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Brenner Tumor of the Ovary: A 10-Year Single Institution Experience and Comprehensive Review of the Literature. Med Sci (Basel) 2023; 11:medsci11010018. [PMID: 36810485 PMCID: PMC9944520 DOI: 10.3390/medsci11010018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 02/09/2023] Open
Abstract
Brenner tumors (BTs) are surface-epithelial stromal cell tumors that are categorized by the World Health Organization as benign, borderline, and malignant. Due to the rarity of BTs, the published literature on these tumors is comprised primarily of case reports and small retrospective studies. We performed a pathology database review spanning the last ten years at our institution revealing nine reported benign BTs. We collected the clinical and pathological data of patients associated with those BTs, describing the clinical presentation and imaging results, and assessing the possible risk factors associated with them. The average age at diagnosis was 58 years. BTs were discovered incidentally in 7/9 cases. The tumor was multifocal and bilateral in 1/9 cases and ranged in size from 0.2 cm to 7.5 cm. Associated Walthard rests were found in 6/9 cases and transitional metaplasia of surface ovarian and/or tubal epithelium was found in 4/9 cases. One patient had an associated mucinous cystadenoma in the ipsilateral ovary. Another patient had an associated mucinous cystadenoma in the contralateral ovary. In conclusion, we found that Walthard rests and transitional metaplasia are common findings in association with BTs. Additionally, pathologists and surgeons need to be aware of the association between mucinous cystadenomas and BTs.
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Harrad M, Watik F, Bouyalik F, Sami Z, Boufettal H, Mahdaoui S, Samouh N. Ovarian cystic tumor composed of brenner tumor and stroma ovarii. Int J Surg Case Rep 2022; 99:107604. [PMID: 36099767 PMCID: PMC9568703 DOI: 10.1016/j.ijscr.2022.107604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/29/2022] [Accepted: 09/03/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction Brenner's tumors are transitional cell ovarian tumors composed of mature cells similar to urothelial cells forming nests within a fibromatous stroma. Case report In this observation we report the case of a brenner's tumor diagnosed in a 63 year old female patient. The positive diagnosis was difficult to retain. Discussion Brenner tumors are rare fibroepithelial ovarian tumors, representing 1 to 2 % of all ovarian tumors. They are almost always benign. Conclusion The treatment is essentially surgical and the indication of chemotherapy remains debatable. Brenner's tumors are transitional cell ovarian tumors composed of mature cells similar to urothelial. Brenner tumors are rare fibroepithelial ovarian. it is usually an echogenic mass, with an echogenicity close to the myometrium. The treatment of ovarian cysts is primarily surgical and the indication of chemotherapy remains debatable.
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Pillay L, Wadee R. A retrospective study of the epidemiology and histological subtypes of ovarian epithelial neoplasms at Charlotte Maxeke Johannesburg Academic Hospital. SOUTHERN AFRICAN JOURNAL OF GYNAECOLOGICAL ONCOLOGY 2021. [DOI: 10.1080/20742835.2021.1962084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Lusela Pillay
- Department of Anatomical Pathology, University of the Witwatersrand/National Health Laboratory Service (NHLS), Johannesburg, South Africa
| | - Reubina Wadee
- Department of Anatomical Pathology, University of the Witwatersrand/National Health Laboratory Service (NHLS), Johannesburg, South Africa
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Ricotta G, Maulard A, Genestie C, Pautier P, Leary A, Chargari C, Candiani M, Morice P, Gouy S. Brenner Borderline Ovarian Tumor: A Case Series and Literature Review. Ann Surg Oncol 2021; 28:6714-6720. [PMID: 33768396 DOI: 10.1245/s10434-021-09879-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/04/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Most frequent borderline ovarian tumors are serous and mucinous subtypes. Less frequent borderline diseases are endometrioid, clear-cell, and Brenner tumors (BBOT). Very little is known about the latter subtype, and most studies include very short series or case reports. The aim of this study is to determine the prognosis of a continuous series of BBOT and analyze data published in the literature on this rare entity. PATIENTS AND METHODS A retrospective review of patients with BBOT treated or referred to our institutions was conducted. A centralized histological review by a reference pathologist and data on the clinical characteristics, management, and outcomes of patients were required for inclusion. RESULTS Overall, 17 patients were identified. Median age was 62 (range 42-85) years. Six patients underwent unilateral salpingo-oophorectomy, and 11 bilateral salpingo-oophorectomy +/- hysterectomy and/or staging surgery. In total, 16 patients had unilateral tumor, and all patients had stage I disease. Stromal microinvasion was observed in three cases. Median follow-up was 60 months (range 7-118 months). One patient developed a recurrence in contralateral ovary after unilateral salpingo-oophorectomy. One patient had previous history of urothelial tumor. CONCLUSIONS Peritoneal staging surgery is not required because all patients reported had stage I disease. One recurrence occurred. When reviewing all the 82 cases reported in the literature (including ours), 9% had previous history or synchronous urothelial tumor, suggesting the need to carefully check for urological disease in patients with BBOT.
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Affiliation(s)
- Giulio Ricotta
- Department of Gynaecologic Surgery, Gustave-Roussy, Villejuif, France
| | - Amandine Maulard
- Department of Gynaecologic Surgery, Gustave-Roussy, Villejuif, France
| | | | - Patricia Pautier
- Department of Medical Oncology, Gustave-Roussy, Villejuif, France
| | - Alexandra Leary
- Department of Medical Oncology, Gustave-Roussy, Villejuif, France
| | - Cyrus Chargari
- Department of Radiation Oncology, Gustave-Roussy, Villejuif, France
| | - Massimo Candiani
- IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Philippe Morice
- Department of Gynaecologic Surgery, Gustave-Roussy, Villejuif, France. .,Paris Sud University, Kremlin Bicetre, France.
| | - Sebastien Gouy
- Department of Gynaecologic Surgery, Gustave-Roussy, Villejuif, France
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Salibay CJ, Zanfagnin V, Miller H, Walia S, Brunette LL, Wang T. Borderline Brenner Tumor of the Ovary Coexisting With an Ovarian Mucinous Cystadenoma With Focal Atypical Epithelial Proliferation: A Rare Case With Review of the Literature. Int J Surg Pathol 2021; 29:788-793. [PMID: 33635096 DOI: 10.1177/1066896921999459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Ovarian Brenner tumors, accounting for ∼5% of overall ovarian epithelial neoplasm, are often reported in association with mucinous neoplasm. Histogenetically, the two tumors are thought to arise from similar precursors. To date, fewer than 60 borderline Brenner tumors alone have been reported, and the concomitant presence of atypical proliferative components in Brenner and mucinous tumors is even rarer. Therefore, the clinicopathological characteristics and prognosis of patients with the borderline Brenner tumors alone or coexisting with mucinous neoplasm are extremely limited. Herein, we report a unique case of a 53-year-old woman with a unilateral ovarian borderline Brenner tumor associated with focal atypical mucinous epithelial proliferation and her clinical presentations. The clinicopathological features of the tumor are documented and the literature review along with the clinical molecular advances are summarized in this study.
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Affiliation(s)
- Christine J Salibay
- 5116Department of Pathology and Laboratory Medicine, University of Southern California, Los Angeles, CA, USA
| | - Valentina Zanfagnin
- 5116Department of Pathology and Laboratory Medicine, University of Southern California, Los Angeles, CA, USA
| | - Heather Miller
- Department of Clinical Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Saloni Walia
- 5116Department of Pathology and Laboratory Medicine, University of Southern California, Los Angeles, CA, USA
| | - Laurie L Brunette
- Department of Clinical Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Tiannan Wang
- 5116Department of Pathology and Laboratory Medicine, University of Southern California, Los Angeles, CA, USA
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Abstract
Brenner tumors arise from ovarian epithelium, accounting for approximately 5% of benign ovarian epithelial tumors. The World Health Organization classification groups them into benign, borderline, and malignant on the basis of proliferation and invasiveness, and borderline Brenner tumor is defined as “displaying epithelial proliferation beyond that seen in benign Brenner's tumor, but lacking stromal invasion.” Borderline Brenner tumors are rare. Fewer than 60 cases have been reported. The more recent articles mostly focus on pathogenesis. We reviewed the literature on borderline Brenner tumor and have summarized the clinical and pathologic findings, as well as the treatment, differential diagnoses, and recent advances in histogenesis and molecular pathogenesis.
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Affiliation(s)
- Ruifang Zheng
- From the Department of Pathology, Rutgers-New Jersey Medical School, Newark, New Jersey
| | - Debra S. Heller
- From the Department of Pathology, Rutgers-New Jersey Medical School, Newark, New Jersey
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7
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Pfarr N, Darb-Esfahani S, Leichsenring J, Taube E, Boxberg M, Braicu I, Jesinghaus M, Penzel R, Endris V, Noske A, Weichert W, Schirmacher P, Denkert C, Stenzinger A. Mutational profiles of Brenner tumors show distinctive features uncoupling urothelial carcinomas and ovarian carcinoma with transitional cell histology. Genes Chromosomes Cancer 2017. [DOI: 10.1002/gcc.22480] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Nicole Pfarr
- Institute of Pathology, Technical University Munich (TUM); Munich, Germany
| | | | - Jonas Leichsenring
- Institute of Pathology, University Hospital Heidelberg; Heidelberg, Germany
| | - Eliane Taube
- Institute of Pathology, Charité University Hospital; Berlin, Germany
| | - Melanie Boxberg
- Institute of Pathology, Technical University Munich (TUM); Munich, Germany
| | - Ioana Braicu
- Institute of Pathology, Charité University Hospital; Berlin, Germany
| | - Moritz Jesinghaus
- Institute of Pathology, Technical University Munich (TUM); Munich, Germany
| | - Roland Penzel
- Institute of Pathology, University Hospital Heidelberg; Heidelberg, Germany
| | - Volker Endris
- Institute of Pathology, University Hospital Heidelberg; Heidelberg, Germany
| | - Aurelia Noske
- Institute of Pathology, Technical University Munich (TUM); Munich, Germany
| | - Wilko Weichert
- Institute of Pathology, Technical University Munich (TUM); Munich, Germany
- German Cancer Consortium (DKTK), Heidelberg, Berlin, and Munich partner sites, and German Cancer Research Center (DKFZ); Heidelberg, Germany
| | - Peter Schirmacher
- Institute of Pathology, University Hospital Heidelberg; Heidelberg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Berlin, and Munich partner sites, and German Cancer Research Center (DKFZ); Heidelberg, Germany
| | - Carsten Denkert
- Institute of Pathology, Charité University Hospital; Berlin, Germany
- German Cancer Consortium (DKTK), Heidelberg, Berlin, and Munich partner sites, and German Cancer Research Center (DKFZ); Heidelberg, Germany
| | - Albrecht Stenzinger
- Institute of Pathology, University Hospital Heidelberg; Heidelberg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Berlin, and Munich partner sites, and German Cancer Research Center (DKFZ); Heidelberg, Germany
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Wang Y, Wu RC, Shwartz LE, Haley L, Lin MT, Shih IM, Kurman RJ. Clonality analysis of combined Brenner and mucinous tumours of the ovary reveals their monoclonal origin. J Pathol 2015; 237:146-51. [PMID: 26095692 DOI: 10.1002/path.4572] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 06/03/2015] [Accepted: 06/10/2015] [Indexed: 01/22/2023]
Abstract
The derivation of ovarian intestinal-type mucinous tumours is not well established. Some are derived from teratomas but the origin of the majority is not clear. It has been recently proposed that the non-germ cell group may be derived from Brenner tumours, as the association of a mucinous tumour with a Brenner tumour is frequently observed. In order to explore the histogenesis of these neoplasms, we undertook a clonality analysis of the two components of ten combined Brenner and mucinous tumours using a human androgen receptor gene (HUMARA) assay. All eight informative cases of ten showed a concordant X-chromosome inactivation pattern between the two tumour components, indicative of a shared clonal origin (p = 0.0039). Microsatellite genotyping in five of the combined tumours displayed an identical heterozygous pattern with paired Fallopian tube tissue, indicative of a somatic cell origin. In addition, paired box protein 8, a highly sensitive Müllerian epithelial marker, was not detected by immunohistochemistry in either tumour component in any of the ten tumours, suggesting that this subset of mucinous tumours does not originate from Müllerian-derived epithelium. In conclusion, this study demonstrates that in combined mucinous and Brenner tumours, there is a shared clonal relationship between the two different tumour components and suggests that some pure mucinous tumours may develop from a Brenner tumour in which the Brenner tumour component becomes compressed and obliterated by an expanding mucinous neoplasm.
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Affiliation(s)
- Yihong Wang
- Department of Pathology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Ren-chin Wu
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.,Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Lauren Ende Shwartz
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Lisa Haley
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Ming-tse Lin
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Ie-ming Shih
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.,Department of Gynecology and Obstetrics, Johns Hopkins Medical Institutions, Baltimore, MD, USA.,Department of Oncology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Robert J Kurman
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.,Department of Gynecology and Obstetrics, Johns Hopkins Medical Institutions, Baltimore, MD, USA.,Department of Oncology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
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Aoun F, Kourie HR, Sirtaine N, Hawaux E. Disappearance of Upper Urinary Tract Urothelial Carcinoma after Treatment of a Borderline Brenner Tumor: Case Report and Literature Review. Oncol Res Treat 2015; 38:379-81. [DOI: 10.1159/000433488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 04/09/2015] [Indexed: 11/19/2022]
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Roma AA, Masand RP. Different staining patterns of ovarian Brenner tumor and the associated mucinous tumor. Ann Diagn Pathol 2014; 19:29-32. [PMID: 25596159 DOI: 10.1016/j.anndiagpath.2014.12.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 12/16/2014] [Indexed: 12/12/2022]
Abstract
The association of ovarian Brenner tumors and adjacent mucinous tumors is well known but not completely understood. In this study, we analyzed immunohistochemical markers on Brenner tumors and their associated mucinous tumor to explore Mullerian as well as Wolffian and germ cell derivation and determine if the mucinous component is independent or related to the Brenner tumor. Of 32 consecutive cases of Brenner tumors, 8 were identified with significant mucinous component, and 7 additional cases included foci of mucinous epithelium within the Brenner transitional nests. All Brenner tumors were diffusely positive for GATA3 and negative for Paired box gene 8, PAX2, and Sal-like protein 4. Interestingly, the areas of mucinous epithelium as well as mucinous tumors, intermixed and adjacent to the Brenner tumor, were negative for all 4 markers; however, occasional basal-like cells retained expression of GATA3. The immunoprofile of mucinous tumors associated with Brenner tumors shares the lack of Mullerian markers PAX2 and Paired box gene 8 with the Brenner tumor but differs in the expression of GATA3 only in the Brenner tumor component.
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Affiliation(s)
- Andres A Roma
- Department of Anatomic Pathology, Robert J Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH.
| | - Ramya P Masand
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX
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Abstract
OBJECTIVE The borderline ovarian Brenner tumor (BOBT) of the ovary is a rare tumor, and fewer than 25 cases have been reported in the literature. The aim of this study was to determine the prognosis of a series of BOBT collected in 2 reference centers. METHODS A retrospective review of patients with BOBT treated or referred to our institutions. A centralized histological review by a reference pathologist and data on the clinical characteristics, management, and outcomes of patients were required for inclusion. RESULTS Ten patients were identified between 2000 and 2010. The median age of patients was 69 years (range, 52-84 years). Eight patients had pure BOBT and 2 had mixed histotype (mucinous and Brenner tumor). All patients had unilateral tumor and a stage I disease. No case of stromal microinvasion or intraepithelial carcinoma was observed. Among 5 patients with data on the follow-up, 1 lethal recurrence (50 months after initial surgery) was observed (the first reported in the literature). CONCLUSIONS During the management of BOBT, peritoneal staging surgery is not required because all patients reported in the present series (and all but one in the literature) had stage I disease. One recurrence had occurred in this retrospective series. Nevertheless, among 35 cases (including those in the present study) reported in the literature with outcomes, this tumor carries a good prognosis. The power of this conclusion is, however, limited because of the relatively small number of patients studied (but this is a rare entity) and the short follow-up period.
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12
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Abstract
Ovarian malignant Brenner tumors are rare neoplasms that are typically admixed with benign and borderline Brenner tumor elements. We report 3 cases of an unusual variant of malignant Brenner tumor where the infiltrative malignant component arose directly from a benign Brenner tumor rather than from borderline elements and did not exhibit a desmoplastic stromal response. Borderline elements were present in 1 case, but the invasive component did not arise from these. Our cases highlight that an absence of a borderline element should not dissuade the pathologist from diagnosing a malignant Brenner tumor.
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Dierickx I, Valentin L, Van Holsbeke C, Jacomen G, Lissoni AA, Licameli A, Testa A, Bourne T, Timmerman D. Imaging in gynecological disease (7): clinical and ultrasound features of Brenner tumors of the ovary. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 40:706-713. [PMID: 22407678 DOI: 10.1002/uog.11149] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/24/2012] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To describe clinical and ultrasound features of Brenner tumors of the ovary. METHODS In this retrospective study, the databases of the International Ovarian Tumor Analysis (IOTA) studies and one tertiary center were searched to identify patients who had undergone an ultrasound scan before surgery for an adnexal mass that proved to be a Brenner tumor. Twenty-eight patients with 29 Brenner tumors were included, most of which had been collected within the framework of the IOTA studies. An experienced ultrasound examiner reviewed available ultrasound images (available for 14 tumors), searching for a pattern specific to Brenner tumors. RESULTS Most patients were postmenopausal and asymptomatic. Twenty-four (83%) tumors were benign, two (7%) were borderline and three (10%) were malignant. Most benign tumors (17/24, 71%) contained solid components and manifested no or minimal blood flow on Doppler examination (19/24, 79%). Information about calcifications was available for 15 benign tumors, and in 13 (87%) calcifications were present. The five borderline and invasively malignant tumors contained solid components less often than did the benign ones (3/5, 60%) and were more richly vascularized on Doppler examination. Information about calcifications was available for four borderline or invasively malignant tumors, and in three (75%) calcifications were present. CONCLUSION We failed to demonstrate ultrasound features specific to Brenner tumors. A prospective study is needed to determine if ultrasound features of calcifications can discriminate between Brenner tumors and other types of ovarian tumor.
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Affiliation(s)
- I Dierickx
- Department of Obstetrics and Gynecology, Algemeen Ziekenhuis Sint-Lucas, Gent, Belgium
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Shukla S, Acharya S, Rajput D, Vagha S, Acharya N. Brenner or non-Brenner′s?: A diagnostic challenge!! CLINICAL CANCER INVESTIGATION JOURNAL 2012. [DOI: 10.4103/2278-0513.102902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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15
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A singular observation of a giant benign Brenner tumor of the ovary. Arch Gynecol Obstet 2011; 284:513-6. [PMID: 21594602 DOI: 10.1007/s00404-011-1930-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Accepted: 05/05/2011] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Brenner tumors are rare transitional cell tumors of the ovary. They are usually benign neoplasms, of solid or solid-cystic structure and small size. We describe the case of a benign, predominantly cystic Brenner tumor measuring 39 cm in diameter. CASE REPORT A 62-year-old woman presented to the outpatient visit complaining about vague abdominal symptoms such as constipation and meteorism. Ultrasonography and CT scan showed the presence of a voluminous cystic mass, with fluid content, displacing other intra-abdominal organs. The patient underwent elective surgical excision, and there were no complications. Definitive pathological examination showed a metaplastic benign Brenner tumor. CONCLUSION The largest benign Brenner tumors reported in literature have been up to 30 cm in size, and greater size has been thought to be a predictor of malignancy. We have seen, however, that it is possible for larger lesions of this type to have a completely benign behavior; consequently, a benign nature should not be excluded even in the event of a large ovarian lesion.
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Abstract
This review covers the group of relatively uncommon nonserous ovarian epithelial tumors. The authors focus on the group's distinctiveness from the much more common serous tumors and show the similarities across entities. Diagnostic criteria that separate the different entities are currently being debated. Particular problems include the reproducible diagnosis of high-grade endometrioid, transitional cell, mixed epithelial and undifferentiated carcinomas. Furthermore, despite recognition that most malignant mucinous tumors involving ovary represent metastases from extraovarian primary sites, many misdiagnoses still occur. The authors discuss their rationale behind their opinions about these problematic topics.
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Affiliation(s)
- Guangming Han
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue New York, NY 10065, USA; Department of Pathology & Laboratory Medicine, Foothills Medical Centre, University of Calgary, AB T2N 2T9, Canada
| | - Robert A Soslow
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue New York, NY 10065, USA.
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Transitional cell tumor of the ovary: computed tomographic and magnetic resonance imaging features with pathological correlation. J Comput Assist Tomogr 2009; 33:106-12. [PMID: 19188796 DOI: 10.1097/rct.0b013e3181638121] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe computed tomographic (CT) and magnetic resonance (MR) imaging findings of transitional cell tumors, including newly established transitional cell carcinoma, according to tumor type with pathological correlation. METHODS We retrospectively reviewed the CT and MR images of 22 patients with transitional cell tumors of ovary (14 benign Brenner, 2 borderline Brenner, 2 malignant Brenner, and 4 transitional cell carcinomas) for the following factors: size, location, configuration, signal intensity, staging, and accompanying ovarian tumors. RESULTS Sixteen tumors were detected on CT or MRI (8 benign, 2 borderline, and 6 malignant tumors), and the mean size of measurable tumors was 8.8 cm. Benign Brenner tumors were homogeneous solid (n = 6) or unilocular cystic (n = 2). Two borderline Brenner tumors were multilocular cystic. Malignant tumors, including malignant Brenner tumors and transitional cell carcinomas, were heterogeneous solid (n = 3) or multilocular cystic (n = 3). The signal intensity of solid components on T2-weighted images was isointense compared with that of muscle in benign and borderline Brenner tumors and hyperintense in malignant tumors. CONCLUSIONS The CT and MR appearance of transitional cell tumors varied according to tumor type. Benign Brenner tumors were homogeneous solid or unilocular cystic pattern, and malignant tumors were heterogeneous solid or multilocular cystic.
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Expression of the Urothelial Differentiation Markers GATA3 and Placental S100 (S100P) in Female Genital Tract Transitional Cell Proliferations. Am J Surg Pathol 2009; 33:347-53. [DOI: 10.1097/pas.0b013e3181908e24] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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19
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Seidman JD, Khedmati F. Exploring the histogenesis of ovarian mucinous and transitional cell (Brenner) neoplasms and their relationship with Walthard cell nests: a study of 120 tumors. Arch Pathol Lab Med 2008; 132:1753-60. [PMID: 18976011 DOI: 10.5858/132.11.1753] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2008] [Indexed: 11/06/2022]
Abstract
CONTEXT The origin of and relationship between ovarian mucinous and transitional cell (Brenner) neoplasms are enigmatic. The reported association ranges from 1% to 16%, and whether there is an association with Walthard cell nests is unknown. OBJECTIVE To clarify the histologic relationship between mucinous and Brenner tumors. DESIGN A total of 40 mucinous cystadenomas, 67 Brenner tumors, and 13 combined tumors were studied. Peritoneal surfaces were examined for Walthard nests in 83 patients compared with 272 controls. RESULTS A total of 25% of tumors with a mucinous component contained a Brenner component, and 16% of tumors with a Brenner component contained a mucinous component. Most calcifications were spiculated (nonpsammomatous). In 6 combined tumors, the relative volume of the 2 components was less than 1:3000 (transitional-mucinous). Walthard nests were found in 50% of patients with Brenner tumors and 59% of patients with mucinous tumors. This was significantly higher than the 28% found in controls (P = .002 and P < .001, respectively). The number of fallopian tube blocks examined was correlated with the likelihood of finding Walthard nests, and accordingly, sampling accounted for 39% of the increase with Brenner tumors but strengthened the association with mucinous tumors. CONCLUSIONS The strong association of mucinous and transitional cell components, similar type of calcification, complementary size distributions, and frequent identification of a transitional component in the face of an exceedingly small estimated proportion of that component suggest that this association has been underestimated. The association of Brenner tumors with Walthard nests, although significant, appears weak and not strongly supportive of a histogenetic relationship. The stronger association of Walthard nests with mucinous tumors remains unexplained.
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Affiliation(s)
- Jeffrey D Seidman
- Department of Pathology, Washington Hospital Center, 110 Irving St, NW, Washington, DC 20010, USA.
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Kourda N, Elloumi H, Chérif K, Jilani SB, Zermani R. Tumeur de Brenner proliférante : à propos d’un cas. ACTA ACUST UNITED AC 2008; 36:292-5. [DOI: 10.1016/j.gyobfe.2007.11.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2007] [Accepted: 11/27/2007] [Indexed: 11/25/2022]
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Liao XY, Xue WC, Shen DH, Ngan HYS, Siu MK, Cheung AN. p63 expression in ovarian tumours: a marker for Brenner tumours but not transitional cell carcinomas. Histopathology 2007; 51:477-83. [PMID: 17880529 DOI: 10.1111/j.1365-2559.2007.02804.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To investigate p63 expression in ovarian neoplasms. METHODS AND RESULTS Immunohistochemistry using an antibody that detects all p63 isoforms was performed on 103 primary ovarian neoplasms of different histological types. Diffuse nuclear immunoreactivity of p63 was demonstrated in the 17 benign and five borderline Brenner tumours. Only one of the six malignant Brenner tumours displayed p63 expression. p63 immunoreactivity was absent in all the ovarian transitional cell carcinomas (TCC), but was demonstrated extensively in TCCs of the urinary bladder. Besides focal p63 expression in epidermal basal cells of immature and mature teratomas, all other ovarian lesions were devoid of p63 expression. p63 expression was also demonstrated in cervical transitional cell metaplasia and Walthard cell nests of fallopian tubes. CONCLUSIONS Expression of p63 protein is apparently cell lineage specific and in ovarian neoplasms is confined to benign and borderline Brenner tumours. The loss of expression in malignant Benner tumours suggests a role for p63 in Brenner carcinogenesis. The distinct patterns of p63 expression in TCCs in the ovary and urinary bladder may help in their differential diagnosis.
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Affiliation(s)
- X Y Liao
- Department of Pathology, University of Hong Kong, Queen Mary Hospital, Hong Kong
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22
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23
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Monaghan H, Williams ARW. Brenner tumour with carcinoma in situ: evidence for a spectrum from benign to malignant. Histopathology 2003; 43:502-4. [PMID: 14636281 DOI: 10.1046/j.1365-2559.2003.01698.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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24
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Abstract
An ovarian Brenner tumor from a 39-year-old woman exhibited striking microcystic change that was so extensive it largely obscured the nature of the tumor, causing initial diagnostic difficulty. The patient presented with symptoms related to a pelvic mass and had a unilateral, 24 cm in maximal dimension, stage I tumor that was solid and cystic. Microscopic examination revealed extensive microcystic change within the epithelial nests in large areas of the tumor such that transitional-type epithelium was only recognized very focally. The tumor had minor areas (<5%) that showed marked cytological atypia and mitotic activity, interpreted as microscopic foci of intraepithelial carcinoma, but was predominantly benign. The presence of characteristic fibromatous stroma and mucinous metaplasia within the epithelial nests provided important clues to the correct diagnosis.
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Affiliation(s)
- Patricia M Baker
- Department of Pathology, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada
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25
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Nagai Y, Kishimoto T, Nikaido T, Nishihara K, Matsumoto T, Suzuki C, Ogishima T, Kuwahara Y, Hurukata Y, Mizunuma M, Nakata Y, Ishikura H. Squamous predominance in mixed-epithelial papillary cystadenomas of borderline malignancy of mullerian type arising in endometriotic cysts: a study of four cases. Am J Surg Pathol 2003; 27:242-7. [PMID: 12548172 DOI: 10.1097/00000478-200302000-00014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Mixed-epithelial papillary cystadenoma of borderline malignancy of mullerian type (MEBMM) is composed of a mixture of mullerian epithelial types, such as mucinous, serous, endometrioid, and squamous. Four cases of MEBMM with squamous overgrowth (MEBMMSO) were reviewed. The patients' median age was 56 years, and all cases were unilateral. The clinical stages were Ia (two cases), Ic (one case), and IV based on the presence of tumor cells in pleural fluid (one case). No recurrence was seen in three of the cases. In one of those three cases, there was no recurrence after undergoing surgery only; in the other two of those three cases, there was no recurrence after undergoing surgery and receiving postoperative chemotherapy. In the single case that was at stage IV at initial presentation, a recurrent MEBMMSO nodule was found at a second look 17 months after the initial surgery. In terms of gross findings, all of the tumors were cystic with intracystic papillary fronds. In addition, old endometriotic lesions lined the cysts. The tumors were mainly composed of a proliferation of squamous-type epithelium, with minor foci containing a mixture of other mullerian-type epithelia, especially mucinous. Intraepithelial infiltration by neutrophilic leukocytes was prominent. The differential diagnosis of MEBMMSO includes proliferating Brenner tumors.
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Affiliation(s)
- Yuichiro Nagai
- Department of Molecular Pathology, Chiba University Graduate School of Medicine, Japan
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26
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Ogawa K, Johansson SL, Cohen SM. Immunohistochemical analysis of uroplakins, urothelial specific proteins, in ovarian Brenner tumors, normal tissues, and benign and neoplastic lesions of the female genital tract. THE AMERICAN JOURNAL OF PATHOLOGY 1999; 155:1047-50. [PMID: 10514386 PMCID: PMC1867018 DOI: 10.1016/s0002-9440(10)65206-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Uroplakins are the characteristic integral membrane proteins in terminally differentiated, superficial urothelial asymmetric unit membrane. Brenner tumors of the ovary and Walthard cell nests of Fallopian tubes have been considered to represent urothelial differentiation in the female genital tract, but no definitive differentiation marker has been demonstrated supporting such a conclusion. An immunohistochemical analysis was performed to assess the expression of uroplakins in these lesions as well as in various benign and neoplastic lesions and normal tissues of the female genital tract. Focal expression of uroplakins was observed on the luminal surface of ovarian Brenner tumor cells forming microcysts in all 5 cases examined. In contrast, uroplakins were slightly expressed in only 1 of 12 cases of Walthard cell nests, even in the presence of microcyst formation. Uroplakins were not expressed in other benign or malignant lesions or normal tissues of the female genital tract. These results support the hypothesis that the Brenner tumor and possibly Walthard cell nests represent urothelial (transitional cell) differentiation.
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Affiliation(s)
- Kumiko Ogawa
- University of Nebraska Medical Center, Omaha, Nebraska; and the First Department of Pathology,†
| | - Sonny L. Johansson
- University of Nebraska Medical Center, Omaha, Nebraska; and the First Department of Pathology,†
| | - Samuel M. Cohen
- University of Nebraska Medical Center, Omaha, Nebraska; and the First Department of Pathology,†
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27
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Badve S, Fehmian C, Cass I, Goldberg GL, Jones JG. Malignant Brenner tumor mimicking a primary squamous cell carcinoma of the cervix. Gynecol Oncol 1999; 74:487-90. [PMID: 10479516 DOI: 10.1006/gyno.1999.5474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
An 86-year-old female presented with a necrotic cervical mass that was biopsy-proven squamous cell carcinoma. She had an elevated CA-125 and a pelvic mass. At surgery, this mass was found to be of adnexal origin and contiguous with the cervix. Histology showed a malignant Brenner tumor with abundant squamous differentiation eroding the cervix and simulating a primary cervical malignancy. We describe this case and review the literature on metastatic tumors to the cervix.
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Affiliation(s)
- S Badve
- Division of Surgical Pathology, Albert Einstein College of Medicine, Bronx, New York, 10467, USA
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28
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Outwater EK, Siegelman ES, Kim B, Chiowanich P, Blasbalg R, Kilger A. Ovarian Brenner tumors: MR imaging characteristics. Magn Reson Imaging 1998; 16:1147-53. [PMID: 9858270 DOI: 10.1016/s0730-725x(98)00136-2] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study describes the appearance of Brenner tumors on MR imaging and compares quantitative signal intensity measurements of Brenner tumors with that of other ovarian tumors. A search of pathologic and MR records disclosed patients who had MRIs showing Brenner tumors prior to surgical excision. Patients (21) with other surgically proven ovarian masses were randomly selected for comparison. MR imaging was performed at 1.5 T with phased array multicoils and fast spin echo T2-weighted images. Region-of-interest measurements of signal intensity (SI) were made to calculate signal intensity ratios (SIR = mass SI/muscle SI). Brenner tumors showed significantly lower SIR than other tumors on T2-weighted images (p = 0.004) and similar SIR on T1-weighted images. Brenner tumors show lower signal intensity on T2-weighted images than other non-fibrous ovarian tumors. This lower signal intensity may result from the extensive fibrous content of these tumors.
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Affiliation(s)
- E K Outwater
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107-5244, USA.
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29
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Nomura K, Aizawa S. A histogenetic consideration of ovarian mucinous tumors based on an analysis of lesions associated with teratomas or Brenner tumors. Pathol Int 1997; 47:862-5. [PMID: 9503468 DOI: 10.1111/j.1440-1827.1997.tb03718.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
To investigate the histogenesis of ovarian mucinous tumors, clinicopathologic and histologic studies of mucinous tumors associated with teratomas or Brenner tumors were performed. Of 458 ovarian mucinous tumors, 13 (2.8%) and 8 (1.7%) were associated with teratomas or Brenner tumors, respectively. Of patients younger than 40 years, 5.1% had teratomas. Of patients 50 years or older, 3.5% had Brenner tumors. Histologically, nine lesions with teratomas and six lesions with Brenner tumors showed transitions or intimate admixtures of both elements. The findings of the present study suggest that teratomas and Brenner tumors make small contributions to the histogenesis of ovarian mucinous tumors but may give rise to some mucinous tumors, especially in younger patients and older patients, respectively.
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Affiliation(s)
- K Nomura
- Department of Pathology, Jikei University, School of Medicine, Tokyo, Japan
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Kataoka A, Nishida T, Imaishi K, Sugiyama T, Yakushiji M. Malignant Brenner tumor of the ovary: two cases of unusual histologic features of relapsed tumors. JOURNAL OF OBSTETRICS AND GYNAECOLOGY (TOKYO, JAPAN) 1995; 21:249-56. [PMID: 8590361 DOI: 10.1111/j.1447-0756.1995.tb01005.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
This study focused on unusual histologic features observed in 2 relapsed Brenner tumors. Case 1: A 67-year-old woman had a malignant Brenner tumor. The tumor relapsed was squamous-cell carcinoma. Case 2: A 51-year-old woman had a proliferating and malignant Brenner tumor with mucinous metaplasia. The relapsed tumor was a well-differentiated mucinous adenocarcinoma. These cases suggest that: (1) the relapsed tumor cells survived chemotherapy; and (2) the relapsed tumor cells transformed.
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Affiliation(s)
- A Kataoka
- Department of Obstetrics and Gynecology, Kurume University, School of Medicine, Fukuoka, Japan
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32
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Joh K, Aizawa S, Ohkawa K, Dohzono H, Aida S, Ohgoshi E. Case report of a malignant Brenner tumor with hyperestrogenism. Pathol Int 1995; 45:75-84. [PMID: 7704247 DOI: 10.1111/j.1440-1827.1995.tb03382.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
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.
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Affiliation(s)
- K Joh
- Department of Pathology, Jikei University School of Medicine, Tokyo, Japan
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Abstract
BACKGROUND. Ovarian cancer accounts for approximately 23% of all gynecologic tumors and is the most common fatal gynecologic malignancy. These tumors can occur in women of all ages, but there are differences in the histologic types during various decades of life. CONCLUSIONS. During infancy and childhood, the predominant type of neoplasms are those of germ cell origin, such as teratomas, dysgerminomas, and endodermal sinus tumors. In adults, epithelial neoplasms, or tumors that originate from the epithelium that covers the ovarian surface, are the most common, accounting for almost 85% of all neoplasms after the age of 50 years. The peak incidence of benign epithelial tumors occurs between the ages of 20 and 40 years. Young women (30 to 40 years of age) are frequently affected by the so-called "tumors of low malignant potential," which have excellent prognosis. Older women, on the other hand, usually have the most aggressive forms of ovarian cancer, present with advanced disease, and have a dismal prognosis.
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Affiliation(s)
- M J Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892
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35
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Francis IR, Gikas PW. Metastatic transitional cell carcinoma simulating primary ovarian malignancy. UROLOGIC RADIOLOGY 1992; 14:214-7. [PMID: 1290216 DOI: 10.1007/bf02926934] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A case of metastatic transitional cell carcinoma (TCC) to the ovaries in a patient with prior grade I TCC of the bladder, which morphologically resembled a primary ovarian malignancy on computed tomography (CT), is described. Other tumors whose ovarian metastases can resemble primary ovarian tumors are also listed.
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Affiliation(s)
- I R Francis
- Department of Diagnostic Radiology, University of Michigan Hospitals, Ann Arbor
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36
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37
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Affiliation(s)
- D A Bell
- Department of Pathology, Harvard Medical School, Boston, MA
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38
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Santini D, Gelli MC, Mazzoleni G, Ricci M, Severi B, Pasquinelli G, Pelusi G, Martinelli G. Brenner tumor of the ovary: a correlative histologic, histochemical, immunohistochemical, and ultrastructural investigation. Hum Pathol 1989; 20:787-95. [PMID: 2744751 DOI: 10.1016/0046-8177(89)90074-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
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.
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Affiliation(s)
- D Santini
- Istituto di Anatomia Patologica, University of Bologna, Italy
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39
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Fox H. The concept of borderline malignancy in ovarian tumours: a reappraisal. CURRENT TOPICS IN PATHOLOGY. ERGEBNISSE DER PATHOLOGIE 1989; 78:111-34. [PMID: 2651022 DOI: 10.1007/978-3-642-74011-4_6] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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40
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Abstract
Three cases of stage III malignant Brenner tumor of the ovary in which chemotherapy or radiotherapy favorably altered the clinical courses are reported, and the literature is reviewed.
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Affiliation(s)
- K T Chen
- Department of Pathology, Fresno Community Hospital and Medical Center, California
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41
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Lifschitz-Mercer B, Czernobilsky B, Shezen E, Dgani R, Leitner O, Geiger B. Selective expression of cytokeratin polypeptides in various epithelia of human Brenner tumor. Hum Pathol 1988; 19:640-50. [PMID: 2454213 DOI: 10.1016/s0046-8177(88)80169-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
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.
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42
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Trebeck CE, Friedlander ML, Russell P, Baird PJ. Brenner tumours of the ovary: a study of the histology, immunohistochemistry and cellular DNA content in benign, borderline and malignant ovarian tumours. Pathology 1987; 19:241-6. [PMID: 3324024 DOI: 10.3109/00313028709066557] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Brenner tumours are now generally regarded as being of ovarian epithelial origin. Most have a limited growth potential and are benign. For this reason they are usually found incidentally at hysterectomy. In common with other epithelial ovarian tumours there is a histopathological spectrum of appearances ranging from benign through borderline to invasive malignancy. In this series all 54 tumours were graded according to the degree of cytological atypia, presence of mitoses and tumour necrosis. Heterogeneity of DNA content was observed in the higher grade tumours, two of the four being diploid and two being aneuploid (all benign tumours being diploid). The presence of aneuploidy correlated with the histological features and a poor clinical prognosis. Immunohistochemical staining for keratoprotein was found to be of limited value in the diagnosis of Brenner tumours and their metastases.
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Affiliation(s)
- C E Trebeck
- Department of Histopathology, Westmead Centre
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Abstract
In this study, nine malignant Brenner tumors were reviewed and divided into well and poorly differentiated types. To meet the criteria for malignancy, stromal invasion must be observed. A component of typical benign, metaplastic, and/or proliferating Brenner tumor should be identified. The presence of these latter elements is necessary because the malignant component is often too poorly differentiated to be identified as a Brenner tumor, and a metastatic lesion cannot otherwise be ruled out on pathologic grounds. Well-differentiated tumors often occurred in close relationship to proliferating and occasionally to metaplastic areas, and poorly differentiated ones in relationship to low malignant potential areas. The malignant component may consist of transitional cell, squamous, or undifferentiated carcinoma or an admixture of these. A component of adenocarcinoma may be associated with other malignant elements, but pure mucinous or serous adenocarcinomas would be regarded as separate neoplasms. Although the number of cases is small, the well-differentiated tumors appear to have a better prognosis than the poorly differentiated ones.
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