Predictors of dysphagia screening and pneumonia among patients with intracerebral haemorrhage in China: a cross-sectional hospital-based retrospective study.

OBJECTIVES: This study aimed to investigate factors associated with undergoing dysphagia screening (DS) and developing pneumonia, as well as the relationship between DS and pneumonia in patients with intracerebral haemorrhage (ICH). DESIGN: Our study was a cross-sectional hospital-based retrospective study. STUDY DESIGN AND SETTINGS: We derived data from the China Stroke Centre Alliance, a nationwide clinical registry of ICH from 1476 participating hospitals in mainland China. To identify predictors for pneumonia, multivariable logistic regression models were used to identify patient characteristics that were independently associated with DS and pneumonia. PARTICIPANTS: We included 31 546 patients in this study with patient characteristics, admission location, medical history, hospital characteristics and hospital grade from August 2015 to July 2019. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcomes were DS and pneumonia during acute hospitalisation. RESULTS: In total, 25 749 (81.6%) and 7257 (23.0%) patients with ICH underwent DS and developed pneumonia. Compared with patients without pneumonia, those who developed pneumonia were older and had severe strokes (Glasgow Coma Scale 9-13: 52.7% vs 26.9%). Multivariable analyses revealed that a higher pneumonia risk was associated with dysphagia (OR, 4.34; 95% CI, 4.02 to 4.68), heart failure (OR, 1.85; 95% CI, 1.24 to 2.77) and smoking (OR, 1.12; 95% CI, 1.12 to 0.20). DS was associated with lower odds of pneumonia (OR, 0.65; 95% CI, 0.44 to 0.95). CONCLUSION: Our findings further confirm that dysphagia is an independent risk factor for pneumonia; one-fifth of patients with ICH did not undergo DS. However, comprehensive dysphagia evaluation and effective management are crucial. Nursing processes ensure the collection of complete and accurate information during evaluation of patients. There is a need to increase the rate of DS in patients with ICH, especially those with severe stroke or older. Further, randomised controlled trials are warranted to determine the effectiveness of DS on clinical outcomes.

Mediation effect of stroke recurrence in the association between post-stroke interleukin-6 and functional disability.

AIM: Post-stroke inflammation increases the risk of functional disability through enlarged cerebral infarct size directly and follow-up stroke event indirectly. We aimed to use post-stroke proinflammatory cytokine interleukin-6 (IL-6) as a marker of inflammatory burden and quantify post-stroke inflammation's direct and indirect effect on functional disability. METHODS: We analyzed patients with acute ischemic stroke admitted to 169 hospitals in the Third China National Stroke Registry. Blood samples were collected within 24 h of admission. Stroke recurrence and functional outcome measured by the modified Rankin scale (mRS) were assessed via face-to-face interviews at 3 months. Functional disability was defined as an mRS score ≥2. Mediation analyses under the counterfactual framework were performed to examine the potential causal chain in which stroke recurrence may mediate the relationship between IL-6 and functional outcome. RESULTS: Among the 7053 analyzed patients, the median (interquartile range [IQR]) NIHSS score was 3 (1-5), and the median (IQR) level of IL-6 was 2.61 (1.60-4.73) pg/mL. Stroke recurrence was observed in 458 (6.5%) patients, and functional disability was seen in 1708 (24.2%) patients at the 90-day follow-up. Per stand deviation (4.26 pg/mL) increase in the concentration of IL-6 was associated with an increased risk of stroke recurrence (adjusted odds ratio [aOR], 1.19; 95% CI, 1.09-1.29) and disability (aOR, 1.22; 95% CI, 1.15-1.30) within 90 days. Mediation analyses revealed that 18.72% (95% CI, 9.26%-28.18%) of the relationship between IL-6 and functional disability was mediated by stroke recurrence. CONCLUSIONS: Stroke recurrence mediates less than 20% of the association between IL-6 and functional outcome at 90 days among patients with acute ischemic stroke. In addition to typical secondary prevention strategies for preventing stroke recurrence, more attention should be paid to novel anti-inflammatory therapy to improve functional outcomes directly.

Pre-stroke dementia and in-hospital outcomes in the Chinese Stroke Center Alliance.

Background: Little is known about the impact of prevalent dementia on in-hospital outcomes of patients with incident stroke in China. Using data from the Chinese Stroke Center Alliance (CSCA), we aim to quantify the prevalence of pre-stroke dementia and whether this group is at higher risk of adverse in-hospital outcomes compared to those without pre-stroke dementia. Methods: We used multivariable logistic regression models to assess the associations between pre-stroke dementia and ambulation by day 2, in-hospital mortality, in-hospital complications, and being discharged home. Covariates included age, sex, comorbidities [dyslipidemia, atrial fibrillation, peripheral vascular disease (PVD), smoking, and alcohol use], medication history (antiplatelet drugs or lipid-lowering drugs), stroke severity [measured by the National Institute of Health Stroke Scale (NIHSS)], administration of intravenous tissue plasminogen activator (IV tPA) within 4.5 hours of stroke onset, and receipt of deep vein thrombosis (DVT) prophylaxis if indicated. Results: In the final analytic sample of 559,070 ischemic stroke patients with no prior stroke history enrolled across 1,476 hospitals, those with pre-stroke dementia (n=1,511; 0.3%) were older and more likely to be female. Despite having received similar treatment, patients with pre-stroke dementia had lower odds of ambulating by day 2 [odds ratio (OR) =0.69; 95% confidence interval (CI): 0.62-0.78], higher odds of in-hospital mortality (OR =2.01; 95% CI: 1.35-2.99) or complications (OR =2.17; 95% CI: 1.93-2.44), and lower odds of being discharged home compared to those without pre-stroke dementia (OR =0.71; 95% CI: 0.62-0.83). Conclusions: Worse in-hospital outcomes among patients with pre-stroke dementia may be explained by pre-existing cognitive impairment that limited their ability to advocate for care needs. Further research is needed to determine whether a different care pathway or additional attention from clinicians is necessary for patients with pre-stroke dementia.

Guideline-directed low-density lipoprotein management in high-risk ischemic stroke or transient ischemic attack admissions in China from 2015 to 2019.

BACKGROUND: Lowering low-density lipoprotein cholesterol (LDL-C) is crucial for secondary stroke prevention in stroke patients with preexisting cardiovascular diseases (CVD) or cerebrovascular diseases (CeVD). However, data on attainment of guideline-recommended LDL-C levels are lacking. METHODS: We analyzed data from the Chinese Stroke Center Alliance (CSCA) program for patients with ischemic stroke and transient ischemic attack (TIA) hospitalized between August 2015 and July 2019. Participants were classified into different disease groups according to preexisting CeVD (stroke/TIA) or CVD [coronary heart disease (CHD) or myocardial infarction (MI)]. RESULTS: Of 858,509 patients presenting with an acute stroke/TIA, 251,176 (29.3%) had a preexisting CeVD, 44,158 (5.1%) had preexisting CVD, 33,070 (3.9%) had concomitant preexisting CeVD and CVD, and 530,105 (61.7%) had no documented history of CeVD/CVD. Overall, only 397,596 (46.3%) met the target for LDL-C <2.6 mmol/L, 128,177 (14.9%) for LDL-C <1.8 mmol/L and 55,275 (6.4%) for LDL-C <1.4 mmol/L, and patients with concomitant CeVD and CVD had higher attainment rates than other disease groups (P<0.001). Despite improvements over time in the proportion of patients who attain LDL-C targets (P for trend <0.05), it remains suboptimal. Younger age, women, having a history of hypertension or dyslipidemia, current smoking or drinking, and being admitted to hospitals located in eastern China were associated with lower odds of meeting the LDL-C goals. CONCLUSIONS: Overall attainment of guideline LDL-C targets in a population of stroke/TIA patients is low and indicates the need for better management of dyslipidemia, particularly for high-risk stroke patients with pre-existing CeVD or CVD.

Placental mesenchymal dysplasia: a case of a normal-appearing fetus with intrauterine growth restriction.

In this paper, we described a placenta with vesicular lesions in a 23-year-old woman (1-gravid) who visited our hospital at 13 weeks of gestation on prenatal routine examination. Ultrasound findings showed multiple vesicular lesions which gradually increased as the pregnancy advanced, and a live normal-appearing fetus which was confirmed of IUGR at 30 weeks of gestation in her uterus. Throughout gestation, the maternal serum ß-human chorionic gonadotropin level keeps normal, but the serum alpha-fetoprotein was higher than average. The patient delivered an 1800-g female without obvious anomalies at 35 weeks 5 days of gestation due to premature rupture of membrane. The diagnosis of placental mesenchymal dysplasia was determined on the pathological examination and androgenetic/biparental mosaicism in the placenta was identified by immunohistochemical staining of p57kip2.

Forkhead box protein P1 is a useful marker for the diagnosis of mucinous minimal deviation adenocarcinoma of uterine cervix.

Mucinous minimal deviation adenocarcinoma (MDA) is a rare highly differentiated tumor of uterine cervix, of which the confusing histopathology resembling some benign lesions usually makes difficulty for pathologic diagnosis. The expression of forkhead box protein P1 (FOXP1) is found in some kinds of human tumors and is considered to be associated with the progression of the tumors. The purpose of this study is to detect the FOXP1 expression in MDA and evaluate its possible role in the diagnosis of MDA. Twenty-two MDA cases and 20 control cases consisting of 10 cases of lobular endocervical glandular hyperplasia and 10 cases of normal endocervical tissue were included in this study. All available clinical data were collected and immunostaining for FOXP1, carcinoembryonic antigen (CEA), human milk fat globule antigen 1 (HMFG1), estrogen receptor, and progesterone receptor were performed on these cases. The nuclear/cytoplasmic expression of FOXP1 was found in 18 of 22 MDA cases while in 1 of 20 control cases, which showed statistical significance (P = .000). The cytoplasmic CEA expression was found in 14 of 22 MDA cases and 2 of 20 control cases (P = .000), whereas cytoplasmic HMFG1 expression was found in 10 of 22 MDA cases and 4 of 20 control cases (P = .081). No statistical difference was found between FOXP1 and CEA expression (P = .083) or between FOXP1 and HMFG1 expression (P = .375) in MDA. Neither estrogen receptor nor PR expression was found in MDA. The significant expression of FOXP1 in MDA may be helpful to some extent in the pathologic diagnosis of cervical MDA. A widened observation range and further researches are needed to elucidate the potential mechanism.

Placental site trophoblastic tumor in the pelvic wall: a case report and review of the literature.

Extra-uterine placental site trophoblastic tumor (PSTT) is extremely rare. To our knowledge, PSTT that occurs in the pelvic wall has not yet been reported. A 29-year-old woman presented with amenorrhea and irregular vaginal bleeding of 1 month. A solid tumor mass was detected by ultrasonography in the right pelvic wall. The tumor was comprised of large, polygonal tumor cells, with brisk mitosis and obvious vascular invasion. Immunohistochemical staining demonstrated that tumor cells were positive for human placental lactogen, CD146, cytokeratin, placental alkaline phosphatase, human chorionic gonadotropin were positive, the Ki-67 proliferative index was about 80%. The pathological diagnosis was PSTT. After the operation, the patient was treated with six cycles of etoposide, methotrexate, actinomycin, cyclophosphamide, and vincristine. The patient was followed for 18 months without recurrence. The report shows that extra-uterine PSTT is extremely rare and may have a good prognosis; surgical resection and adjuvant chemotherapy are good options. However, further experience to diagnose and cure this rare tumor is warranted.

[Pathologic features and prognostic factors of ovarian granulose cell tumor].

OBJECTIVE: To identify the pathological features, clinical symptoms and the prognostic factors for adult granulose cell tumor (AGCT) and juvenile granulose cell tumor (JGCT). METHODS: The pathological features and clinical characters of 40 patients with granulose cell tumors (GCT) between April 2002 and September 2011 were reviewed, and the relevant prognostic factors were analyzed. RESULTS: 34 cases (85%) were AGCT, and the average age of onset was 50.1 years old. 6 cases (15%) were JGCT, with an average 35.3 years old age of onset. The difference of average onset age was significant (P = 0.034). The histopathological patterns of AGCT were mainly follicular, insular and trabecular, Call-Exner bodies were found frequently, while the luteinization, hemorrhage and necrosis of tumor cells were not common. In contrast, the histopathological pattern of JGCT was mainly diffuse, Call-Exner bodies were rare, while the luteinization, hemorrhage and necrosis of tumor cells were common. The pathological features of the cases with unfavorable prognosis were: (1) Mixed mode with tumor cell histopathological pattern (follicular, insular, trabecular and diffuse pattern, the tumor cells were mainly organized in two or more than two kinds of patterns above). (2) Call-Exner bodies were rare; (3) mitosis number of tumor cells > or = 3/10 HPF (4) low expression of PTEN and high expression of Ki-67. CONCLUSION: The histological patterns, mitosis number, the expression rate of PTEN and Ki-67 were identified to predict the prognosis for GCT of ovary.

Granular cell tumor of the uterine cervix. A case report.

BACKGROUND: Granular cell tumor (GCT) is a relatively rare and nearly always benign neoplasm that has been described in many sites and organs including the tongue, skin, subcutaneous tissue, breast, and vulva. However, it is rarely seen in the uterine cervix. CASE: We report a case of granular cell tumor of the cervix in a 38-year-old woman. Upon microscopic examination the tumor was found to comprise large polygonal cells with an abundant eosinophilic granular cytoplasm and round to oval nuclei. Upon immunohistochemical staining the large cells showed S-100, neuron specific enolase, and CD68 positive in the cytoplasm. Clinical presentation of the patient, histopathological features of the lesion, and treatment approach are discussed. CONCLUSION: GCTs of the cervix are extremely rare. To the best of our knowledge this report is the first Chinese case of cervical GCT in the English-language literature. GCTs should always be considered during the diagnosis process with large cell lesions of the cervix. Extensive surgical resection appears to be adequate for most GCTs. Because of the unpredictable clinical outcome of this tumor, strict and long-term follow-up are recommended.

[Effect of FK506 and CsA on vascular endothelium of hyperlipidemic rats].

OBJECTIVE: To observe the influence of ciclosporin A (CsA) or/and FK506 on vascular endothelium of hyperlipidemic rats. METHODS: Hyperlipidemic rat model was established as previously described. The injury of vascular endothelium of these rats was observed after stimulation with FK506 or/and CsA. The mRNA transcription and protein expression of the vascular endothelium growth factor (VEGF), decay-accelerating factor (DAF) and C reactive protein (CRP) in vascular endothelium of rats were measured. The serum reactive oxygen species (ROS) was detected. RESULTS: Compared with FK506, CsA was more likely to cause injury of vascular endothelium, damaging the integrity of endothelium of hyperlipidemic rats. CsA inhibited the expression of VEGF and the complement inhibitor DAF and increased the expression of CRP of vascular endothelial cells. CsA also up-regulated the serum level of ROS. FK506 showed no such impacts. CONCLUSION: CsA can damage vascular endothelium of hyperlipidemic rats by activating the complement system induced by VEGF/DAF and ROS/CRP pathway. FK506 has no influence on the VEGF/DAF pathway and the expression of ROS/CRP.

Stage IV Primary Vaginal Leiomyosarcoma with Lung and Breast Metastases.

BACKGROUND: Reproductive tract sarcomas metastasizing to the breast are uncommon. To our knowledge, metastasis of vaginal leiomyosarcoma to the breast has not been previously reported in the literature. CASE REPORT: We present the first report of a FIGO stage IV primary vaginal leiomyosarcoma with metastases to the lung and left breast. Treatment included neoadjuvant chemotherapy followed by surgery and postoperative chemotherapy. Lung metastasis disappeared but recurred 14 months later in conjunction with left breast metastasis which was resected. CONCLUSION: Primary vaginal sarcoma with lung and breast metastases is very rare in female genital malignancies. We present this case to alert gynecologists to the need for early diagnosis and aggressive management.

Langerhans cell histiocytosis of the female genital tract: a literature review with additional three case studies in China.

PURPOSE: To summarize the clinical and pathological features of all reported Langerhans cell histiocytosis (LCH) cases of female genital tract and to provide our additional three cases, and the emphasis is put on the pathological diagnosis to remind both gynecologists and pathologists of this rare disease. METHODS: Literatures available are reviewed and the routine hematoxylin and eosin stained sections and immunohistochemical stained sections are studied for the diagnosis of our cases. RESULTS: Only 18 female genital tract LCH cases have been previously reported in medical literatures. The three cases we provide are diagnosed as LCH by both morphology and immunochemical staining after biopsy. All the patients presented papulous or ulcerative lesions on vulva or cervix, and the following systemic laboratory and radiologic examinations demonstrated no other affected site. After various treatments based on surgery and chemotherapy, most patients showed no signs of local or systemic recurrence. CONCLUSIONS: 'Pure' LCH of female genital tract without any other spreading is a quite rare disease and it might be misrecognized as some other diseases, so both gynecologists and pathologists should keep it in mind when encountered with such cases. The three patients we reported appeared to be the first cases having 'pure' lesion of female genital tract in China.

[Primitive neuroectodermal tumor in female genital tract: a clinicopathologic study].

OBJECTIVE: To study the clinicopathologic features of primitive neuroectodermal tumor (PNET) in female genital tract. METHODS: Six cases of PNET arising in female genital tract were retrospectively reviewed. The clinicopathologic features, immunohistochemical findings and EWS gene translocation study results were analyzed. RESULTS: The age of patients ranged from 10 to 27 years (mean = 20 years). The sites of involvement included ovary (1 case), uterus (1 case), vulva (2 cases) and vagina (2 cases). The greatest diameter of the tumor ranged from 2 to 10 cm (mean = 5.4 cm). The tumor had nodular appearance and showed grayish-pink fleshy cut surface, accompanied by foci of hemorrhage and necrosis. Histologically, the tumor was composed of malignant small round cells with indistinct cell borders, hyperchromatic nuclei, dense chromatin, tiny nucleoli and scanty cytoplasm. The tumor cells were arranged in sheets or lobules. Homer-Wright rosettes were identified in 1 case. Immunohistochemical study showed that the tumor cells were positive for CD99, FLI-1 and CD56 (6/6). Focal expression of vimentin (5/6), NSE (5/6), nestin (4/6), synaptophysin (4/6), S-100 protein (2/6) and chromogranin A (1/6) was also demonstrated. EWS gene translocation was detected in 5 cases studied. Follow-up information was available in 2 patients (7 and 17 months of follow up, respectively). One of them died of tumor metastasis 17 months after diagnosis. The other patient was still alive. CONCLUSIONS: PNET arising in female genital tract is rare. It mainly involves ovary, uterus, vulva and vagina. Immunohistochemical study using a panel of antibodies and fluorescence in-situ hybridization play an important role in definitive diagnosis of this rare malignancy.

Expression of the insulin-like growth factor-II mRNA-binding protein 3 (IMP3) and carcinoembryonic antigen (CEA) in mucinous minimal deviation adenocarcinoma.

Mucinous minimal deviation adenocarcinoma (MDA) is a rare highly differentiated mucinous adenocarcinoma of the uterine cervix, which always remains a diagnostic dilemma. Lobular endocervical glandular hyperplasia (LEGH), a rare benign lesion of the uterine cervix, is identified as precursor of mucinous MDA. The insulin-like growth factor-II mRNA-binding protein 3 (IMP3) is expressed in a number of cancers and is associated with progression of the tumors. The purpose of this study was to evaluate the expression of the IMP3, carcinoembryonic antigen (CEA), and cyclin-dependent kinase inhibitor p16(INK4a) in mucinous MDA and LEGH, and to estimate the possible role of these biomarkers in the diagnosis of mucinous MDA. Twelve samples of MDA, eight samples of lobular endocervical glandular hyperplasia (LEGH), and 20 normal control cases were included in this study. Typical lesions and less well-differentiated lesions coexisted in 11/12 mucinous MDA samples. Positive cytoplasmic expression for IMP3 and CEA was found in less well-differentiated lesions of all 11 mucinous MDA samples, primarily with strong to intermediate staining intensity. The typical well-differentiated lesions of all 12 MDA cases and 8 cases of LEGH showed negativity for both IMP3 and CEA. No exact p16(INK4a) positivity was observed in 12 mucinous MDA and 8 LEGH. The significant expression of IMP3 and CEA in less well-differentiated foci of mucinous MDA may be helpful in the diagnosis of mucinous MDA to some extent, particularly in small specimens from cervical biopsy. More cases and in-depth researches are needed to elucidate the potential different mechanisms between typical and less well-differentiated lesions of mucinous MDA.

[The protein expression of ERCC1 and survivin in epithelial ovarian carcinoma and their clinical significance].

OBJECTIVE: To investigate the protein expression of ERCC1 (excision repair cross complementation group 1) and survivin gene in platinum-resistant and platinum-sensitive epithelial ovarian carcinoma (EOC), and to explore the relationship among ERCC1 expression, survivin expression, the major clinicopathological characteristics as well as platinum sensitivity. METHODS: Expression of ERCC1 and survivin were detected in 64 EOC tissues by immunohistochemical method. RESULTS: No significant differences were found in patients' age, FIGO stage, pathological type, histological grade, pelvic lymph node and/or vessel infiltration, in all of three pairs of comparison. They were platinum-sensitive group vs. platinum-resistant group, ERCC1-positive group vs. ERCC1-negative group and surviving-positive group vs. survivn-negative group (all P > 0.05). The positive rate of ERCC1 expression (67.85%, 19/28) in platinum-resistant patients' tissues was significantly higher than that in platinum-sensitive patients' tissues (25.00%, 9/36) (P = 0.001). While the positive rate of survivin in platinum-resistant patients' tissues (78.57%, 22/28) was slightly higher than that of in platinum-sensitive patients' tissues (75.00%, 29/36), however without significant (P = 0.74). No evidence was found that the expression of ERCC1 correlate with the expression of survivin (r(s) = 0.12, P = 0.36) too. The proportion of platinum-resistant in patients with coexpression of ERCC1 and surviving (65.22%, 15/23) was insignificantly lower than that of in patients with single expression of ERCC1 (80.00%, 4/5) (P = 0.91). CONCLUSION: Expression of ERCC1 in EOC patients' tumor tissue could be a predictive indicator for their platinum susceptibility and it might be helpful for prevention and reverse of platinum resistance in clinical practice. The expression of survivin seems of no definite value in prediction of platinum susceptibility.

Primary solitary fibrous tumor of the vulva: a case report.

BACKGROUND: Solitary fibrous tumor (SFT) of the female genital tract is an extremely rare neoplasm of mesenchymal origin. CASE: A case of primary SFT originated from the vulva of a 39-year-old woman. The tumor presented as a 10-cm, well-circumscribed lump and was composed of bland-looking cells admixed with thin and thick collagen fibers with the appearance of hemangiopericytoma. Immunohistochemically, the spindle cells were strongly positive for CD99 and vimentin, with focal positivity for CD34, and were negative for S100, SMA, desmin, ER, PR, etc. Microscopic evaluation and immunohistochemistry supported the diagnosis of a primary benign vulvar SFT. The patient remained well 10 months after excision. CONCLUSION: To the best of our knowledge, this report is the first Chinese case of vulvar SFT in the English-language literature. SFT should be taken into consideration during the diagnostic process with spindle cell lesions of the vulva. The outcome of this tumor is based mostly on complete surgical resection.

[Clinical and pathological analysis on ovarian granulosa cell tumors].

OBJECTIVE: To identify different clinical and pathological features for adult and juvenile granulosa cell tumors. METHODS: The clinical records of 42 patients with granulosa cell tumors of ovary, including pathological features, treatments and follow up results between April 2001 and September 2009 were reviewed. RESULTS: 1) There were 38 newly diagnosed cases after 2001, and 4 cases were relapsed cases diagnosed before 2001. The 38 cases accounted for 3.13% of ovarian cancer cases treated in our hospital. 2) Twenty nine of the 38 cases (76.3%) were Adult Type, while the other 9 (23.7%) were Juvenile Type. The median onset age were 53 and 25 years old for the Adult Type and Juvenile Type, respectively, which shows significant difference (z = -2.990, P = 0.003). 3) The most common symptoms and signs were abdominal pain (44.7%), vaginal bleeding (42.1%), and abdominal mass (76.3%). The most common complications were endometrial hyperplasia (52.6%) and hysteromyoma (21.1%). 4) Stage I, II and III comprised 73.7%, 23.7% and 2.6% of the 38 cases, respectively. Ten patients ng the underwent conservative unilateral oophorectomy or ovarian enucleation. Twenty patients underwent total abdominal hysterectomy plus bilateral salpingo-oophorectomy. Eight patients underwent cytoreductive surgery. The 42 patients had been followed up for 7 to 175 months, with 14 patients lost of contact. No death was recorded. Inhibin, calretinin, and vimentin were demonstrated to be useful for the diagnosis of granulose cell tumors. CONCLUSION: With low incidence rate, ovarian granulosa cell tumor is a low-grade malignant and functional tumor. Most are unilateral diseases. Most Adult-type granulosa cell tumors occur in middle aged and elderly people, while most juvenile granulosa cell tumors occur in adolescents and children. Acute abdomen symptom may occur but ascites are less likely to occur in patients with granular cell tumors than those with epithelial ovarian cancers. Ovarian granulosa cell tumors are usually detected early, but easily relapse. Long-term follow-up is needed.