[Borderline ovarian tumors and global radiation in relation with climate change impact]

There is limited information on borderline ovarian tumor detected intra-surgically and its most favorable treatment in relation with global radiation and climate changes.

AIM

To study the pre-surgery and intra-surgery differentiation criteria of borderline ovarian tumors from invasive carcinoma, and to make a very complex analysis of the frequency, distribution, and variation in time of global radiation, temperature, and precipitation in North-East Romania.

MATERIAL AND METHOD

The 54 patients (age range 20-78 years, mean age 46 years) included in this study had borderline ovarian tumors surgically treated during the last 22 years (January 1988 - December 2009) at the 4th Gynecological Clinic at Iaşi, and representing 4.87% of the total 1107 ovarian tumors detected and treated during this interval. The histological types were: serous (18 cases), mucinous (27 cases), mixed (8 cases), and Brenner tumor (1 case). In order to analyze the impact of climate changes on borderline ovarian tumors a thorough study on the frequency of global radiation in relation with climate changes based on data recorded in the last 55 years was also carried out.

RESULTS

The distribution of these cases depending on when surgery was performed was analyzed. In our study the frequency of ovarian borderline tumors (4.87%) is lower than in similar reports in the literature being due, in our opinion, to the influence of global radiation in relation with climate changes.

CONCLUSIONS

In our study global radiation is probably responsible for a progression to invasive carcinoma in 0.7% of the borderline ovarian tumors.

Leiomyomatosis peritonealis disseminata and ovarian Brenner tumor associated with tamoxifen use

Tamoxifen is frequently administered as adjuvant therapy for breast carcinoma and produces weak estrogen agonist effects in estrogen sensitive tissues. In addition to producing a measurable increase in the risk of endometrial carcinoma, tamoxifen has also been associated with increasing size of uterine leiomyomata as well as the development of new leiomyomata. As the indications for tamoxifen therapy expand, surveillance for additional potential associated adverse outcomes is warranted. A 44-year-old woman with a history of bilateral breast carcinoma presented with leiomyomatosis peritonealis disseminata and a right ovarian Brenner tumor 18 months after beginning adjuvant tamoxifen therapy. Although a causal link cannot be proven, this case is the second reported association between leiomyomatosis peritonealis disseminata, an ovarian Brenner tumor, and tamoxifen use for the treatment of breast carcinoma. Given the hormonal sensitivity of leiomyomatosis peritonealis disseminata, both mutagenic and mitogenic effects of tamoxifen on this rare entity must be considered. In the setting of continued hormonal treatment for breast carcinoma, the management of leiomyomatosis peritonealis disseminata presents unique clinical challenges.

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.

[Brenner tumor of the ovary--a clinicopathological report of 5 cases]

This paper reports 5 cases of Brenner tumor of the ovary treated in our hospital from 1967 to 1985. The patients' mean age was 54.6 years. Three lesions were solid, 1 cystic and the other occurred on the wall of a borderline malignant mucinous cystadenoma. All the 5 cases were benign by pathology. The clinical symptoms were abdominal pain in 3 cases, 2 of which had a torsion of the tumor pedicle, abdominal mass in 1 and abdominal swelling in the other. All the cases possessed the same feature that the tumor was composed of both hyperplastic epithelial nest and fibrous stroma. In histology, there were 3 transitional epithelial cell types and 2 basal cell-like types. Histogenesis of the Brenner tumor, according to the authors' observation, was shown by: 1. The epithelial cell nests of Brenner tumor were similar to the transitional epithelium of the urinary tract in 60% of these cases; basal-like cell in the early stage of differentiation comprised 40%, 2. In 80% of patients, there was observed, in the cell nuclei, a longitudinal groove, which resembled the cells of Walthard cell nests; 3. The transitional epithelial cells were found in the cyst wall of 1 polycystic tumor; another case was complicated with mucinous cystadenoma and there was no sharp demarcation between the two tumors under microscope. It suggests that the histogenesis imply that the Brenner tumor may arise from the coelomic epithelium of para-mesonephros. The authors also believe that certain Brenner tumors have endocrine activity, but the relation between which and the tumor stroma luteinization should be further studied.

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.