[Clinicopathologic features observation of ovarian transitional cell tumors]

OBJECTIVE

To assess clinical and pathological features of ovarian transitional cell tumors.

METHODS

Fourteen cases of ovarian transitional cell carcinoma (TCC) were selected and investigated for their clinical and pathological features. Their immunohistochemical profiles were compared with 12 cases of serous adenocarcinoma (SC) admixed with TCC and 4 cases of EC admixed with TCC 20 cases of pure high-grade serous adenocarcinoma (HG-SC), 15 cases of endometrioid adenocarcinoma (EC), 6 cases of Brenner tumor (BT, 2 cases of malignant BT and 4 cases of benign BT).

RESULTS

The patients' age ranged from 36-63 years (mean, 56 years). All cases underwent surgery and postoperative chemotherapy with TP or CAP program. Clinical follow-up was available in 9 cases, of which 2 patients died. Histologically, all cases showed features of transitional cell carcinoma without BT component. Immunohistochemically, 13 of 14 TCCs were positive for WT-1 and all were positive for CK7, ER, PR and CA125, but negative for Uroplakin III and CK20.Similar immunohistochemical staining patterns were seen in SC admixed with TCC and pure HG-SC. Percentage of the 14 TCC cases were also diffusely positive for BRCA1. All SCs admixed with TCC and pure HG-SCs were diffusely or heterogeneously positive for WT-1, with a sharp contrast and mottled distribution pattern in the heterogeneous cases. All TCCs were diffusely and strongly positive for p53, while 16 of 20 cases of pure HG-SC were positive. The positive ratio of p53 in SCs admixed with TCC cases was 11/12.WT-1 expression in TCCs was significantly higher than BTs, ECs and ECs admixed with TCC (P < 0.01), while no obvious difference was seen when compared with SCs admixed with TCC and pure HG-SCs.SCs admixed with TCC, TCCs and EC were positive for BRCA1 except pure ECs and BTs. The positive rate of Ki-67 of BTs was low, while it was higher in TCCs, SCs admixed with TCC and pure HG-SCs. Only BTs expressed Uroplakin III.

CONCLUSIONS

Ovarian TCC has characteristic morphological and immunohistochemical features, similar to SC but different from BT. Therefore, TCC should be considered as a morphological variant of HG-SC.

Different staining patterns of ovarian Brenner tumor and the associated mucinous tumor

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.

An unusual case of a borderline Brenner tumor associated with bilateral serous cystadenoma and endometrial carcinoma

Brenner tumor accounts for 1.5 to 2.5% of ovarian tumors. Nearly all are benign and 1% malignant. Less than twenty-five cases of borderline Brenner tumor have been reported worldwide. Our case is the first one related to a bilateral ovarian serous cystadenofibroma and endometrioid adenocarcinoma. This unusual case increases the limited data for borderline Brenner tumors.

Transitional cell tumors of the ovary: a compact group with a heterogeneous histological and immunophenotypical pattern

A small percentage of ovarian neoplasms are transitional cell tumors, which proves to be a distinct group with various histological and immunohistochemical patterns. In this study, 13 archived formalin-fixed paraffin-embedded samples of transitional cell tumors of the ovary have been assessed using standard HE stain and the indirect tristadial ABC peroxidase IHC method for 11 antibodies (CA125, CK7, CEA, EMA, MNF116, CK20, Vim, ER, PgR, PCNA, Ki-67). More than 50% were malignant Brenner tumors. CA125 was positive in all malignant tumors (of Brenner type and transitional cell carcinomas), but not in benign and borderline tumors, while CK7 was positive in approximately 70% of all cases. These two antibodies have shown a high sensitivity and low specificity, but do not correlate to each other. PCNA was positive in the study batch with a mean value of 40% and Ki-67 with a mean value under 25%. A direct correlation statistically significant has been noted between the aforementioned proliferation factors and the tumor grade (r = 0.4, p = 0.05). The other markers were unspecific, with low sensitivity and independently of the histopathological type.

p63 expression in ovarian tumours: a marker for Brenner tumours but not transitional cell carcinomas

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.

Expression and subcellular localization of maspin in human ovarian epithelial neoplasms: correlation with clinicopathologic features

BACKGROUND AND PURPOSE

Maspin is an inhibitor of serine proteinases with tumor suppressor activity that is down-regulated in breast and prostate cancer, but overexpressed in pancreatic carcinoma. However, there were very few published data regarding the role of maspin in ovarian carcinoma. The aim of the present study was to evaluate maspin expression in ovarian epithelial neoplasms and correlate its expression with some clinicopathologic parameters.

MATERIAL AND METHODS

Seventy eight paraffin embedded ovarian specimens from patients with ovarian epithelial neoplasms comprised the material of this study. They included 18 benign, 14 low malignant potential (LMP) and 46 malignant epithelial ovarian neoplasms, in addition to seven specimens from normal ovarian tissues as a control.

RESULTS

Immunohistochemical study of maspin expression using streptavidin biotin immunoperoxidase method revealed that, normal ovarian surface epithelium did not express maspin as well as benign serous and mucinous ovarian epithelial neoplasm. However, all benign Brenner ovarian tumors were maspin positive. On the other hand, 57.14% of LMP tumors showed weak maspin expression and 63% of malignant ovarian epithelial tumors showed maspin expression with 39.1% over expression. The two malignant Brenner tumors studied were maspin negative. There was a trend for maspin expression with high grade, high stage, bilateral tumors and tumors with metastasis. Tumors that showed maspin over-expression showed higher mitotic index (MI) (p=0.02). Invasive cancers were more likely to have predominantly cytoplasmic staining compared to LMP tumors.

CONCLUSION

Maspin was expressed in a substantial proportion of ovarian tumors with poor prognostic parameters. These results may offer new insights regarding the role of maspin in ovarian cancer that may also impact diagnosis and treatment strategies. Moreover, variation in maspin expression between Brenner tumor and other epithelial surface ovarian tumors may indicate that the different histological types probably represent distinct disease entities and involve different molecular pathways.

Metastatic Brenner tumor--a case report

In our report we present a case of metastatic Brenner tumor of the right ovary in a 74-year-old woman. The diagnosis was based on microscopic examination of surgical specimen and a comparison of the immunohistochemical profile of the primary and metastatic tumors. Additionally, we proved urothelial differentiation of the proliferating Brenner tumor, which is in accordance with the literature.

Coexisting Brenner tumor and struma ovarii in the right ovary: Case report and review of the literature

A bilateral ovarian tumor composed of mixed Brenner tumor and struma ovarii in the right ovary and mature cystic teratoma in the left ovary, is described. Mixed Brenner tumor and struma ovarii is rare; eight cases are reviewed. In this case, in addition to the typical Brenner tumor and struma ovarii, some nests composed of both Brenner tumor and struma ovarii in one nest were found in the right ovarian tumor. Immunohistochemically, the struma ovarii is stained for thyroglobulin, and Brenner nests showed various degrees of positive stain for thyroglobulin, which is a specific finding. Brenner tumor, in this case, may produce thyroglobulin or have a receptor to thyroglobulin or analog of thyroglobulin. The origin of mixed Brenner tumor and struma ovarii may be germ cell, as described in some literature, or the Brenner tumor may be of a metaplastic nature, although the Brenner tumor is fourfold the size of struma ovarii in the case presented.

Immunoprofile of Ovarian Tumors With Putative Transitional Cell (Urothelial) Differentiation Using Novel Urothelial Markers

Ovarian tumors containing cells with transitional cell morphology are recognized in the 1999 World Health Organization classification of ovarian tumors and include benign Brenner tumor, borderline and malignant Brenner tumor, and transitional cell carcinoma. Recent immunohistochemical investigations have reached conflicting conclusions regarding true urothelial differentiation in ovarian Brenner tumors. We evaluated a panel consisting of antibodies to uroplakin III (UROIII), thrombomodulin (THR), cytokeratin 7 (CK7), cytokeratin 20 (CK20), and Wilms' tumor protein (WT1) to study urothelial differentiation in ovarian transitional cell tumors. Additionally, we compared the immunohistochemical profile of transitional cell carcinoma of the ovary (TCC-O) with that of transitional cell carcinoma of the bladder (TCC-B), to ascertain if immunohistochemistry may aid in distinguishing primary from metastatic TCC-O. Seventeen benign Brenner tumors and 17 TCC-O were stained with antibodies to UROIII, THR, CK7, CK20, and WT1. Additionally, 6 Brenner tumors of borderline malignancy were stained with antibodies to UROIII, THR, CK7, and CK20. The immunohistochemical results were compared with those of 30 cases of noninvasive TCC-B (low malignant potential n=14, low grade n=16) and 36 cases of invasive TCC-B stained with a similar panel of antibodies as part of another study. Twenty-one nontransitional cell ovarian carcinomas (9 serous, 4 clear cell, 5 endometrioid, 2 mixed endometrioid/serous, and 1 mucinous) were used as controls. Most Brenner tumors showed positivity with UROIII (82%) and THR (76%), supporting true urothelial differentiation in these tumors. Although TCC-O has considerable morphologic overlap with TCC-B, they had only partial immunophenotypic overlap. TCC-O rarely expressed UROIII (6%) and THR (18%) and none expressed CK20. In contrast, nearly 40% of invasive TCC-B expressed UROIII, 61% expressed THR, and 50% expressed CK20. Nearly 82% of TCC-O expressed WT1, which was negative in all TCC-B. Our results may have diagnostic value in distinguishing TCC-O (CK20-, UROIII-/+, WT1+) and invasive TCC-B (CK20+, UROIII+/-, WT1-) metastatic to the ovary. They also indicate that the morphologic similarity between TCC-O and TCC-B does not indicate any histogenic similarity and, as others have noted, TCC-O is a variant morphology in the spectrum of surface epithelial carcinomas.

Thrombospondin-1 and -2 messenger RNA expression in epithelial ovarian tumor

BACKGROUND

The role of thrombospondin (TSP) in tumor progression remains controversial. The association of TSP with clinicopathological features regarding prognostic significance was examined in patients with epithelial ovarian tumor.

MATERIALS AND METHODS

Gene expression of TSP-1 and TSP-2 was assessed by reverse transcriptase-polymerase chain reaction in 6 borderline and 29 malignant epithelial ovarian tumors.

RESULTS

TSP-1 mRNA expression was detected in 14 out of the 29 malignant epithelial ovarian tumors (48.3%), whereas TSP-2 mRNA expression was detected in 7 malignant epithelial ovarian tumors (24.1%). In contrast, no specimen from the borderline epithelial ovarian tumors expressed TSP mRNA. TSP-1 expression was significantly higher in tumors with advanced stage, massive ascites, positive peritoneal cytology and high grade. TSP-2 expression was significantly higher in tumors with massive ascites. Patients exhibiting TSP-1 and -2 mRNA expression demonstrated a markedly poorer prognosis than those lacking TSP-1 and -2 mRNA expression.

CONCLUSION

These findings provide evidence that TSP expression may be associated with an aggressive phenotype in this class of neoplasm.

Luteinizing hormone receptor expression in leiomyomatosis peritonealis disseminata

BACKGROUND

Leiomyomatosis peritonealis disseminata has been attributed to estrogen stimulation and is seen only rarely in postmenopausal women. In such cases, pathogenesis is uncertain.

CASE

Leiomyomatosis peritonealis disseminata tumors were resected from a postmenopausal woman. She was receiving tamoxifen therapy for breast cancer and had bilateral ovarian Brenner tumors. Estrogen and progesterone receptors were detected. Immunohistochemical analysis indicated that LH receptors were present.

CONCLUSION

Luteinizing hormone receptors were identified in leiomyomatosis peritonealis disseminata in one woman. Levels of FSH and LH increase after menopause, and immunohistochemical analysis showed the presence of LH receptors, so gonadotropin rather than estrogen stimulation might have contributed to development of leiomyomatosis peritonealis disseminata in this uncommon case.

Brenner tumor of the vagina

Two cases of Brenner tumor of the vagina were encountered in postmenopausal asymptomatic women who presented with polypoid lesions measuring 0.5 and 1.2 cm, respectively, in the upper and mid-vagina. DNA flow cytometry in one tumor showed a diploid histogram, and Ki-67 (MIB-1) proliferation marker was very low in both tumors. To the best of our knowledge, only two vaginal Brenner tumors have been previously reported. Transition between the vaginal surface epithelium and the tumor in one of our cases may support a metaplastic mullerian origin for these tumors.

EGF-R and PCNA expression in ovarian carcinomas--correlation with classic prognostic factors

Expression of the epidermal growth factor-receptor (EGF-R) and the proliferating cell nuclear antigen (PCNA) was immunohistochemically studied in 75 ovarian cancer samples using formalin-fixed, parafin-embedded tissue. Correlations between these factors and conventional histomorphologic factors were investigated. 44 (58.7%) tumors were EGF-R positive (> 10% positive cells). 18 tumors (24%) showed a weak EGF-R-expression (< or = 50% positivity) and 26 tumors (34.7%) had a strong EGF-R-expression. Expression of EGF-R did not correlate with any of the other prognostic factors investigated. The PCNA-proliferative fraction was classified using the median value (< or = 34%/ > 34%) and a categorization in three groups (< 20%/20%-50%/ > 50%). PCNA-expression showed no correlation with FIGO-stage, histologic tumor type, lymph node-status and EGF-R. However, both PCNA-classifications correlated with the size of the residual tumor (PCNA < or = 34%/ > 34%/p = 0.046; PCNA < 20%/20%-50%/ > 50%/p = 0.086) and the histologic grading (p = 0.076; p = 0.02 respectively). Thus, the PCNA-proliferative fraction might be an additional indicator for tumor aggressiveness and disease outcome.

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.

A case of ovarian Brenner tumor with stromal estrogenic activity

An 88-year-old menopausal Japanese female suffering from atypical genital bleeding received a left oophorectomy for a tumor of the left ovary. A vaginal smear before removal of the tumor revealed high estrogenic activity. The patient's ovarian tumor was a benign Brenner tumor and contained theca-like cells in its stroma. The pathological findings relating to these theca-like cells suggested their estrogenic activity, and a vaginal smear after removal of the tumor revealed that estrogenic activity had disappeared.

[An immunohistochemical study of ferritin in ovarian epithelial tumours]

Ferritin in 93 ovarian epithelial tumors, 10 normal adult ovaries and 4 fetal ovaries were studied with double-PAP technique. Ferritin was demonstrated in 38.89% of the benign ovarian tumors, 46.67% of the borderline and 70.0% of the malignant tumors (P less than 0.05). The positive distribution of ferritin in the serous tumors was more than that in the mucinous and endometrioid tumor (P less than 0.05) and the positive grading of ferritin starring was corresponding to the pathohistopathologic grading of the ovarian tumors. It is considered that ferritin might be used as an immunohistochemical marker in the study of ovarian tumors.

Malignant Brenner tumor of the testis and epididymis

We present the case of a 62-year-old man with a malignant Brenner tumor of the testis and epididymis. The neoplasm showed the distinctive histologic features of Brenner tumors of the ovary, including the presence of nests of transitional epithelium with focal mucinous differentiation, surrounded by septae of dense fibrous tissue. In addition to areas of typical Brenner epithelium, the tumor displayed a component of transitional and squamous carcinoma that invaded the testicular parenchyma, epididymis, and vas deferens, and metastasized to periaortic lymph nodes. To our knowledge, there are only four previously described instances of testicular Brenner tumors. Our case appears to represent the first description of a malignant Brenner tumor of the testis and epididymis.

[Brenner tumor. Apropos of 3 recent cases]

In reference to three recent clinical cases, the authors review the literature regarding Brenner's tumors. It is a rare ovarian tumor (2 p. cent of ovarian tumors), often associated with other utero-adnexal pathological processes. Hormone secretions may be present in 50 p. cent of the cases. Malignant or "borderline" forms are rare. Its histogenesis is discussed.

Hormonal activity of epithelial ovarian tumours in post-menopausal women

Concentrations of progesterone and oestradiol in peripheral serum and tumour cyst fluid were measured in 42 post-menopausal women with epithelial ovarian tumours (17 cancer, 6 borderline malignant, 19 benign tumours) and in 19 post-menopausal women without ovarian neoplasms. The hormonal response of the endometrium was assessed, progestogen and oestrogen receptor content in the tumour tissue case recorded, and tumour deoxyribonucleic acid (DNA) ploidy was measured by flow cytometry. No significant differences were found between the mean serum steroid levels in patients with malignant, borderline or benign tumours, but the mean serum levels of oestradiol in patients with malignant or benign ovarian tumours were higher than those in the controls. Endometrial hormonal activity was seen in 19% of the samples studied. Malignant and benign mucinous epithelial tumours were the types most frequently associated with hormonal activity. Increased levels of sex steroids were seen in the cyst fluid of serous malignant and borderline malignant tumours, while benign tumours were inactive. The steroid receptor content of the various tumour types did not vary significantly. Ten (59%) out of 17 ovarian carcinomas were found to be aneuploid and 41% diploid as measured by flow cytometry. No significant differences in serum levels of progesterone and oestradiol were found between aneuploid and diploid ovarian carcinomas. These results contribute to our knowledge of the hormonal activity of epithelial ovarian tumours in post-menopausal women.

Correlation of multiple steroid receptors with histological type and grade in human ovarian cancer

One hundred eight human ovarian cancers were analyzed for estrogen (ER), progestin (PgR), and androgen (AR) receptors. The receptor levels were related to histological type and grade of the tumor. There were 103 common epithelial carcinomas subdivided into serous (36), endometrioid (36), mucinous (18), clear cell (5), malignant Brenner (3), mixed epithelial (2), and undifferentiated (3) types. Of the remaining five, four were sex cord-stromal tumors and there was a single case of germ cell tumor. ER was detected in 52%, PgR in 52%, and AR in 91% of the cases. There was no correlation between the presence of ER and AR and the tumor histology. The presence of PgR correlated with the grade of endometrioid carcinoma, while no clear correlation existed for the other tumor types. PgR was absent in the three undifferentiated carcinomas. Interestingly, high PgR levels were detected in the three granulosa cell tumors.

Estrogen synthesizing rare malignant Brenner tumor of the ovary with the presence of progesterone and androgen receptors in the absence of estrogen receptors

A case of a malignant Brenner tumor of a postmenopausal woman presenting with vaginal bleedings is described. Clinical and laboratory findings demonstrated estrogenic secretory function and action. The presence of aromatase activity based on in vitro tumor microsomal metabolism of androgen to estrogen is described. Tumor cytosol contained progestin and androgen binding components in the absence of estrogen binding activity. Estrogen binding activity was undetectable both by biochemical as well as histochemical assays.

Malignant Brenner tumor. A histologic, morphometrical, immunohistochemical, and ultrastructural study

The histologic, morphometric, immunohistochemical, and ultrastructural study of a malignant Brenner tumor in a postmenopausal women presenting with vaginal bleeding is described. A comparison with transitional cell carcinomas is made, and the use of morphometry in grading the urothelial-like epithelium in malignant Brenner tumors is suggested. High preoperative urinary estrogen, low serum luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels and histologically confirmed atypical endometrial hyperplasia suggested a hyperestrogenism. The reduction in urinary estrogen and the increase in serum LH and FSH after tumor removal and the presence of aromatase activity detected in tumor microsomes confirmed that the tumor was synthesizing estrogen. Estrogen receptors were undetectable both by biochemical and histochemical analysis in the tumor.

Endocrine cells in the prostate gland, urothelium and Brenner tumors. Immunohistological and ultrastructural studies

Endocrine cells are a normal constituent of the prostate gland, prostatic urethra and urinary bladder mucosa. Positive results using immunohistochemical technics were obtained only with antiserotonin antibodies. In normal tissues, there was a close similarity between the distribution of argyrophilic cells (Grimelius) and serotonin-storing cells. Some striking features were the patchy distribution of endocrine cells, the presence of slender cytoplasmic processes occasionally reaching the luminal surface and the paucity of specialized cells in bladder mucosa. It is unlikely that endocrine cells participate in conventional neoplasms of prostate and bladder. Exceptions are lobular hyperplasia, certain adeno-carcinomas of prostate and inverted papilloma of bladder. An ultrastructural study permitted the distinction of two types of endocrine cells characterized by a different morphology of their granules. Another relevant finding was the presence of serotonin-storing cells in Brenner tumors. The latter observation emphasizes the close similarity between this neoplastic epithelium and urothelium. This implies that endocrine cells may be of mesodermal derivation.

Immunoreactive prekeratin in Brenner tumors of the ovary

In an attempt to further characterize benign, proliferating, and malignant Brenner tumors, immunoperoxidase staining for prekeratin was undertaken in a group of these neoplasms as well as in a variety of histologically different tumors of the ovary. All Brenner tumors reacted positively for prekeratin, whereas none of the other epithelial or sex cord-stromal tumors of the ovary stained. On the basis of these findings, we conclude that prekeratin might be a useful marker for differentiating malignant Brenner tumors from histologically similar, poorly differentiated ovarian neoplasms.

Histogenesis of Brenner tumors, II: histochemistry and CEA

The histochemical characteristics of 21 benign Brenner tumors were studied. The mucins associated with these tumors are of transitional cell origin and do not represent a secondary metaplasia of transitional to intestinal-type epithelium. The goblet and ciliated columnar cells associated with the proliferative Brenner tumor are thought to represent a parallel mucinous metaplasia from celomic epithelium. Thirteen of the 16 benign Brenner tumors and the one proliferative Brenner tumor were found to contain carcinoembyronic antigen (CEA), indicating an additional antigenic similarity to transitional epithelium.