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July 1967, Vol 114, No. 1 >
Article | July 1967

Precocious Pseudopuberty Due to Granulosa Cell Tumor in Three Girls FREE

Nenita Iturzaeta, MD; Frederic M. Kenny, MD; William Sieber, MD
[+] Author Affiliations

Received for publication Jan 13, 1967.

Reprint requests to Children's Hospital of Pittsburgh, 125 DeSoto St, Pittsburgh 15213 (Dr. Kenny).


Am J Dis Child. 1967;114(1):29-35. doi:10.1001/archpedi.1967.02090220035006.
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FEMINIZING TUMORS of the ovary are usually of the granulosa, theca, or lutein cell origin. Of the three, granulosa cell tumors are the most common.1 Although they are usually diagnosed after the menopause, 5% to 10% of the tumors are recognized before puberty.2 The youngest patient reported had a granulosa cell tumor removed at 16 weeks of age.3

The production of large amounts of estrogens by these tumors results in striking changes in prepubertal individuals: appearance of mammary hypertrophy, enlargement of the labia minora, pubic and axillary hair growth, a rapid increase in height, and enlargement of the vagina and uterus, often with periodic uterine bleeding.4

Granulosa cell tumors are nearly always readily palpable on abdominal or rectal examination by the time the child shows signs of premature sexual development.5 To our knowledge there is only one previous report in which a granulosa cell tumor,

REFERENCES

1 +
Boyd, W.: Textbook of Pathology , ed 7, Philadelphia: Lea and Febiger, 1961;, p 933.
2 +
Browne, F.J., and McClure, J.C.: Postgraduate Obstetrics and Gynecology , ed 3, London: Butterworth and Co., Ltd., 1963;.
3 +
Zemke, E.E., and Herrell, W.E.:  Bilateral Granulosa Cell Tumors , Amer J Obstet Gynec 41:704-707, 1941;.
4 +
Soffer, L.J.: Diseases of Endocrine Glands , ed 2, Philadelphia: Lea and Febiger, 1956;, p 704-705.
5 +
Wilkins, L.; Blizzard, R.M.; and Migeon, C.J.: The Diagnosis and Treatment of Endocrine Disorders in Childhood and Adolescence , ed 3, Springfield, Ill: Charles C Thomas, Publisher, 1965;, p 229-231.
6 +
Eberlein, W.R., et al:  Ovarian Tumors and Cysts Associated With Sexual Precocity , J Pediat 57:484-497, 1960;.
7 +
Steiner, M.M., and Hadawi, S.:  Granulosa Cell Tumor With Sexual Precocity , Amer J Dis Child 104:380-384, 1962;.
8 +
Marsh, J.M., et al:  Estrogen Synthesis in a Feminizing Ovarian Granulosa Cell Tumor , J Clin Endocr 22:1196-1200, 1962;.
9 +
Reis, R.L., and Koop, C.E.:  Ovarian Tumors in Infants and Children , J Pediat 60:96-102, 1962;.
10 +
Litton, M.A., and Fox, T.C.:  Hemorrhage From Granulosa: Theca Cell Tumor of the Ovary: An Unusual Case of Acute Abdominal Pain in a Child , Wisconsin Med J 64:282-284, 1965;.
11 +
Bernard, R., et al:  A propos de deux cas de tumeur feminisante de l'ovaire chez, des sujets, de 14 mois et 3 ans 1/2 - operation - guerison , Pediatriae 17:277-284, 1962;.
12 +
Niswander, K.R.; Courey, N.G.; and Woodward, T.:  Precocious Pseudopuberty Caused by Ovarian Tumors , Obstet Gynec 26:381-387, 1965;.
13 +
Wuester, W.O.:  Granulosa: Theca Cell Tumor of the Ovary in a Five-Year-Old Child , J Med Soc New Jersey 58:256-257, 1961;.
14 +
Bruk, I.; Dancaster, C.P.; and Jackson, W.P.:  Granulosa Cell Tumors Causing Precocious Puberty. Oestrogen Fractionations in Two Patients Brit Med J 2:26-28, 1960;.
15 +
Forshall, I.:  Ovarian Neoplasms in Children , Arch Dis Child 35:17-21, 1960;.
16 +
Spreer, F.; Holzhausen, G.; and Hunger, H.:  Maligner Granulosazeltumor im Kindesalter , Zbl Allg Path 102:461-471, 1961;.
17 +
Kutty, M.K., and Sreedharan, T.:  Granulosa Cell Tumor of the Ovary: A Case of Luteinizing Granulosa Cell Tumor in a Child of Nine , Indian J Pediat 31:41-45 ( (Feb) ) 1964;.
18 +
Gonzales, J.R.:  Tumor de celulas de la granulosa en una nina de ocho anos , Prensa Med Argent 48:300-310, ( (Feb 3) ) 1961;.
19 +
Watson, E.H., and Lowrey, G.H.: Growth and Development in Children , ed 4, Chicago: The Year Book Publishers, 1962;, pp 70-73.
20 +
Greulich, W.W., and Pyle, I.S.: A Roentgenologic Atlas of Skeletal Maturation of the Hand and Wrist , ed 2, Stanford, Calif: Stanford University Press, 1959;.
21 +
Callow, N.H.; Callow, R.K.; and Emmens, C.W.:  Colorimetric Determination of Substances Containing Grouping: CH2CO in Urine Extracts as Indication of Androgen Content , Biochem J 32:1312-1331, 1938;.
22 +
Kenny, F.M.; Malvaux, P.; Migeon, C..J:  Cortisol Production Rate in Newborn Babies, Infants, and Children , Pediatrics 31:360-373, 1963;.
23 +
Brown, J.B.:  Chemical Method for Determination of Estriol, Estrone and Estradiol in Human Urine , Biochem J 60:185-193, 1955;.
24 +
Klinefelter, H.F.; Albright, F.; and Griswold, G.C.:  Experience With a Quantitative Test for Normal or Decreased Amounts of Follicle Stimulating Hormone in the Urine in Endocrinological Diagnosis , J Clin Endocr 3:531-544, 1943;.
25 +
Preeyasombat, C., and Kenny, F.M.:  Urocytograms in Normal Children and Various Abnormal Conditions , Pediatrics 38:436-443, 1966;.
26 +
Pedowitz, P.; Felmus, L.B.; and Macklet, A.:  Precocious Pseudopuberty Due to Ovarian Tumors , Obstet Gynec Survery 10:633-653, 1955;.
27 +
Wilson, J.R.; Beecham, C.T.; and Carrington, E.R.: Obstetrics and Gynecology , ed 2, St. Louis: C. V. Mosby Co., 1963;, p 650.
28 +
Paschkis, K.E.; Rakoff, A.E.; and Cantarow, A.: Clinical Endocrinology , ed 2, New York: Paul B. Hoeber, Inc., 1958;, p 489.
29 +
Seckel, H.P.:  Precocious Sexual Development in Children , Med Clin N Amer 30:183-206, 1946;.
30 +
Groeber, W.R.:  Ovarian Tumors in Infancy and Childhood , Amer J Obstet Gynec 86:1027-35, 1963;.
31 +
Diddle, A.W.:  Granulosa and Theca Cell Ovarian Tumors, Prognosis , Cancer 5:215-228, 1952;.
32 +
Aimes, A.; Guilbert, H.L.; and Galvaing, P.:  Retroperitoneal Recurrence of a Granulosa Cell Tumor Following Removal of a Right Ovarian Tumor at the Age of 8 Years , Gynec Obstet 45:801-806, 1946;.
33 +
Novak, E.: Gynecologic and Obstetric Pathology , ed 3, Philadelphia: W. B. Saunders Co., 1952;, p 421.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

References

1 +
Boyd, W.: Textbook of Pathology , ed 7, Philadelphia: Lea and Febiger, 1961;, p 933.
2 +
Browne, F.J., and McClure, J.C.: Postgraduate Obstetrics and Gynecology , ed 3, London: Butterworth and Co., Ltd., 1963;.
3 +
Zemke, E.E., and Herrell, W.E.:  Bilateral Granulosa Cell Tumors , Amer J Obstet Gynec 41:704-707, 1941;.
4 +
Soffer, L.J.: Diseases of Endocrine Glands , ed 2, Philadelphia: Lea and Febiger, 1956;, p 704-705.
5 +
Wilkins, L.; Blizzard, R.M.; and Migeon, C.J.: The Diagnosis and Treatment of Endocrine Disorders in Childhood and Adolescence , ed 3, Springfield, Ill: Charles C Thomas, Publisher, 1965;, p 229-231.
6 +
Eberlein, W.R., et al:  Ovarian Tumors and Cysts Associated With Sexual Precocity , J Pediat 57:484-497, 1960;.
7 +
Steiner, M.M., and Hadawi, S.:  Granulosa Cell Tumor With Sexual Precocity , Amer J Dis Child 104:380-384, 1962;.
8 +
Marsh, J.M., et al:  Estrogen Synthesis in a Feminizing Ovarian Granulosa Cell Tumor , J Clin Endocr 22:1196-1200, 1962;.
9 +
Reis, R.L., and Koop, C.E.:  Ovarian Tumors in Infants and Children , J Pediat 60:96-102, 1962;.
10 +
Litton, M.A., and Fox, T.C.:  Hemorrhage From Granulosa: Theca Cell Tumor of the Ovary: An Unusual Case of Acute Abdominal Pain in a Child , Wisconsin Med J 64:282-284, 1965;.
11 +
Bernard, R., et al:  A propos de deux cas de tumeur feminisante de l'ovaire chez, des sujets, de 14 mois et 3 ans 1/2 - operation - guerison , Pediatriae 17:277-284, 1962;.
12 +
Niswander, K.R.; Courey, N.G.; and Woodward, T.:  Precocious Pseudopuberty Caused by Ovarian Tumors , Obstet Gynec 26:381-387, 1965;.
13 +
Wuester, W.O.:  Granulosa: Theca Cell Tumor of the Ovary in a Five-Year-Old Child , J Med Soc New Jersey 58:256-257, 1961;.
14 +
Bruk, I.; Dancaster, C.P.; and Jackson, W.P.:  Granulosa Cell Tumors Causing Precocious Puberty. Oestrogen Fractionations in Two Patients Brit Med J 2:26-28, 1960;.
15 +
Forshall, I.:  Ovarian Neoplasms in Children , Arch Dis Child 35:17-21, 1960;.
16 +
Spreer, F.; Holzhausen, G.; and Hunger, H.:  Maligner Granulosazeltumor im Kindesalter , Zbl Allg Path 102:461-471, 1961;.
17 +
Kutty, M.K., and Sreedharan, T.:  Granulosa Cell Tumor of the Ovary: A Case of Luteinizing Granulosa Cell Tumor in a Child of Nine , Indian J Pediat 31:41-45 ( (Feb) ) 1964;.
18 +
Gonzales, J.R.:  Tumor de celulas de la granulosa en una nina de ocho anos , Prensa Med Argent 48:300-310, ( (Feb 3) ) 1961;.
19 +
Watson, E.H., and Lowrey, G.H.: Growth and Development in Children , ed 4, Chicago: The Year Book Publishers, 1962;, pp 70-73.
20 +
Greulich, W.W., and Pyle, I.S.: A Roentgenologic Atlas of Skeletal Maturation of the Hand and Wrist , ed 2, Stanford, Calif: Stanford University Press, 1959;.
21 +
Callow, N.H.; Callow, R.K.; and Emmens, C.W.:  Colorimetric Determination of Substances Containing Grouping: CH2CO in Urine Extracts as Indication of Androgen Content , Biochem J 32:1312-1331, 1938;.
22 +
Kenny, F.M.; Malvaux, P.; Migeon, C..J:  Cortisol Production Rate in Newborn Babies, Infants, and Children , Pediatrics 31:360-373, 1963;.
23 +
Brown, J.B.:  Chemical Method for Determination of Estriol, Estrone and Estradiol in Human Urine , Biochem J 60:185-193, 1955;.
24 +
Klinefelter, H.F.; Albright, F.; and Griswold, G.C.:  Experience With a Quantitative Test for Normal or Decreased Amounts of Follicle Stimulating Hormone in the Urine in Endocrinological Diagnosis , J Clin Endocr 3:531-544, 1943;.
25 +
Preeyasombat, C., and Kenny, F.M.:  Urocytograms in Normal Children and Various Abnormal Conditions , Pediatrics 38:436-443, 1966;.
26 +
Pedowitz, P.; Felmus, L.B.; and Macklet, A.:  Precocious Pseudopuberty Due to Ovarian Tumors , Obstet Gynec Survery 10:633-653, 1955;.
27 +
Wilson, J.R.; Beecham, C.T.; and Carrington, E.R.: Obstetrics and Gynecology , ed 2, St. Louis: C. V. Mosby Co., 1963;, p 650.
28 +
Paschkis, K.E.; Rakoff, A.E.; and Cantarow, A.: Clinical Endocrinology , ed 2, New York: Paul B. Hoeber, Inc., 1958;, p 489.
29 +
Seckel, H.P.:  Precocious Sexual Development in Children , Med Clin N Amer 30:183-206, 1946;.
30 +
Groeber, W.R.:  Ovarian Tumors in Infancy and Childhood , Amer J Obstet Gynec 86:1027-35, 1963;.
31 +
Diddle, A.W.:  Granulosa and Theca Cell Ovarian Tumors, Prognosis , Cancer 5:215-228, 1952;.
32 +
Aimes, A.; Guilbert, H.L.; and Galvaing, P.:  Retroperitoneal Recurrence of a Granulosa Cell Tumor Following Removal of a Right Ovarian Tumor at the Age of 8 Years , Gynec Obstet 45:801-806, 1946;.
33 +
Novak, E.: Gynecologic and Obstetric Pathology , ed 3, Philadelphia: W. B. Saunders Co., 1952;, p 421.

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