What is the role of lab tests in the workup of granulosa cell tumors (GCTs) of the ovaries?

Updated: Aug 30, 2018
  • Author: David C Starks, MD, MPH; Chief Editor: Warner K Huh, MD  more...
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Answer

Order a pregnancy test in all reproductive-aged patients (even at the extremes of reproductive age) who present with abdominopelvic symptoms.

The standard workup for a patient with an adnexal mass varies depending on patient age, as follows:

  • In patients who are prepubertal or younger than 30 years, especially if the mass has solid components present, obtain blood to check for beta–human chorionic gonadotropin (bhCG), alpha-fetoprotein (AFP), lactate dehydrogenase (LDH), and cancer antigen 125 (CA125). Each of these may be elevated in women with ovarian malignancies and in patients with a normal or abnormal pregnancy. CA125 levels in menstruating women can be slightly to moderately elevated due to a host of benign disorders including, but not limited to, endometriosis, uterine leiomyoma, appendicitis, pancreatitis, and inflammatory bowel disease. In this group of patients, CA125 level is not as useful as a diagnostic test, but it may be helpful in monitoring patients long term if they are found to have a tumor that causes elevation of this tumor marker.

  • In reproductive-aged women older than 30 years, CA125 level should be checked; remember that this can be elevated in benign disorders in women who still are menstruating. Serum inhibin levels are now clinically available for work-up of masses suspicious for GCT and should be considered in such patients (see below). This is now the most specific marker for GCTs that is currently clinically available. [4] Serum levels for estrogen, testosterone, and dehydroepiandrosterone can be drawn if elevation of these hormones is suggested based on clinical findings. Abrupt onset or rapid progression of endocrinologic manifestations should heighten the suspicion for a neoplastic process.

  • In postmenopausal women, obtain blood for a CA125 test. A CA125 level higher than 60 U/mL in a postmenopausal woman has a good positive predictive value for malignancy. Again, serum sex hormone levels can be ordered based on clinical findings consistent with excess hormone production.

Other ancillary laboratory studies that may be useful in narrowing the differential include stool guaiac testing, CBC count with differential, blood chemistries, urinalysis, and cervical cultures for gonorrhea and chlamydia.

Several other tumor markers have been evaluated in patients with GCTs.


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