## Distinguishing Epithelial Ovarian Cancer from Granulosa Cell Tumor ### Histopathologic Gold Standard **Key Point:** Call-Exner bodies are pathognomonic for granulosa cell tumor and are NOT seen in epithelial ovarian cancer. These are small rosette-like structures formed by granulosa cells around a central cavity containing follicular fluid or cellular debris. ### Comparative Feature Table | Feature | Epithelial Ovarian Cancer (EOC) | Granulosa Cell Tumor (GCT) | | --- | --- | --- | | **Call-Exner bodies** | Absent | Present (pathognomonic) | | **Age at presentation** | 45–65 years (peak 5th–6th decade) | 45–50 years (peak 5th decade) | | **Inhibin levels** | Normal or mildly elevated | Markedly elevated | | **Laterality** | 70% bilateral (especially serous) | 95% unilateral | | **Hormone production** | Rare (occasional estrogen) | Common (estrogen → abnormal bleeding) | | **CA-125** | Elevated in 80% | Usually normal | | **Grade & stage** | Graded (G1–G3); staged (I–IV) | Low-grade; usually stage I | ### Clinical Pearl **Clinical Pearl:** GCT is a sex cord–stromal tumor, not an epithelial malignancy. Although both can present in postmenopausal women, GCT typically causes abnormal uterine bleeding due to estrogen production, whereas EOC presents with constitutional symptoms and ascites. The presence of Call-Exner bodies on histology is the definitive microscopic discriminator. ### High-Yield Distinction **High-Yield:** While both may occur in the 5th–6th decade and both can be unilateral or bilateral, the histologic finding of Call-Exner bodies is unique to GCT and is the single best discriminating feature. Inhibin elevation is also characteristic of GCT but requires serology; Call-Exner bodies are identified on routine H&E histology. [cite:Robbins 10e Ch 24]
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