[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Female genital tract](https://durgical.com/en/general-pathology/areas/female-genital/) › Granulosa cell tumours: adult and juvenile # Granulosa cell tumours: adult and juvenile - Lesion An ovarian tumour that makes estrogen: it causes bleeding and endometrial cancer in older women, early puberty in girls, and can come back decades later. Updated Nov 12, 2026 ## Key points - Adult type: FOXL2 C134W mutation in nearly all; peri- and postmenopausal women. - Call–Exner bodies: small spaces with eosinophilic material surrounded by granulosa cells; nuclei with longitudinal grooves (coffee-bean). - Estrogen effects: endometrial hyperplasia, endometrial carcinoma, postmenopausal bleeding, breast tenderness. - Inhibin (and calretinin, SF1, FOXL2) by immunostaining; serum inhibin and anti-Müllerian hormone follow the disease. - Juvenile type: no FOXL2 mutation; follicle-like spaces and round nuclei without grooves; precocious puberty in girls. - Behaviour: indolent but recurrences, often in the abdomen, appear many years later. ## What it is Granulosa cell tumours are the most common malignant sex cord–stromal tumours. The adult type, which occurs around and after menopause, is defined by a somatic FOXL2 mutation and forms small rosettes called Call–Exner bodies among cells with grooved nuclei. Many tumours secrete estrogen, causing endometrial hyperplasia or carcinoma, and inhibin, a useful serum marker. The juvenile type affects children and young women and causes isosexual precocious puberty. Both are low-grade malignancies that can recur many years after removal. ## Structure - Gross: unilateral, solid and cystic, yellow to white tumour, often with haemorrhage; can rupture and cause haemoperitoneum. - Adult: diffuse, trabecular, insular or microfollicular patterns of small cuboidal cells with scant cytoplasm and grooved nuclei. - Juvenile: macrofollicles filled with secretion, cells with more cytoplasm and luteinisation, more mitoses. ## Step by step - A granulosa cell acquires a FOXL2 mutation that alters its transcriptional program (adult type). - The clone proliferates and keeps granulosa functions: aromatase converts androgens to estrogen and the cells make inhibin. - Estrogen stimulates the endometrium and breast. - The tumour grows slowly; cells left in the peritoneum may form recurrences years later. ## Markers - Inhibin - Calretinin - SF1 - FOXL2 - Serum inhibin and anti-Müllerian hormone ## Clinical notes - Postmenopausal bleeding with a solid adnexal mass; always sample the endometrium, since hyperplasia or carcinoma is often present. - In a girl, breast development and vaginal bleeding before the expected age with an abdominal mass suggest a juvenile granulosa cell tumour. - Long follow-up is needed because of late recurrence. ## Memory aid Granulosa is the estrogen factory that never closes: Call–Exner rooms, coffee-bean workers and an inhibin receipt. ## Test yourself Think of the answer, then tap the question to see it. ## Which mutation defines the adult granulosa cell tumour? A somatic FOXL2 mutation (C134W). ## What are Call–Exner bodies? Small rosette-like spaces containing eosinophilic material surrounded by granulosa cells. ## Why should the endometrium be sampled in a woman with a granulosa cell tumour? Estrogen from the tumour can cause endometrial hyperplasia or carcinoma. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/general-pathology/granulosa-cell-tumours-adult-and-juvenile/) [More Pathology questions →](https://durgical.com/en/practice/?f=pathology) ## Elsewhere in DurgiPedia - [Puberty](https://durgical.com/en/physiology/puberty/) - [Actions of estrogen and progesterone](https://durgical.com/en/physiology/actions-of-estrogen-and-progesterone/) - [Aromatase (CYP19A1)](https://durgical.com/en/biochemistry/enzymes/aromatase/) - [Ovary: follicles, ovulation and corpus luteum](https://durgical.com/en/histology/ovary-follicles-ovulation-and-corpus-luteum/) ## Connections ## Related 6 - [Other sex cord–stromal tumours](https://durgical.com/en/general-pathology/other-sex-cord-stromal-tumours/) - [Ovarian tumours: classification](https://durgical.com/en/general-pathology/ovarian-tumours-classification/) - [Endometrial polyps and hyperplasia](https://durgical.com/en/general-pathology/endometrial-polyps-and-hyperplasia/) - [Endometrioid endometrial carcinoma](https://durgical.com/en/general-pathology/endometrioid-endometrial-carcinoma/) - [Non-germ cell testicular tumours](https://durgical.com/en/general-pathology/non-germ-cell-testicular-tumours/) - [Tumour markers: serum and tissue, and what each one is for](https://durgical.com/en/general-pathology/tumour-markers-serum-and-tissue-and-what-each-one-is-for/) ## Related conditions 4 - [Ovarian germ-cell and sex cord–stromal tumours](https://durgical.com/en/conditions/ovarian-germ-cell-and-sex-cord-stromal-tumours/) - [Endometrial hyperplasia](https://durgical.com/en/conditions/endometrial-hyperplasia/) - [Endometrial cancer](https://durgical.com/en/conditions/endometrial-cancer/) - [Abnormal uterine bleeding](https://durgical.com/en/conditions/abnormal-uterine-bleeding/) [← All of general pathology](https://durgical.com/en/general-pathology/) Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given. Sources: [FOXL2 gene: MedlinePlus Genetics](https://medlineplus.gov/genetics/gene/foxl2/) (MedlinePlus, US National Library of Medicine, 2026); [Ovarian Epithelial, Fallopian Tube, and Primary Peritoneal Cancer Treatment (PDQ®)–Health Professional Version](https://www.cancer.gov/types/ovarian/hp/ovarian-epithelial-treatment-pdq) (National Cancer Institute, 2026). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/general-pathology/granulosa-cell-tumours-adult-and-juvenile/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/granulosa-cell-tumours-adult-and-juvenile/