View report page

A CASE OF GRANULOSA-CELL CARCINOMA OF OVARY.
By R. Kelson Ford, M.D., M.M.S.A., Medical Superintendent, St. Olave's Hospital.
Granulosa-cell carcinoma of the ovary is of sufficient rarity to justify at present
the reporting of every case observed.
Case report.
Mrs. A. A. (30565), aged 51, was admitted to hospital in a very exsanguinated condition.
It was stated that the patient, who had had four children, had ceased to menstruate for two
years. Vaginal haemorrhage had. however, appeared three months previously and had persisted.
the patient becoming steadily weaker until she had fainted. Apart from evidence of
serious loss of blood, and some gingivitis, general physical examination revealed no abnormality.
On pelvic examination, the cervix was normal, the uterus somewhat enlarged and displaced
to the right, and a slightly movable cystic swelling was palpable in Douglas' pouch. Following
blood transfusion, sufficient improvement was made to justify operation, and low median laparotomy
was performed. A dark, thin-walled cyst was found in the left meso-salpinx, and this
proved on section to be a simple epoophoric cyst. In addition, there was what appeared to be a
large, thick-walled cyst of the right ovary, somewhat incarcerated in the pelvis, of about the size
fig. 1.
fig. 2.
of a grape-fruit, which was also removed. Apart from a little post-anaesthetic bronchitis, the
patient made an uninterrupted recovery and radio-therapy at Lambeth hospital was arranged.
She was seen again one year after operation, when she appeared well, and stated that she felt
better than for many years.
Pathological Findings (kindly provided by Dr. W. G. Barnard, director, Central histological
laboratory):
Macroscopic appearance.—Pieces of tissue making up a mass 10.5 by 8.5 by 2.5 cm. and
representing half of an oval tumour. The capsule is smooth and pearly white, and to it is attached
the terminal 5 cm. of Fallopian tube. The cut surface is mostly smooth and creamy white, in it
are a few red dots and streaks. Beneath the capsule and around the border nearest the Fallopian
tube are numerous spongy areas and throughout there are cysts (varying in size from 1.5 cm.
to 0.5 cm. in diameter) containing thin watery fluid.
Microscopic appearance.—Five pieces of the tumour were embedded in paraffin and
sections were stained by Ehrlich's hæmatoxylin and eosin and by Van Gieson's method and
counterstained by iron hæmatoxylin. The tumour is made up of alveoli, solid acini and trabeculæ
of polygonal cells separated by scanty fibrous tissue. The majority of the trabeculæ are
two or more cells thick and some of the spaces in the alveoli contain pink homogeneous material.
Both the acini and alveoli contain rounded spaces and in a few of these there are large ova-like
cells. The polygonal cells for the most part have abundant protoplasm and round or fat oval
nuclei, the nuclei having a sharp outline, scanty chromatin net and distinct chromatin nodes.
(114)