Ovarian tumors and uterine bleeding. I. Granulosa cell tumors

Abnormal uterine bleeding in association with ovarian tumors has been analyzed as to cause and frequency in a group of 376 cases from the Surgical Pathological Laboratory of the Johns Hopkins Hospital and the Gynecological Service of the Church Home and Infirmary and the cases have been studied according to their pathologic classification. It has been found that abnormalities in menstruation occur among a variety of pathologic types of ovarian tumors but that the mechanism responsible for these abnormalities varies with the tumor type. The highest occurrence of abnormal uterine bleeding was found in association with the tumors of granulosa derivation. It is this group which has been considered in the present paper. A group of 35 cases heretofore included under the classification of papillary serous cystadenocarcinoma has been added to the granulosa cell tumors as papillary granulosa cell carcinoma on the basis of morphologic and clinical characteristics. In 35 cases reviewed, 45 per cent were associated with abnormal uterine bleeding. A group of 59 solid granulosa cell tumors has been reviewed according to the pathologic type and 62 per cent were found to be associated with menstrual abnormalities. In both groups where endometrium was available, endometrial hyperplasia was the direct cause of the uterine bleeding. The hyperplasia is presumably produced by the estrogenic secretion of the tumor itself. A more careful study of the uterine endometrium, together with hormonal studies on the blood and urine of patients with ovarian neoplasms, will render valuable assistance in the correct classification of ovarian tumors.