Oncology and Fibroids
Call Exner bodies are seen in (AIIMS Nov. 2009)
|A||Granulosa cell tumour|
|B||Yolk sac tumor|
|D||Embryonal cell carcinoma|
Granulosa Cell Tumor
1. These tumours are part of the sex cord-gonadal stromal tumour group of tumours
2. Clinical Presentation
Estrogens are produced by functioning tumours, and the clinical presentation depends on the patient's age and sex.
i. If the patient is postmenopausal, she usually presents with abnormal uterine bleeding.
ii. If the patient is of reproductive age, she would present with menometrorrhagia. However, in some cases she may stop ovulating altogether.
iii. If the patient has not undergone puberty, early onset of puberty may be seen
a. The most characteristic gross appearance is a smooth surfaced solid and cystic lesion with the cysts filled with blood.
b. There have been cases where the tumour presented as a single cyst-like space, but with no bleeding into the space.
c. Hemoperitoneum is an infrequent but classical presentation.
d. A large variety of histological presentations exists, but they have two key features:
i. Call-Exner bodies (granulosa cells arranged haphazardly around a space containing eosinophilic fluid); and
ii. Pale uniform nuclei, often with grooves
4. Gene Defect
a. 97% of granulosa cell tumours contain an identical mutation in the FOXL2 gene.
b. This is a somatic mutation meaning it is not usually transmitted to descendants.
c. It is believed that this mutation may be the cause of granulosa cell tumours