at periphery

Compact spindle cell areas with hemangiopericytoma like pattern

Loose edematous areas with abortive follicles

Spindle cells are SMA+


High MIB-1 expression

ER+ and PR+

Images hosted on other servers:

Gross, H&E and inhibin

Positive stains
  • Inhibin, calretinin
Negative stains
  • HER2
Molecular / cytogenetics description
  • Consistent trisomy 12 (as with adult granulosa cell tumors)
  • More aneuploidy in juvenile than adult granulosa cell tumors
Differential diagnosis
  • Adult granulosa cell tumor: more regularly shaped follicles with basement membrane material, prominent nuclear grooves and no hyperchromasia
  • Clear cell carcinoma: older patients, diffuse hobnail cells, no follicles and no juvenile granulosa type cells
  • Thecoma: older patients, no follicles, no atypia and no mitotic figures