When a 46-year-old woman presented with a 17-centimeter pelvic mass, gynecologic oncologist Jeanine Staples had reason to hope it was benign since it was mostly cystic, although she had concerns about a solid area. The mass would turn out to be Stage 1C granulosa cell tumor — a rare, slow-growing form of ovarian cancer.
“This is a rare histology, but it’s treated along the same guidelines as other ovarian cancers,” says Staples, who practices at the Sibley Memorial Hospital Center for Gynecologic Oncology and Advanced Pelvic Surgery. “We did the full staging surgery, followed by six cycles of chemotherapy.”
Granulosa cell tumor accounts for 2%–5% of ovarian cancers and affects about 1 in 100,000 women in the United States per year.
“It’s really nice having this large group with different levels of experience. With that input, we can really feel confident going forward with a treatment plan.”
— Jeanine Staples
Because the mass was so large and encompassed a large portion of the right ovary, Staples and her team planned to remove the mass and the rest of the right fallopian tube and ovary. Staples did not want to remove the mass alone because by separating it from the ovary, there was a greater risk that it would rupture and cause seeding of potentially cancerous cells elsewhere. As discussed with the patient, if the mass was found to be cancerous — which the team wouldn’t know until during the surgery — Staples planned a more extensive surgery so the patient wouldn’t have to come back for a second procedure.
A frozen section biopsy was performed while the patient was still in the operating room; when the cells came back as cancerous, Staples went ahead with the full staging surgery, removing the other tube and ovary, the uterus, cervix, lymph nodes and omentum. The patient was discharged a few days later.
When the complete pathology report came back the following week, it showed that the cancer was the rare granulosa cell tumor, and, also, that it had not spread to the patient’s lymph nodes or other organs.
While the granulosa cell tumor hadn’t visibly ruptured or spread, the final pathology report noted that there were microscopic cells noted in the washings, making the cancer Stage 1C, for which chemotherapy is recommended. The patient completed six cycles of chemo with Bruce Kressel, a medical oncologist at Johns Hopkins Kimmel Cancer Center at Sibley. Afterward, the patient had no evidence of disease, and now sees Staples every three months for a pelvic exam and blood work.
Complex and rare cancer cases such as this one are approached in a multidisciplinary manner at the Cancer Center. In addition to Staples, Kressel, and the pathologist who tested the frozen section, the patient’s case was reviewed in a biweekly multidisciplinary tumor board meeting, during which medical oncologists, radiation oncologists, pathologists and radiologists analyze cases together.
“Everybody gives their opinions, and we come up with a consensus,” Staples says. “We also see if there are any clinical trials that patients are eligible for. It’s really nice having this large group with different levels of experience. With that input, we can really feel confident going forward with a treatment plan.”