Brenner tumors. Histogenetic and clinical studies

Brenner tumor associated with rete ovarii: a histologic and immunohistochemical analysis of six cases exploring the relationship between these entities

The association of Brenner tumor (BT) with rete ovarii (RO) has been rarely alluded to in the literature. Both entities have debatable histogenesis. In this study of six cases of BT associated with RO, we describe the morphologic features and performed immunohistochemical staining for markers of Mullerian, Wolffian, mesothelial, and sex cord stromal derivation to explore the relationship between these entities. Histologically, all BTs were benign, microscopic, and incidental. RO was prominent and hyperplastic with gradual or abrupt transition to BT. In addition, focal areas of rete entrapped between BT nests were seen. All BTs were positive for GATA-3 and negative for PAX-8. Conversely, the RO in all cases was negative for GATA-3 and positive for PAX-8. WT-1 was positive in both entities. Sex cord stromal and mesothelial markers (other than WT-1) were negative in BT and RO. Although morphologically, BTs seem to arise from RO in these cases, they have a distinct immunophenotype. It is possible that at least some BTs arise from metaplastic changes in RO epithelium.

Coexistence of Benign Brenner Tumor with Mucinous Cystadenoma in an Ovarian Mass

Ovarian cancer is the most lethal gynecologic malignancy. The surface epithelial tumor is the most common type of ovarian cancer. Among these, the mucinous tumors account for 10-15% of ovarian tumors. Mucinous ovarian tumors are among the most difficult ovarian neoplasms for surgical pathologists to interpret. Mucinous tumors sometimes coexist with other surface epithelial tumors. Therefore, making the accurate diagnosis of the mucinous tumors is essential. On the other hand, association of Brenner tumors with other neoplasms is rare. Ovarian Brenner tumor has always been discussed by pathologists as an enigmatic tumor, because of its rarity and disputed histogenesis. Here, we reported a case of large mucinous cystadenoma with Brenner component.

Brenner tumor of the ovary: immunoanalysis of steroidogenic enzymes in 23 cases

Immunohistochemical analysis of cytochromes P-450 aromatase and P-450 17 alpha-hydroxylase, which catalyze the production of estrogens and androgens, respectively, was performed for 23 cases of ovarian Brenner tumor. Immunoreactivity for P-450 aromatase was observed in the epithelial cells of the tumor distinctly in two cases and faintly in four cases, while immunoreactivity for P-450 17 alpha-hydroxylase was seen in two cases. No immunoreactivity was observed in the stromal cells of the tumors, nor were luteinized cells observed in the cases examined. No correlation was observed between the immunoreactivity of cytochromes P-450 in the epithelial cells of the tumor and endometrial abnormalities. These findings, together with a review of the literature, suggest that the usual Brenner tumor is not associated with specific steroidogenesis. Rare massive Brenner tumors may, however, be capable of androgenic or estrogenic activity.

Brenner tumor of the ovary: a correlative histologic, histochemical, immunohistochemical, and ultrastructural investigation

The histologic, histochemical, immunohistochemical, and ultrastructural features of Brenner tumor (BT) were studied. BT was compared with transitional bladder cells, and close similarities between the two tissues were identified. Abundant glycogen in all cellular layers, an alcianophilic/sialomucinic surface mucous coat, and argyrophilic cells characterized both BT and bladder epithelium. Immunohistochemically, chromogranin and neuron-specific enolase reactivity was observed in all cases examined. An additional relevant finding was the presence of serotonin-storing cells in both BT and urothelium. Moreover, carcinoembryonic antigen, epithelial membrane antigen, and keratin reaction were found in BT and urothelium, indicating an additional antigenic similarity. Additionally, malignant Brenner tumor was ultrastructurally found to share many common features with the bladder tissue. The distinct histochemical, ultrastructural, and antigenic pattern of BT, primarily of the transitional type, is emphasized.

Selective expression of cytokeratin polypeptides in various epithelia of human Brenner tumor

A human ovarian Brenner tumor presenting a wide spectrum of benign and malignant histologic features was studied for its patterns of intermediate filament expression. All epithelial elements of the tumor, regardless of their morphologic type, contained cytokeratins as their only intermediate filament component. Differences were detected, however, between tumor nests that displayed transitional epithelium and those with squamoid features. These differences were manifested by the presence of cytokeratin 18, in the former type only, and by the abundance of cytokeratins 10/11 in the latter. We also detected mixed epithelial nests in which both features were present, suggesting that the transitional epithelium transforms in polar fashion into squamous epithelium. Examination of cytokeratin patterns found in urothelium and in the surface epithelium of the ovary pointed to certain differences from the Brenner tumor epithelia. The significance of these latter findings with regard to cellular transformation and histogenesis of the Brenner tumor are discussed.

Involucrin, a marker of squamous and urothelial differentiation. An immunohistochemical study on its distribution in normal and neoplastic tissues

Involucrin is a soluble protein precursor of the cross-linked envelope present in the submembranous zone of human stratum corneum, and subsequently demonstrated in stratified squamous epithelia. The immunoperoxidase technique was used to assess the distribution of involucrin in 107 normal and 318 abnormal tissues. With few exceptions, involucrin was restricted to squamous epithelia, urothelium, some skin appendages and thymic Hassall's corpuscles. In normal squamous epithelium and normal urothelium, staining was most intense in the superficial layers where it was concentrated at the cell periphery and gradually decreased toward the basal layer. This orderly staining pattern was maintained in benign squamous and urothelial lesions and in grade I papillary urothelial carcinomas. Higher grade papillary urothelial carcinomas, infiltrating urothelial and squamous carcinomas, and in situ urothelial and squamous carcinomas demonstrated abnormal staining patterns for involucrin that are described. Foci of squamous differentiation in adenocarcinomas and other epithelial malignancies stained intensely for involucrin. Brenner tumours of the ovary and Walthard rests of the fallopian tube, lesions of uncertain histogenesis but possibly urothelial-related, also stained for involucrin. Results of this study suggest that involucrin is a sensitive and specific marker for squamous and urothelial differentiation, staining patterns for involucrin may be helpful in distinguishing benign from malignant urothelial and squamous lesions, and presence of involucrin may be helpful in determining the histogenesis of selected lesions.

Proliferative Brenner tumor or ovarian metastases? A case report

A case of low-grade superficial transitional papillomas of the urinary bladder and concomitant bilateral ovarian tumors with close similarities to the rare proliferative Brenner tumor is reported. Due to lack of benign Brenner elements, metastases from the bladder tumors were suggested. Death was apparently related to the effect of chemotherapy, and metastases were never confirmed. In review of the case, the authors found that the morphologic appearances and biological behavior of the ovarian tumors were more consistent with a proliferative Brenner tumor than with metastases. It is pointed out that a proliferative Brenner tumor should not be excluded in the absence of benign Brenner elements when other features are characteristic. Bilateral proliferating Brenner tumors are probably not reported previously. Histogenetic implications of a combined proliferative complex of bladder papillomas and Brenner tumor are briefly discussed.

Malignant Brenner tumor of the ovary. Electron microscopic study of a case responsive to radiation and chemotherapy

A patient with malignant Brenner tumor of the ovary is presented. The tumor responded to combined therapy with radiation plus doxorubicin + cyclophosphamide despite earlier failure on a single alkylating agent (levophenylalanine mustard). The patient next exhibited a brief response to chemotherapy with hexamethylmelamine + cyclophosphamide + amethopterin + 5-fluorouracil. The histologic findings and ultrastructure of the tumor are discussed in detail. The morphologic features are consistent with the proposed origin of Brenner tumors from coelomic epithelium through a process of secondary urothelial metaplasia.

Extraovarian Brenner tumor. Case report and review

We present the fourth case report of an extraovarian Brenner tumor, which was an incidental finding in a total hysterectomy 53-year-old woman. The morphology and pathogenesis of Brenner tumors are discussed.

Pure and mixed Brenner tumors of the ovary: clinicopathologic and histogenetic observations

Fifty-six Brenner tumors of 51 patients were analyzed. The incidence of bilaterality was 9.8%. Most tumors were smaller than 2 cm, and constituted incidental finding. Most of the patients were 30-49 years old (mean 49.7, main 44). A high incidence of associated malignant neoplasms was noticed among the patients with Brenner tumor but was considered coincidental. No evidence of hormone secretion by the tumor was found. Out of 31 tumors, 27 occupied the cortex. Urothelial metaplasia of the ovarian surface epithelium was demonstrated in one case, and continuation of the Brenner column with the surface of ovary in another. There were 12 cases of mixed Brenner tumor in this series (21.1%). The most frequent associated constituents of the mixed Brenner tumors are mucinous cystadenomas. These tumors represent a single mixed neoplasm originating in a multipotential celomic cell which proliferates and differentiates into several mullerian forms. The histogenesis of medullary and hilar Brenner tumors can be explained on the basis of celomic metaplasia. Uncertainty persists in explaining the histogenesis of Brenner tumors mixed with mature cystic teratoma.

The pathological assessment of ovarian neoplasms. I: Introduction to the common 'epithelial' tumours and analysis of benign 'epithelial' tumours

All neoplasms of the ovary encountered in a 25-year study period at the King George V Memorial Hospital were classified according to the World Health Organisation Histological Classification of Ovarian Tumours. Of these, one thousand fell into the category designated as 'common epithelial tumours'. In this report, the major clinical and pathological correlates and survival data of epithelial tumours as a whole are analysed and criteria are explained for the histological grading of the proliferating and malignant tumours. A detailed histological assessment of the 558 benign epithelial tumours is then presented.

Epithelial mucosubstances and argyrophil cells in Brenner tumours

Brenner tumours of various degree of malignancy were investigated by histochemical methods. The cells lining the cystic cavities in the benign Brenner tumours contained various amounts of PAS-positive, diastase resistant secretory material mixed with small amounts of sulpho- and carboxymucin. The borderline and malignant tumours contained more acidic mucins than the benign tumours. All tumours contained glycogen. Argyrophil and argentaffin cells have not earlier been detected in the Brenner tumours but in this study they were detected in twelve of the 18 Brenner tumours. These cells were not proliferating and therefore Brenner tumour should not be included in the group of APUDomas.