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April 1968, Vol 115, No. 4 >
Article | April 1968

Granulosa-Theca-Cell Tumor of the Ovary in Children FREE

Fereydoun Zangeneh, MD; Vincent C. Kelley, MD, PhD
[+] Author Affiliations

Received for publication Sept 8, 1967.

Reprint requests to University of Washington School of Medicine, Department of Pediatrics, Seattle 98105 (Dr. Kelley).


Am J Dis Child. 1968;115(4):494-508. doi:10.1001/archpedi.1968.02100010496016.
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References
Comments

WITHIN RECENT years granulosa-theca-cell tumors have attracted much interest, primarily because of their hormonal function. These tumors are the principal feminizing neoplasms of the ovary; and it has been emphasized that when they occur in prepubertal females, they almost always cause sexual precocity. Because of this known and rather constant relationship, the diagnosis of granulosa-theca-cell tumor usually is entertained in the differential diagnosis of isosexual precocity in females. Although it is appropriate that some consideration should be given to this diagnosis in all such patients, it should be remembered that not more than 10% of cases of sexual precocity in the female arise from ovarian tumors.

The purpose of this article is to review the literature on this interesting problem, especially as it relates to children, and to emphasize the pitfalls in making the diagnosis.

Incidence  The rarity of granulosa-theca-cell tumors of the ovary is appreciated if it is remembered

REFERENCES

1 +
Morris, J.M., and Scully, R.E.: Endocrine Pathology of the Ovary , The C. V. Mosby Company, St. Louis, 1953;.
2 +
Kent, S.W., and McKay, D.C.:  Primary Cancer of the Ovary: Analysis of 349 cases , Amer J Obstet Gynec 80:430, 1960;.
3 +
Busby, T., and Anderson, G.W.:  Feminizing Mesenchymomas of the Ovary: Includes 107 Cases of Granulosa, Granulosa-Theca Cell and Theca Cell Tumors , Amer J Obstet Gynec 68:1391, 1954;.
4 +
Bland, P.B., and Goldstein, L.:  Granulosa Cell and Brenner Tumors of the Ovary , Surg Gynec Obstet 61:250, 1935;.
5 +
Lyon, F.A.; Sinykin, M.B.; and McKelvey, J.L.:  Granulosa-Cell Tumors of the Ovary, Review of 23 Cases , Obstet Gynec 21:67, 1963;.
6 +
Abell, M.R., and Holtz, F.:  Ovarian Neoplasms in Childhood and Adolescence: II. Tumors of Non-Germ Cell Origin , Amer J Obstet Gynec 93:850, 1965;.
7 +
Marshal, J.R.:  Ovarian Enlargement in the First Year of Life: Review of 45 Cases , Ann Surg 161:372, 1965;.
8 +
Groeber, W.R.:  Ovarian Tumors During Infancy and Childhood , Amer J Obstet Gynec 86: 1027, 1963;.
9 +
Jolly, H.: Sexual Precocity , Charles C Thomas, Publisher, Springfield, Ill., 1955;.
10 +
Thamdrup, E.:  Precocious Sexual Development: A Clinical Study of One Hundred Children , Danish Med Bull 8:140, 1961;.
11 +
Eberlein, W.R., et al:  Ovarian Tumors and Cysts Associated With Sexual Precocity , J Pediat 57:484, 1960;.
12 +
Wilkins, L.: The Diagnosis and Treatment of Endocrine Disorders in Childhood and Adolescence , ed 3, Charles C Thomas, Publisher, Springfield, Ill, 1955;.
13 +
Dockerty, M.B., and MacCarty, W.C.:  Granulosa-Cell Tumors With a Report of 34 Pound Specimen and a Review , Amer J Obstet Gynec 37:425, 1939;.
14 +
Reddy, D.B.; Rao, D.B.; and Sarojini, J.S.:  Extraovarian Granulosa-Cell Tumor , J Indian Med Assoc 41:254, 1963;.
15 +
Litton, M.A.; Litton, E.W.; and Fox, J.C.:  Hemorrhage From Granulosa-Theca Cell Tumor of the Ovary: An Unusual Cause of Acute Abdominal Pain in a Child , Wisconsin Med J 64:282, 1965;.
16 +
Novak, E.R., and Woodruff, J.D.: Gynec & Obstet Path , ed 5, W. B. Saunders Co., Philadelphia, 1962;.
17 +
Willis, R.A.: Pathology of Tumors , ed 3, Butterworth & Co., Washington, DC, 1960;.
18 +
Novak, E.R.; Seegar Jones, G.E.; and Jones, H.W., Jr.: Novak's Textbook of Gynecology , ed 7, The Williams & Wilkins Company, Baltimore, 1965;.
19 +
Stowens, D.: Pediatric Pathology , ed 2, The Williams & Wilkins Company, Baltimore, 1966;.
20 +
Dargeon, H.W.: Tumors of Childhood: A Clinical Treatise , Paul B. Hoeber, Inc., New York, 1960;.
21 +
Michael, P.: Tumors of Infancy and Childhood , J. B. Lippincott Co., Philadelphia, 1964;.
22 +
Dockerty, M.B., and MacCarty, W.C.:  Granulosa Cell Neoplasm With a Discussion of Possible Histogenesis , Amer J Obstet Gynec 38:698, 1939;.
23 +
McKay, D.G.; Hertig, A.T.; and Hickey, W.F.:  The Histogenesis of Granulosa and Theca-Cell Tumors of the Human Ovary , Obstet Gynec 1:125, 1953;.
24 +
Meyer, R.:  Pathology of Some Special Ovarian Tumors and Their Relation to Sex Characteristics , Amer J Obstet Gynec 22:697, 1931;.
25 +
Brambell, F.W.R.; Parkes, A.S.; and Fielding, U.:  Changes in the Ovary of the Mouse Following Exposure to X-rays: II. Irradiation at or Before Birth , Proc Roy Soc 101:95, 1927;.
26 +
Novak, E., and Brawner, J.N.:  Granulosa Cell Tumors of the Ovary , Amer J Obstet Gynec 28: 637, 1934;.
27 +
Furth, J., and Butterworth, J.S.:  Neoplastic Diseases Occuring Among Mice Subjected to General Irradiation to X-rays: II. Ovarian Tumors and Associated Lesions , Amer J Cancer 28:66, 1936;.
28 +
Li, H.L., and Gardner, W.U.:  Experimental Studies on the Pathogenesis and Histogenesis of Ovarian Tumors in Mice , Cancer Res 7:549, 1947;.
29 +
Biskind, M.S., and Biskind, G.S.:  Development of Tumors in the Rat Ovary After Transplantation Into the Spleen , Proc Soc Exp Biol Med 55:176, 1944;.
30 +
Paschkis, K.E., et al: Clinical Endocrinology ed 3, Paul B. Hoeber, Inc., New York, 1967;, p 640.
31 +
Seckel, H.P.G., and Plotz, E.J.:  Sexual Precocity Due to Estrogen and Progesterone Producing Organoid Luteoma of the Ovary , Z Kinderheilk 76:593, 1955;.
32 +
Lloyd, C.W.:  Precocious Puberty of the Female Type , J Clin Endocr 15:1518, 1955;.
33 +
Betson, J.R., Jr., and Eicher, P.M.:  Isosexual Precocity Produced by an Ovarian Thecoma: Report of a Case , Obstet Gynec 22:219, 1963;.
34 +
Daugherty, C.M.; Thompson, W.B.; and McCall, M.L.:  Hilus-Cell and Granulosa-Cell Tumors in the Same Ovary , Amer J Obstet Gynec 76:653, 1958;.
35 +
Samuels, L.T.:  "Metabolism of Steroid Hormones,"  in Greenberg, D.M. (ed.): Metabolic Pathways vol 1, Academic Press, New York, 1960;, p 431.
36 +
Richardson, G.S.:  Ovarian Physiology , New Eng J Med 274:1121, 1966;.
37 +
Kumari, L., and Goldzieher, J.W.:  In Vitro Steroidogenesis in Normal Human Ovarian Tissue , Acta Endocr 52:455, 1966;.
38 +
Ryan, K.J., and Petro, A.:  Steroid Biosynthesis by Human Ovarian Granulosa and Thecal Cells , J Clin Endocr 26:46, 1966;.
39 +
Rice, B.F., and Savard, K.:  Steroid Hormone Formation in the Human Ovary: IV. Ovarian Stromal Compartment; Formation of Radioactive Steroids From Acetate-1-14C and Action of Gonadotropins , J Clin Endocr 26:593, 1966;.
40 +
Marsh, J.M., et al:  Estrogen Synthesis in a Feminizing Ovarian Granulosa Cell Tumor , J Clin Endocr 22:1196, 1962;.
41 +
Griffith, K.; Grant, J.K.; and Symington, T.:  Steroid Biosynthesis In Vitro by Granulosa-Theca Cell Tumor Tissue , J Clin Endocr 30:247, 1964;.
42 +
Richardson, G.S.:  Ovarian Physiology , New Eng J Med 274:1183, 1966;.
43 +
Kase, N.:  Steroid Synthesis in Abnormal Ovaries: II. Granulosa Cell Tumor , Amer J Obstet Gynec 90:1262, 1964;.
44 +
Loutfi, G., and Hageman, D.D.: Metabolism of Progesterone and Pregnenelone by an Ovarian Granulosa Cell Tumor In Vitro, Proceedings of the 47th Meeting of the Endocrinology Society, New York, June 1965, p 106.
45 +
Allen, E., and Doisy, E.A.:  Ovarian Hormone: Preliminary Report on its Localization, Extraction and Partial Purification and Action in Test Animals , JAMA 81:819, 1923;.
46 +
Corner, G.W.: Hormones in Human Reproduction , Princeton Univ Press, Princeton, NJ, 1942;.
47 +
McKay, D.G.; Robinson, D.; and Hertig, A.T.:  Histochemical Observations on Granulosa-Cell Tumors, Thecomas and Fibromas of the Ovary , Amer J Obstet Gynec 58:625, 1949;.
48 +
McKay, D.G., et al:  Adult Human Ovary: Histochemical Study , Obstet Gynec 18:13, 1961;.
49 +
Falck, B.:  Site of Production of Oestrogen in Rat Ovary as Studied in Micro-Transplants , Acta Physiol 47 ( (suppl. 163) ):1, 1959;.
50 +
Goldberg, B.; Seegar Jones, G.E.; and Woodruff, J.D.:  A Histochemical Study of Steroid 3β-ol-dehydrogenase Activity in Some Steroid-Producing Tumors , Amer J Obstet Gynec 86:1003, 1963;.
51 +
Chieffi, G., and Botte, V.:  Distribution of Some Enzymes Involved in Steroidogenesis of Hen's Ovary , Experientia 21:16, 1965;.
52 +
Israel, S.L., and Mutch, J.C.:  Endocrinologic Effects of Certain Ovarian Tumors , Surg Gynec Obstet 105:166, 1957;.
53 +
White, R.F., et al:  Histochemical and Histochemical Observations on the Corpus Luteum of Human Pregnancy With Special Reference to Corpora Lutea Associated With Early Normal and Abnormal Ova , Contrib Embryol 34:55, 1951;.
54 +
Deane, H.W.; Lobel, B.L.; and Romney, S.L.:  Enzymatic Histochemistry of Normal Human Ovaries of the Menstrual Cycle, Pregnancy and Early Puerperium , Amer J Obstet Gynec 83:281, 1962;.
55 +
Shippel, S.:  The Ovarian Theca Cell , J Obstet Gynaec Brit Comm 57:557, 1950;.
56 +
Eckstein, P., in Zuckerman, S. (ed.): The Ovary , vol 1, Academic Press, New York, 1962;.
57 +
Richardson, G.S.:  Ovarian Physiology , New Eng J Med 274:1008, 1966;.
58 +
Betson, J.R., and Eicher, P.M.:  Isosexual Precocity Produced by an Ovarian Thecoma , Obstet Gynec 22:219.
59 +
Iturzaeta, N.; Kenny, F.M.; and Sieber, W.:  Precocious Pseudopuberty Due to Granulosa Cell Tumor in Three Girls , Amer J Dis Child 114:29, 1967;.
60 +
Gross, R.E.:  Neoplasms Producing Endocrine Disturbances in Childhood , Amer J Dis Child 59: 579, 1940;.
61 +
Wagner, R.; Cohen, M.M.; and Hunt, E.E.:  Dental Development in Idiopathic Sexual Precocity, Congenital Adrenal Hyperplasia, and Adrenogenic Virilism , J Pediat 63:566, 1963;.
62 +
Christian, C.D., et al:  Peutz-Jegher Syndrome Associated With Functioning Ovarian Tumor , JAMA 190:935, 1964;.
63 +
Meigs, J.V., and Cass, J.W.:  Fibroma of the Ovary With Ascites and Hydrothorax: With a Report of Seven Cases , Amer J Obstet Gynec 33:249, 1937;.
64 +
Knaus, W.E.; Compos, J.; and William Rose, M.L.:  Meigs' Syndrome: A Report of a Case in a Child , J Pediat 43:88, 1953;.
65 +
Faber, H.K.:  Meigs' Syndrome With Thecomas of Both Ovaries in a 4-Year-Old Girl , J Pediat 61:769, 1962;.
66 +
Caffey, J.: Pediatric X-Ray Diagnosis , ed 4, Year Book Medical Publishers, Inc., Chicago, 1961;.
67 +
Buka, N.J., and MacFarlane, K.T.:  Malignant Tumors of the Ovary , Amer J Obstet Gynec 90: 383, 1964;.
68 +
Paul, L.W., and Juhl, J.H.: The Essentials of Roentgen Interpretation , ed 2, Paul B. Hoeber Inc., New York, 1965;.
69 +
Betson, J.R., and Eicher, P.M.:  Isosexual Precocity Produced by an Ovarian Thecoma , Obstet Gynec 22:219, 1963;.
70 +
Pedowitz, P.; Felmus, L.B.; and Mackles, A.:  Precocious Pseudopuberty Due to Ovarian Tumors , Obstet Gynec Survey 10:633, 1955;.
71 +
Steiner, M.M., and Hadawi, S.:  Granulosa-Cell Tumor of Ovary With Sexual Precocity , Amer J Dis Child 104:380, 1962;.
72 +
Bruk, I.; Dancaster, C.P.; and Jackson, W.P.U.:  Granulosa-Cell Tumours Causing Precocious Puberty: Oestrogen Fractionations in Two Patients , Brit Med J 2:26, 1960;.
73 +
Greene, J.W., and Prencel, R.W.:  Feminizing Mesenchymomas, A Review of 42 Cases , Obstet Gynec 18:190, 1961;.
74 +
Paulsen, C.A.: Estrogen Assays in Clinical Medicine , Workshop, Univ. of Wash. Press, Seattle, 1965;.
75 +
Gray, C.H., and Bacharach, A.L.: Hormones in Blood , Academic Press, New York, 1961;.
76 +
Diddle, A.W.:  Granulosaand Theca-Cell Tumors: Prognosis , Cancer 5:215, 1952;.
77 +
Grollman, A.: Clinical Endocrinology and Its Physiologic Basis , J. B. Lippincott Co., Philadelphia, 1964;.
78 +
Kottmeier, H.L.:  The Classification and Treatment of Ovarian Tumors , Acta Obstet Gynec Scand 31:313, 1952;.
79 +
Hodgson, J.E.; Dockerty, M.B.; and Mussey, R.D.:  Granulosa Cell Tumor of the Ovary: A Clinical and Pathological Review of 62 Cases , Surg Gynec Obstet 81:631, 1945;.
80 +
Duckett, H.D.; David, C.D.; and Fetter, B.F.:  Granulosa-Cell Carcinoma of the Ovary: Clinical and Pathological Review of 17 Patients , Obstet Gynec 2:611, 1953;.
81 +
Seckel, H.P.G.:  Precocious Sexual Development in Children , Med Clin N Amer 30:183, 1946;.
82 +
Seckel, H.P.G.; Scott, W.W.; and Benditt, E.P.:  Six Examples of Precocious Sexual Development: I. Studies in Diagnosis and Pathogenesis , Amer J Dis Child 78:484, 1949;.
83 +
Stoll, B.A.:  The Radiosensitivity of the Granulosa-Cell Tumors , Obstet Gynec 6:395, 1955;.

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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 +
Morris, J.M., and Scully, R.E.: Endocrine Pathology of the Ovary , The C. V. Mosby Company, St. Louis, 1953;.
2 +
Kent, S.W., and McKay, D.C.:  Primary Cancer of the Ovary: Analysis of 349 cases , Amer J Obstet Gynec 80:430, 1960;.
3 +
Busby, T., and Anderson, G.W.:  Feminizing Mesenchymomas of the Ovary: Includes 107 Cases of Granulosa, Granulosa-Theca Cell and Theca Cell Tumors , Amer J Obstet Gynec 68:1391, 1954;.
4 +
Bland, P.B., and Goldstein, L.:  Granulosa Cell and Brenner Tumors of the Ovary , Surg Gynec Obstet 61:250, 1935;.
5 +
Lyon, F.A.; Sinykin, M.B.; and McKelvey, J.L.:  Granulosa-Cell Tumors of the Ovary, Review of 23 Cases , Obstet Gynec 21:67, 1963;.
6 +
Abell, M.R., and Holtz, F.:  Ovarian Neoplasms in Childhood and Adolescence: II. Tumors of Non-Germ Cell Origin , Amer J Obstet Gynec 93:850, 1965;.
7 +
Marshal, J.R.:  Ovarian Enlargement in the First Year of Life: Review of 45 Cases , Ann Surg 161:372, 1965;.
8 +
Groeber, W.R.:  Ovarian Tumors During Infancy and Childhood , Amer J Obstet Gynec 86: 1027, 1963;.
9 +
Jolly, H.: Sexual Precocity , Charles C Thomas, Publisher, Springfield, Ill., 1955;.
10 +
Thamdrup, E.:  Precocious Sexual Development: A Clinical Study of One Hundred Children , Danish Med Bull 8:140, 1961;.
11 +
Eberlein, W.R., et al:  Ovarian Tumors and Cysts Associated With Sexual Precocity , J Pediat 57:484, 1960;.
12 +
Wilkins, L.: The Diagnosis and Treatment of Endocrine Disorders in Childhood and Adolescence , ed 3, Charles C Thomas, Publisher, Springfield, Ill, 1955;.
13 +
Dockerty, M.B., and MacCarty, W.C.:  Granulosa-Cell Tumors With a Report of 34 Pound Specimen and a Review , Amer J Obstet Gynec 37:425, 1939;.
14 +
Reddy, D.B.; Rao, D.B.; and Sarojini, J.S.:  Extraovarian Granulosa-Cell Tumor , J Indian Med Assoc 41:254, 1963;.
15 +
Litton, M.A.; Litton, E.W.; and Fox, J.C.:  Hemorrhage From Granulosa-Theca Cell Tumor of the Ovary: An Unusual Cause of Acute Abdominal Pain in a Child , Wisconsin Med J 64:282, 1965;.
16 +
Novak, E.R., and Woodruff, J.D.: Gynec & Obstet Path , ed 5, W. B. Saunders Co., Philadelphia, 1962;.
17 +
Willis, R.A.: Pathology of Tumors , ed 3, Butterworth & Co., Washington, DC, 1960;.
18 +
Novak, E.R.; Seegar Jones, G.E.; and Jones, H.W., Jr.: Novak's Textbook of Gynecology , ed 7, The Williams & Wilkins Company, Baltimore, 1965;.
19 +
Stowens, D.: Pediatric Pathology , ed 2, The Williams & Wilkins Company, Baltimore, 1966;.
20 +
Dargeon, H.W.: Tumors of Childhood: A Clinical Treatise , Paul B. Hoeber, Inc., New York, 1960;.
21 +
Michael, P.: Tumors of Infancy and Childhood , J. B. Lippincott Co., Philadelphia, 1964;.
22 +
Dockerty, M.B., and MacCarty, W.C.:  Granulosa Cell Neoplasm With a Discussion of Possible Histogenesis , Amer J Obstet Gynec 38:698, 1939;.
23 +
McKay, D.G.; Hertig, A.T.; and Hickey, W.F.:  The Histogenesis of Granulosa and Theca-Cell Tumors of the Human Ovary , Obstet Gynec 1:125, 1953;.
24 +
Meyer, R.:  Pathology of Some Special Ovarian Tumors and Their Relation to Sex Characteristics , Amer J Obstet Gynec 22:697, 1931;.
25 +
Brambell, F.W.R.; Parkes, A.S.; and Fielding, U.:  Changes in the Ovary of the Mouse Following Exposure to X-rays: II. Irradiation at or Before Birth , Proc Roy Soc 101:95, 1927;.
26 +
Novak, E., and Brawner, J.N.:  Granulosa Cell Tumors of the Ovary , Amer J Obstet Gynec 28: 637, 1934;.
27 +
Furth, J., and Butterworth, J.S.:  Neoplastic Diseases Occuring Among Mice Subjected to General Irradiation to X-rays: II. Ovarian Tumors and Associated Lesions , Amer J Cancer 28:66, 1936;.
28 +
Li, H.L., and Gardner, W.U.:  Experimental Studies on the Pathogenesis and Histogenesis of Ovarian Tumors in Mice , Cancer Res 7:549, 1947;.
29 +
Biskind, M.S., and Biskind, G.S.:  Development of Tumors in the Rat Ovary After Transplantation Into the Spleen , Proc Soc Exp Biol Med 55:176, 1944;.
30 +
Paschkis, K.E., et al: Clinical Endocrinology ed 3, Paul B. Hoeber, Inc., New York, 1967;, p 640.
31 +
Seckel, H.P.G., and Plotz, E.J.:  Sexual Precocity Due to Estrogen and Progesterone Producing Organoid Luteoma of the Ovary , Z Kinderheilk 76:593, 1955;.
32 +
Lloyd, C.W.:  Precocious Puberty of the Female Type , J Clin Endocr 15:1518, 1955;.
33 +
Betson, J.R., Jr., and Eicher, P.M.:  Isosexual Precocity Produced by an Ovarian Thecoma: Report of a Case , Obstet Gynec 22:219, 1963;.
34 +
Daugherty, C.M.; Thompson, W.B.; and McCall, M.L.:  Hilus-Cell and Granulosa-Cell Tumors in the Same Ovary , Amer J Obstet Gynec 76:653, 1958;.
35 +
Samuels, L.T.:  "Metabolism of Steroid Hormones,"  in Greenberg, D.M. (ed.): Metabolic Pathways vol 1, Academic Press, New York, 1960;, p 431.
36 +
Richardson, G.S.:  Ovarian Physiology , New Eng J Med 274:1121, 1966;.
37 +
Kumari, L., and Goldzieher, J.W.:  In Vitro Steroidogenesis in Normal Human Ovarian Tissue , Acta Endocr 52:455, 1966;.
38 +
Ryan, K.J., and Petro, A.:  Steroid Biosynthesis by Human Ovarian Granulosa and Thecal Cells , J Clin Endocr 26:46, 1966;.
39 +
Rice, B.F., and Savard, K.:  Steroid Hormone Formation in the Human Ovary: IV. Ovarian Stromal Compartment; Formation of Radioactive Steroids From Acetate-1-14C and Action of Gonadotropins , J Clin Endocr 26:593, 1966;.
40 +
Marsh, J.M., et al:  Estrogen Synthesis in a Feminizing Ovarian Granulosa Cell Tumor , J Clin Endocr 22:1196, 1962;.
41 +
Griffith, K.; Grant, J.K.; and Symington, T.:  Steroid Biosynthesis In Vitro by Granulosa-Theca Cell Tumor Tissue , J Clin Endocr 30:247, 1964;.
42 +
Richardson, G.S.:  Ovarian Physiology , New Eng J Med 274:1183, 1966;.
43 +
Kase, N.:  Steroid Synthesis in Abnormal Ovaries: II. Granulosa Cell Tumor , Amer J Obstet Gynec 90:1262, 1964;.
44 +
Loutfi, G., and Hageman, D.D.: Metabolism of Progesterone and Pregnenelone by an Ovarian Granulosa Cell Tumor In Vitro, Proceedings of the 47th Meeting of the Endocrinology Society, New York, June 1965, p 106.
45 +
Allen, E., and Doisy, E.A.:  Ovarian Hormone: Preliminary Report on its Localization, Extraction and Partial Purification and Action in Test Animals , JAMA 81:819, 1923;.
46 +
Corner, G.W.: Hormones in Human Reproduction , Princeton Univ Press, Princeton, NJ, 1942;.
47 +
McKay, D.G.; Robinson, D.; and Hertig, A.T.:  Histochemical Observations on Granulosa-Cell Tumors, Thecomas and Fibromas of the Ovary , Amer J Obstet Gynec 58:625, 1949;.
48 +
McKay, D.G., et al:  Adult Human Ovary: Histochemical Study , Obstet Gynec 18:13, 1961;.
49 +
Falck, B.:  Site of Production of Oestrogen in Rat Ovary as Studied in Micro-Transplants , Acta Physiol 47 ( (suppl. 163) ):1, 1959;.
50 +
Goldberg, B.; Seegar Jones, G.E.; and Woodruff, J.D.:  A Histochemical Study of Steroid 3β-ol-dehydrogenase Activity in Some Steroid-Producing Tumors , Amer J Obstet Gynec 86:1003, 1963;.
51 +
Chieffi, G., and Botte, V.:  Distribution of Some Enzymes Involved in Steroidogenesis of Hen's Ovary , Experientia 21:16, 1965;.
52 +
Israel, S.L., and Mutch, J.C.:  Endocrinologic Effects of Certain Ovarian Tumors , Surg Gynec Obstet 105:166, 1957;.
53 +
White, R.F., et al:  Histochemical and Histochemical Observations on the Corpus Luteum of Human Pregnancy With Special Reference to Corpora Lutea Associated With Early Normal and Abnormal Ova , Contrib Embryol 34:55, 1951;.
54 +
Deane, H.W.; Lobel, B.L.; and Romney, S.L.:  Enzymatic Histochemistry of Normal Human Ovaries of the Menstrual Cycle, Pregnancy and Early Puerperium , Amer J Obstet Gynec 83:281, 1962;.
55 +
Shippel, S.:  The Ovarian Theca Cell , J Obstet Gynaec Brit Comm 57:557, 1950;.
56 +
Eckstein, P., in Zuckerman, S. (ed.): The Ovary , vol 1, Academic Press, New York, 1962;.
57 +
Richardson, G.S.:  Ovarian Physiology , New Eng J Med 274:1008, 1966;.
58 +
Betson, J.R., and Eicher, P.M.:  Isosexual Precocity Produced by an Ovarian Thecoma , Obstet Gynec 22:219.
59 +
Iturzaeta, N.; Kenny, F.M.; and Sieber, W.:  Precocious Pseudopuberty Due to Granulosa Cell Tumor in Three Girls , Amer J Dis Child 114:29, 1967;.
60 +
Gross, R.E.:  Neoplasms Producing Endocrine Disturbances in Childhood , Amer J Dis Child 59: 579, 1940;.
61 +
Wagner, R.; Cohen, M.M.; and Hunt, E.E.:  Dental Development in Idiopathic Sexual Precocity, Congenital Adrenal Hyperplasia, and Adrenogenic Virilism , J Pediat 63:566, 1963;.
62 +
Christian, C.D., et al:  Peutz-Jegher Syndrome Associated With Functioning Ovarian Tumor , JAMA 190:935, 1964;.
63 +
Meigs, J.V., and Cass, J.W.:  Fibroma of the Ovary With Ascites and Hydrothorax: With a Report of Seven Cases , Amer J Obstet Gynec 33:249, 1937;.
64 +
Knaus, W.E.; Compos, J.; and William Rose, M.L.:  Meigs' Syndrome: A Report of a Case in a Child , J Pediat 43:88, 1953;.
65 +
Faber, H.K.:  Meigs' Syndrome With Thecomas of Both Ovaries in a 4-Year-Old Girl , J Pediat 61:769, 1962;.
66 +
Caffey, J.: Pediatric X-Ray Diagnosis , ed 4, Year Book Medical Publishers, Inc., Chicago, 1961;.
67 +
Buka, N.J., and MacFarlane, K.T.:  Malignant Tumors of the Ovary , Amer J Obstet Gynec 90: 383, 1964;.
68 +
Paul, L.W., and Juhl, J.H.: The Essentials of Roentgen Interpretation , ed 2, Paul B. Hoeber Inc., New York, 1965;.
69 +
Betson, J.R., and Eicher, P.M.:  Isosexual Precocity Produced by an Ovarian Thecoma , Obstet Gynec 22:219, 1963;.
70 +
Pedowitz, P.; Felmus, L.B.; and Mackles, A.:  Precocious Pseudopuberty Due to Ovarian Tumors , Obstet Gynec Survey 10:633, 1955;.
71 +
Steiner, M.M., and Hadawi, S.:  Granulosa-Cell Tumor of Ovary With Sexual Precocity , Amer J Dis Child 104:380, 1962;.
72 +
Bruk, I.; Dancaster, C.P.; and Jackson, W.P.U.:  Granulosa-Cell Tumours Causing Precocious Puberty: Oestrogen Fractionations in Two Patients , Brit Med J 2:26, 1960;.
73 +
Greene, J.W., and Prencel, R.W.:  Feminizing Mesenchymomas, A Review of 42 Cases , Obstet Gynec 18:190, 1961;.
74 +
Paulsen, C.A.: Estrogen Assays in Clinical Medicine , Workshop, Univ. of Wash. Press, Seattle, 1965;.
75 +
Gray, C.H., and Bacharach, A.L.: Hormones in Blood , Academic Press, New York, 1961;.
76 +
Diddle, A.W.:  Granulosaand Theca-Cell Tumors: Prognosis , Cancer 5:215, 1952;.
77 +
Grollman, A.: Clinical Endocrinology and Its Physiologic Basis , J. B. Lippincott Co., Philadelphia, 1964;.
78 +
Kottmeier, H.L.:  The Classification and Treatment of Ovarian Tumors , Acta Obstet Gynec Scand 31:313, 1952;.
79 +
Hodgson, J.E.; Dockerty, M.B.; and Mussey, R.D.:  Granulosa Cell Tumor of the Ovary: A Clinical and Pathological Review of 62 Cases , Surg Gynec Obstet 81:631, 1945;.
80 +
Duckett, H.D.; David, C.D.; and Fetter, B.F.:  Granulosa-Cell Carcinoma of the Ovary: Clinical and Pathological Review of 17 Patients , Obstet Gynec 2:611, 1953;.
81 +
Seckel, H.P.G.:  Precocious Sexual Development in Children , Med Clin N Amer 30:183, 1946;.
82 +
Seckel, H.P.G.; Scott, W.W.; and Benditt, E.P.:  Six Examples of Precocious Sexual Development: I. Studies in Diagnosis and Pathogenesis , Amer J Dis Child 78:484, 1949;.
83 +
Stoll, B.A.:  The Radiosensitivity of the Granulosa-Cell Tumors , Obstet Gynec 6:395, 1955;.

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