Precocious Pseudopuberty Due to Granulosa Cell Tumor in Three Girls

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Abstract
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,