A brenner tumor of the testis

Intratesticular Mullerian Serous Borderline Tumor With Microinvasion: A Rare Tumor and Review of the Literature

Ovarian-type (ie, Mullerian) epithelial tumors occurring in the testicular and paratesticular regions are exceptionally rare, with only a handful reported worldwide. Serous tumors are the most frequently encountered subtype among these rare tumors. The pathogenesis of these tumors within the testicular and paratesticular regions remains a subject of intrigue and debate, with various hypotheses attempting to explain their presence in the paratestis region, where most tumors occur. However, our understanding of the pathogenesis of intratesticular tumors is limited. To date, 11 known examples of intratesticular serous Mullerian tumors have been reported globally. In this report, we present an extraordinary tumor, an intratesticular Mullerian serous borderline tumor with foci of microinvasion, in a 38-year-old male patient. This tumor exhibits histological features similar to their ovarian counterparts and is confirmed through an immunohistochemical panel. Our report underscores the extreme rarity of these tumors, emphasizes the importance of heightened awareness among clinicians and pathologists, and provides valuable insights into their complex development and histogenesis. This contribution aims to enhance diagnostic precision and optimize therapeutic strategies for similar tumors.

Molecular and Clinical Insights in Malignant Brenner Tumor of the Testis With Liver Metastases:A Case Report

Malignant Brenner Tumor (mBT) is extremely rare. Although BT are almost exclusive ovarian neoplasms, they may constitute a highly unusual tumor of the testis; in fact, only seven fully documented cases have been reported to date. Because of their rarity, the pathogenesis of these tumors has not been clarified and there is no standard therapeutic approach. We report the first case of epididymal mBT with synchronous, multiple, liver metastases and a very dramatic clinical course. Both primary tumor and metastasis were subjected to mutational analysis of 20 cancer associated genes. Primary tumor showed FGFR3 Tyr375Cys and PIK3CA His1047Arg missense mutations. Both mutations are reported as pathogenic in ClinVar database. The same FGFR3 mutation was present in liver metastasis. Based on these results we believe that the FGFR pathway could be an ideal candidate for personalized treatment, offering hope to a subset of patients with mBT. Personalized approach, including mutational analysis and molecular testing should be required in patients with rare tumors in order to clarify diagnosis and improve therapeutic strategies.

Extraovarian Brenner tumor in the uterus: a case report and review of literature

BACKGROUND

Extraovarian Brenner tumors (EOBTs) are extremely rare and can be observed incidentally in both female and male patients, raising concerns regarding the origin of Brenner tumors.

CASE PRESENTATION

A 53-year-old postmenopausal woman presented with a nodular lesion in the left side of the corpus uteri, which was found at a routine health check. Macroscopically, the lesion appeared as a solid nodule with a yellowish-gray cut surface, approximately 6 cm in greatest diameter. Microscopically, the lesion consisted of well-defined epithelial nests and spindled stromal cells. Parenchymal cells expressed CK7, GATA3, CK5/6, 34βE12, and p63. A single layer of cavity-lined cells with umbrella-like shape showed apical Uroplakin III positivity. Stromal cells were positive for SMA, ER, and PR. The final diagnosis was EOBT and the patient was followed for 2 months with no recurrence.

CONCLUSIONS

We report here the third case of EOBTs in the uterus. The combination of morphologic and immunohistochemical results supported the involvement of urothelial metaplasia in the development of EOBTs. The similarities between EOBTs and Walthard nests made Müllerian epithelium an attractive candidate as the cellular origin. Changes of tissue structure or sex hormones imbalance may lead to the translocation of Müllerian remnants to distant organs, explaining the pathogenesis of EOBTs.

Ovarian Cystomas and Ovulation, A Histogenetic Concept

The current histologic classification of tumors of the ovary and testis is reviewed, and their relative frequency is illustrated by notifications to the Swedish Cancer Registry from 1959 to 1965. By far the most common neoplasms were epithelial tumors of the ovary (i.e., cystomas). These do not occur in the testis. Cystomas are believed to originate from the surface epithelium (coelomic epithelium, mesothelium) of the ovary, but there is no generally accepted explanation of how the epithelial cells enter the ovary. Based on the absence of cystomas in the testis, the suggestion is advanced that epithelial inclusions may arise during the reparative period following ovulation. The implications of this concept for the histogenesis of cystomas are discussed.

A peculiar case report of extraovarian Brenner tumor arising in the omentum

Background

Brenner tumors almost always develop in the ovary. Exceptionally, extraovarian Brenner tumors have been reported in the lower abdomen or pelvic organs. Here, we introduce a peculiar case of an extraovarian Brenner tumor arising in the omentum.

Case presentation

A 43-year-old woman presented with a palpable abdominal mass. Computed tomography (CT) scan revealed a 9.0-cm solid mass in the omentum. The tumor was not associated with pelvic structures, including the ovaries. It was excised under the clinical impression of an extragastrointestinal stromal tumor or neurogenic tumor. Grossly, the mass was a well-circumscribed solid tumor, with yellow-tan cut surface and minute cystic spaces. Microscopically, the tumor showed well-defined epithelial nests with variable cystic changes embedded in an abundant fibrous stroma. The cells within the nests were reminiscent of benign urothelial cells in that they had oval, frequently grooved nuclei. The epithelial cells focally showed a gradual transition into the surrounding stromal cells with short spindled features. The urothelium-like cells were positive for pancytokeratin, WT-1, p63, CK7, uroplakin-III, and GATA-3 but were negative for CD34, CD10, CK20, c-KIT, DOG-1, PAX-8, and calretinin. Morphological and immunohistochemical features of the tumor were the same as an ovarian Brenner tumor, and so it was diagnosed as an extraovarian Brenner tumor.

Conclusions

Although the location of the tumor was very unusual, we could diagnose the tumor as an extraovarian Brenner tumor on the basis of the histologic and immunohistochemical findings. This is the first case of extraovarian Brenner tumor arising in the omentum near the stomach ever reported in the English literature.

Brenner tumor of the testis: A case report and review of the literature

Brenner tumor is a rare type tumor, which mainly develops in the ovaries and rarely in the adnexal region and urinary system. To the best of our knowledge, only 5 cases of testicular Brenner tumor have been reported to date. In this report, we present the case of a 55-year-old patient who noted a swelling of the right scrotum for ~20 days. The clinical suspicion was an epididymal cyst. However, following surgical resection and subsequent pathological examination, the mass was diagnosed as a testicular Brenner tumor. A supplementary review of previously published cases and literature is also presented. The aim of this report is to help elucidate this disease and reduce the rate of clinical and pathological misdiagnosis.

Vaginal brenner tumor

Extraovarian Brenner tumors are extremely rare. We report a case of vaginal Brenner tumor occurring in an 84-year-old woman. The tumor presented with vulvar irritation and soreness and consisted of a 1.8-cm polypoid mass arising from the lower third of the vagina. Microscopically, it had all the 3 components--urothelial islands, glands, and fibrous stroma--characteristic of a Brenner tumor. We suggest that vaginal Brenner tumors arise from a metaplastic process within the mullerian epithelium.

Selected other problematic testicular and paratesticular lesions: rete testis neoplasms and pseudotumors, mesothelial lesions and secondary tumors

The proximity and, in some instances, communication between several structures in the testis and paratestis (rete testis, epididymis, mesothelium, vestigial epithelium and paratesticular soft tissue) result in a plethora of interesting tumors and tumor-like lesions that together pose a formidable diagnostic challenge both because of their morphologic overlap and rarity. The occasional spread of tumors primarily at other sites to this region adds to the potential problem encountered. This review provides an overview of the pathology of nonmesenchymal paratesticular neoplasms and pseudotumors with a focus on the approach to tubulopapillary neoplasms for which diagnostic considerations may include carcinoma of the rete testis, malignant mesothelioma, ovarian-type epithelial tumors, epididymal carcinoma and metastatic carcinomas. The cornerstone of accurate characterization of these lesions is still a comprehensive, traditional clinicopathologic approach, clinical history (of another primary), gross examination (location) and routine light microscopy, but judicious incorporation of contemporary immunohistochemical markers may aid or in some instances be crucial in resolving the problems encountered.

Serous borderline tumor of the paratestis: a report of seven cases

We report the clinical, morphologic, immunophenotypic, and ploidy findings of seven cases of serous borderline tumor of the paratestis. Mean patient age was 56 years (range, 14-77 years), and the clinical presentation was that of a testicular mass. Tumors ranged in size from 1 to 6 cm (mean, 3.5 cm). Six tumors arose from the tunica albuginea, and two of these tumors were intratesticular. One tumor arose from the tunica vaginalis. Serous borderline tumor of the paratestis is histologically identical to its ovarian counterpart. The tumors were cystic with numerous intracystic blunt papillae lined by stratified epithelial cells with minimal to mild cytologic atypia. Psammoma bodies were present in two cases. In all cases, the neoplastic cells stained strongly and diffusely for cytokeratin 7, estrogen receptor, and CD15, and six of seven cases were positive for progesterone receptor and MOC-31. The cells did not stain for cytokeratin 20, carcinoembryonic antigen, calretinin, and HER2/neu. Proliferative activity, as assessed by MIB-1 staining, ranged from 1.3% to 10% (mean, 5.5%). Five of six tumors were diploid, and one was tetraploid. Patients were treated by radical orchiectomy and followed up from 4 months to 18 years (mean, 48 months; median, 8.5 months). No recurrences or metastases occurred. Serous borderline tumor of the paratestis is morphologically and immunophenotypically identical to ovarian serous borderline tumor. To date, no serous borderline tumor of the paratestis reported in the literature or in our series has recurred or metastasized after resection.

Brenner tumour of the vagina

Polyps of the vagina are rare and are either of inflammatory/reactive or neoplastic origin. A case of extraovarian Brenner tumour of the vagina in a postmenopausal woman, who presented with a vaginal polyp, is described. The polyp was excised and on histological examination, had the triphasic pattern (transitional, glandular and stromal) characteristic of Brenner tumour. The histogenesis of Brenner tumour is discussed in the context of this unusual location and the controversy of its origin.

Non-germ cell tumors of testis

Testicular tumors of non-germ cell origin represent from 5 percent to 10 percent of all testicular neoplasms. Included in this group are sex cord/gonadal stromal tumors, most originating from Leydig or Sertoli cells, mixed tumors, and tumors of mesenchymal or hematopoietic origin. In addition, various miscellaneous lesions, tumor-like conditions, and secondary testicular tumors may be classified as non-germ cell tumors. This review covers the presentation, diagnosis, and treatment of these rare lesions.

Primary intrascrotal nontesticular schwannoma

A supratesticular intrascrotal mass clinically mimicking a spermatocele was found to be a scrotal neoplasm histologically identified as a schwannoma. We herein present the first case of intrascrotal schwannoma to our knowledge.

Histogenesis of Brenner tumors, I: histology and ultrastructure

The histology of 36 benign and four proliferative Brenner tumors is reviewed, and the ultrastructural features of benign Brenner tumors are described. Evidence is presented for the origin of these tumors from celomic inclusion cysts through transitional metaplasia of the cyst lining and progressive growth of branching cords of transitional epithelium. Ovarian lesions associated with the Brenner tumor are described, particularly those containing mucinous epithelia, and their significance is discussed.

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.

Mixed Brenner and adenomatoid tumor of the testis: an ultrastructural study and histogenetic considerations

A previously unreported association of Brenner and adenomatoid tumor found in the tunica vaginalis testis is presented. Many ultrastructural features found in mesothelial cells such as intercellular spaces, deeply indented nuclei, tonofilaments and tight desmosomes, were also shared by cells present in both neoplastic patterns. The previous histogenetic origins ascribed to testicular Brenner tumors are discussed and the evidence for their origin in the mesothelium considered.

Brenner tumor of the uterus

Extraovarian Brenner tumors are extremely rare. Three paratesticular lesions have been observed in men. The only extraovarian Brenner tumor in a woman previously reported was located in the broad ligament. This paper describes a small tumor with histologic features of Brenner tumor within the wall of the uterus. The possible histogenesis is briefly discussed.

Clinical management of non-testicular intrascrotal tumors

Our 10-year experience with non-testicular intrascrotal tumors has been combined with an extensive survey of the literature. The over-all incidence of malignancy affecting intrascrotal structures is high: 1) 25 per cent of epididymal neoplasms are malignant, 2) excluding cord lipomas, 56 per cent of cord tumors are malignant and 3) 59 per cent of scrotal tunic neoplasms are of malignant origin. Because of the high incidence of malignancy and because tumors of these structures are often misdiagnosed, a clinical approach to the diagnosis and management of non-testicular intrascrotal masses is presented.