Brenner tumor of the ovary with Leydig cell hyperplasia. A histologic and ultrastructural study

Case report of a malignant Brenner tumor with hyperestrogenism

A rare malignant Brenner tumor of the ovary presenting with hyperestrogenism in a 79 year old woman was examined immunohistochemically and by light and electron microscopy. High pre-operative serum and urinary estrogen concentrations, low serum luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels, and histologically confirmed atypical endometrial hyperplasia suggested the presence of hyperestrogenism. The reduction in serum and urinary estrogen and the increase in serum LH and FSH concentrations after tumor removal confirmed that the tumor was synthesizing estrogen. Histologically, the malignant element was predominantly a squamous cell carcinoma. Transitional cell carcinoma was partially found on the cyst wall. There was a spectrum of morphologic changes between benign and malignant elements with an intermediate area with a proliferating Brenner tumor. Immunohistochemically, only the carcinoembryonic antigen was positive exclusively on the malignant element as well as in the microcyst in the benign epithelial cord, whereas all of the markers for germ cell tumors were negative. The ultrastructural features of the stromal cells were of two types: fibroblasts and steroid-producing cells. The latter type of cells might correspond morphologically to estrogen-producing cells. The present case is the fourth report showing a malignant Brenner tumor combined with apparent hyperestrogenism.

Ovarian tumors with functioning manifestations

Various categories of ovarian tumors, particularly those of gonadal stromal origin, are capable of producing a variety of hormones that occasionally induce interesting clinical manifestations. The endocrine manifestations associated with gonadal stromal tumors are often due to hormone production by the tumor cells. Sometimes the tumor cells produce only one hormone, while more frequently the hormonal manifestations result from a summation of various hormones including transformation of a variety of prehormones produced by different components of the tumor including its supportive or reactive stroma. The mechanisms involved in the production and transformation of various hormones and prehormones are complex and not thoroughly established at this time. This review will focus on gonadal stromal tumors and discuss evidence available for linkage of the clinical manifestations to hormones produced by the various neoplasms.

Lipid cell thecomas of the ovary

An ovarian tumour of mixed thecomatous and lipid cell structure is described and the clinical and pathological features of this and eleven previously reported cases are reviewed. Functionally the tumours resemble lipid cell tumours in being mainly androgenic and are similar in size range and age incidence to the 'adrenal' type. Three tumours however contained hilus (Leydig) cells with Reinke crystalloids. The tumours furnish additional evidence of the stromal origin of lipid cell tumours and the term 'lipid cell thecoma' is proposed for them as indicating their main morphological affinities. It is suggested that fibromas, fibrothecomas, thecomas, lipid cell thecomas and lipid cell tumours form a series of related stromatogenous tumours of relatively simple structure with functional correlations as one moves from left to right.

Composite mucinous ovarian neoplasms associated with Sertoli-Leydig and carcinoid tumors

The authors describe two mucinous ovarian tumors that were hormonally active due to Sertoli-Leydig elements within the septal stroma. Carcinoid was also present in each case. The mesenchymal stromal cells within the septa of the mucinous tumors have undergone neoplastic proliferation with the Sertoli and Leydig differentiations, leading to the formation of arrhenoblastoma. The carcinoid component of these tumors is thought to have originated from argentaffin cells of the "intestinal" mucinous epithelium.

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.

Ultrastructure of the benign and borderline Brenner tumours

One benign Brenner tumour and one Brenner tumour of borderline malignancy were investigated by electron microscopy. The cells of the benign Brenner tumour nests and the cells in the borderline tumour were similar in ultrastructure. The intercellular spaces were large and reinforced by a moderate number of desmosomes. The nuclei were round or oval. The nuclear membrane was irregular in shape with deep infoldings corresponding to the characteristic nuclear groovings seen by light microscopy. Only few secreting cells could be found in the benign of Brenner tumour. The cystic cavities of the borderline Brenner tumour were lined by nonciliated secreting and ciliated nonsecreting cells. The secretory granules were PAS-positive and diastaseresistant. The granules stained homogeneously and strongly with the PASM-method at the electron microscopical level indicating the presence of 1.2-hydroxyl groups. The Brenner tumours have many similarities to the transitional epithelium and to the Muellerian-derived tubular structures. The findings support the theory that Brenner tumours are of coelomic origin and develop by direct metaplasia from the ovarian surface epithelium.

Oncocytoma of the lung

A tumor diagnosed as an oncocytoma was removed from the lower right lung of a 22-year-old patient. Specimens from the formalin fixed tumor were studied by light microscopy and by electron microscopy. Large numbers of mitochondria were observed in all the tumor cells at the ultrastructural level despite many artefacts due to fixation. The presence of two tumor cell types "typical" oncocytes and "condensed" oncocytes were demonstrated by electron microscopy. This appears to be the second pulmonary oncocytoma in which mitochondrial hyperplaxia has been demonstrated. The tumor was similar to previously reported cases of salivary gland oncocytomas.

Functional ovarian tumors of stromal and sex cord origin

Most functional ovarian tumors are of specific stromal or sex cord origin, capable of differentiating in either a female direction or, less commonly, a male direction. Tumors of stromal origin such as thecoma, stromal luteoma, and Leydig cell tumors are for all practical purposes benign, and evolve from mature ovarian stroma, recapitulating common non-neoplastic transformations such as stromal changes associated with follicle development and nodular stromal hyperplasia. Sex cord tumors of granulosa or Sertoli cell types are generally of a low order of malignancy, tending to late recurrence, occasional peritoneal seeding, and only rarely to distant metastasis. Nonfunctional tumors of the ovary may trigger hormone production from adjacent reactive stroma. Massive edema of the ovary due to partial torsion may simulate neoplasm and may produce hormonal syndromes by an unknown mechanism.

Mixed ovarian tumor composed of Brenner and thyroid elements

An exceedingly rare ovarian neoplasm composed of mixed thyroid and Brenner tumor is reported. Review of the literature yielded only one well-documented case previously described. Although the possibility of a "collision" of two different tumors cannot be completely discarded, a possibility of an endodermal teratoma (thyroid-urothelium) is also proposed.

Gonadoblastoma: ultrastructural evidence for testicular origin

A gonadoblastoma arising in the dysgenetic gonad of a virilized 17-year-old Caucasian with a female phenotype and with a 45,X0/46, X-ring-Y genotype was studied by light microscopic histochemistry, electron microscopy, and ultrastructural histochemistry. The gonadoblastoma was composed of nests of cells containg large germ cells and small "granulosa-Sertoli-like cells," and stromal tissue containing "Leydig-like cells." The germ cells were identical to those found in normal fetal gonads and in germ cell tumors. Charcot-Böttcher crystalloids present in the "granulosa-Sertoli-like cells" strongly suggest that they are, in fact, Sertoli cells. Multilayered basal laminae located in the periphery of the tumor nests and in "hyaline bodies" were identical to those surrounding the seminiferous tubules of the adult testis. The "Leydig-like cells" present in the stroma contained occasional dense bodies and crystalloids which characterize the Leydig cells of the fetal testis. Delta 5-3 beta hydroxysteroid dehydrogenase activity was demonstrated in the periphery of lipid droplets and lysosome-like dense bodies of the Leydig cells, and in some Sertoli cells. The findings support the theory that gonadoblastoma arises in a dysgenetic testis rather than in a dysgenetic ovary.