Brenner tumor is an uncommon epithelial subtype of ovarian tumors. It is often asymptomatic and found incidentally on pathological examination. Their morphology can vary from benign to malignant, although a majority of these tumors are benign.
Images
Presentation
Brenner tumors are predominantly unilateral and usually asymptomatic, particularly when their size is small. The majority of cases are diagnosed incidentally during a pathological evaluation. In symptomatic women, these ovarian tumors can present as postmenopausal uterine bleeding, pain which may or may not be related to pelvic masses and may be associated with endometrial hyperplasia, polyposis, and adenocarcinoma. These tumors can occur in conjunction with other ipsilateral or contralateral benign or malignant ovarian tumors [1] [2] [3].
Other reported clinical features in cases of Brenner tumors include ascites, Meigs' syndrome [4], and urinary retention [5].
Malignant Brenner tumors are usually unilateral but bilateral tumors can also occur. Peritoneal effusion may develop rarely in about 10% of malignant Brenner tumors [6] [7].
Ovarian masses can reach a huge size while still remaining asymptomatic [8]. Such large lesions can lead to cardiovascular, hemodynamic and pulmonary complications resulting from aortocaval compression and an elevated diaphragm [9]. The majority of large ovarian masses are benign while malignant types are more likely to induce symptoms before reaching a greater size [10].
When a tumor has attained a large diameter, it may stay unnoticed because of various reasons such as extreme obesity in the patient or negligence in cases which present at later stages. On clinical examination, it may resemble other conditions like colonic volvulus, massive ascites or pregnancy [11].
Psychiatrical
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Suggestibility
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. [ncbi.nlm.nih.gov]
Neurologic
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Irritability
The tumor presented with vulvar irritation and soreness and consisted of a 1.8-cm polypoid mass arising from the lower third of the vagina. [ncbi.nlm.nih.gov]
Urogenital
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Adnexal Mass
A 30-year-old woman, G1P0, was found to have an adnexal mass at 15 weeks of gestation. The mass was resected at Cesarean section and found to be a Brenner tumor with areas of stromal luteinization. [ncbi.nlm.nih.gov]
On vaginal examination, there was a right adnexal mass with lower pole felt through right fornix, and pouch of douglas (POD) was free. She was investigated in the line of ovarian tumor. Tumor marker analysis showed CA125 30.18 IU and CEA 0.9 IU. [ojionline.org]
Management of adnexal mass. Evid Rep Technol Assess (Full Rep) 2006:1-145. [Figure 1], [Figure 2], [Figure 3] [cancerjournal.net]
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Vulvar Irritation
The tumor presented with vulvar irritation and soreness and consisted of a 1.8-cm polypoid mass arising from the lower third of the vagina. [ncbi.nlm.nih.gov]
Workup
Brenner tumors are often found concurrently with a dermoid cyst or a mucinous cystadenoma. They are rare in comparison to other ovarian neoplasms and most common in women between 50 to 60 years of age. They can be divided into benign, borderline, or malignant types with benign being the most common type and malignant types occurring rarely (about 2% of all Brenner tumors).
These tumors are commonly firm, solid and small (up to 2 centimeters). If they are large in size, they can have cystic components because of degeneration and necrosis. Depending on their malignant status, they have a good to excellent prognosis when they are confined to the ovary [12] [13] [14].
It is not easy to diagnose Brenner tumors using imaging studies. Both ultrasound and computed tomography (CT) have limited specificity because of the nonspecific appearance of the benign type resembling fibroma, pedunculated leiomyoma, and fibrothecoma [15].
Borderline and malignant types are cystic and large with solid areas. However, large benign Brenner tumors are more common. If this is associated with a large mucinous cyst, it may be misdiagnosed as a mucinous cystadenoma. This can be avoided by the identification of transitional cells at the periphery of mucinous cells. The possibility of a large ovarian tumor being benign should not be excluded [16].
X-Ray
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Multiple Lytic Bone Lesions
Imaging studies showed diffuse dural enhancement, multiple lytic bone lesions and a tumor in the left ovary. [ncbi.nlm.nih.gov]
Ultrasound
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Ovarian Mass
Hence, it is justified to think of an ovarian mass, in a known case of breast carcinoma, as a metastasis from the same. [ncbi.nlm.nih.gov]
The majority of large ovarian masses are benign while malignant types are more likely to induce symptoms before reaching a greater size. [symptoma.com]
Other ECG Findings
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Ischemic Changes
Hemorrhage and ischemic changes were seen. Other elements were not recognized. No malignant transformation was noted. These two elements were separately present, and no mergers between them were recognized. [ncbi.nlm.nih.gov]
Treatment
Treatment included complete surgical resection and staging procedure. Pathology revealed a malignant Brenner tumor. [ncbi.nlm.nih.gov]
Diagnosis could be made only with histological examination, and surgery is the mainstay of treatment. [moh-it.pure.elsevier.com]
If cancer cells are found during a biopsy, additional treatment measures, such as chemotherapy or radiation treatment, may become necessary. [wisegeek.com]
Prognosis
The prognosis is much better with survival approaching ten years than if the disease was classified as a single organ disease with metastasis. [ncbi.nlm.nih.gov]
Prognosis Prognosis is usually excellent for patients with Brenner tumor. The tendency for the growth to remain benign also vastly improves morbidity and mortality rates. [knowcancer.com]
The vast majority of Brenner tumors is benign, while only 1{\%} is malignant and associated with a poor prognosis. Diagnosis could be made only with histological examination, and surgery is the mainstay of treatment. [moh-it.pure.elsevier.com]
Depending on their malignant status, they have a good to excellent prognosis when they are confined to the ovary. It is not easy to diagnose Brenner tumors using imaging studies. [symptoma.com]
Etiology
Moreover, immunohistochemical and molecular studies are carried out in the effort to establish the phenotype and etiology of this rare neoplasm. [ncbi.nlm.nih.gov]
Many etiologic theories have been advanced over the years. Although each of the proposed mechanisms is possible and each may contribute to some cases of endometriosis, whether any fully explains the major source of the disease is doubtful. [emedicine.medscape.com]
[…] into the following: Serous cystadenoma Borderline serous tumour Serous cystadenocarcinoma Adenofibroma Cystadenofibroma Mucinous tumours are further classified as: Mucinous cystadenoma Borderline mucinous tumour Mucinous cystadenocarcinoma Adenofibroma Etiology [atlasgeneticsoncology.org]
Epidemiology
Recently, transistional cell carcinoma of the ovary has been related to serous carcinoma ; TCC of the ovary is probably distinct from the malignant Brenner tumour. [3] May arise from the fallopian tube. [4] Can be seen in the testis. [5] Epidemiology [librepathology.org]
Epidemiology Benign ovarian tumours occur in 30% of females with regular menses (eg, luteal cysts as incidental findings on pelvic scans) and 50% of females with irregular menses. [patient.info]
Epidemiology Frequency United States Metastatic lesions that involve the spinal cord affect about 5-10% of patients with cancer. [3] Approximately 15% of all primary CNS lesions arise from the spinal cord, with an estimated incidence rate of 0.5-2.5 cases [emedicine.medscape.com]
Motoki Y, Mizushima S, Taguri M, Takahashi K, Asano R, Kato H, Asai-Sato M, Katayama K, Okamoto N, Hirahara F, Miyagi E Cancer epidemiology 39(5) 700-706 Oct 2015 [Refereed] Radiation Therapy for Para-Aortic Lymph Node Metastasis from Uterine Cervical [researchmap.jp]
[…] female genital tract understand the concept of borderline tumors and how to distinguish them from carcinomas be able to describe clinical features including relevant associations be able to suggest possible clinical outcomes and response to treatment Epidemiology [med-ed.virginia.edu]
Pathophysiology
Pathophysiology Metastatic spinal cord compression usually follows hematogenous dissemination of malignant cells to the vertebral bodies, with subsequent expansion into the epidural space. [emedicine.medscape.com]
Prevention
Pagina 344 - Primary prevention of ischemic stroke: A statement for healthcare professionals from the Stroke Council of the American Heart Association. [books.google.ro]
With or Without Peripheral Stem Cell Transplantation in Treating Patients With Persistent Ovarian Epithelial Cancer Terminated NCT00002819 Phase 3 carboplatin;cyclophosphamide;mitoxantrone hydrochloride;paclitaxel 13 Acetyl-L-Carnitine Hydrochloride in Preventing [malacards.org]
These patients require rapid diagnosis and treatment to prevent permanent complications (see Presentation, Workup, and Treatment. [emedicine.medscape.com]
Sukegawa A, Ohshige K, Arai S, Sakanashi K, Usui M, Hirahara F, Miyagi E The journal of obstetrics and gynaecology research 41(1) 99-106 Jan 2015 [Refereed] Web-based recruiting for a survey on knowledge and awareness of cervical cancer prevention among [researchmap.jp]
References
- Eichhorn JH, Young RH. Transitional cell carcinoma of the ovary: a morphologic study of 100 cases with emphasis on differential diagnosis. Am J Surg Pathol 2004; 28: 453-463.
- Han JH, Kim DY, Lee SW, et al. Intensive systemic chemotherapy is effective against recurrent malignant Brenner tumor of the ovary: An analysis of 10 cases within a single center. Taiwan J Obstet Gynecol 2015; 54: 178-182.
- Singhal VP, Chauhan N, Sharma M, Nadia S. A rare case of unilateral Brenner tumor. Int J Gynecol Plast Surg 2013;5:66-8.
- Yoonessi M, Abell MR. Brenner tumors of the ovary. Obstet Gynecol 1979; 54: 90–96.
- Roth LM, Czernobilsky B. Ovarian Brenner tumors. II. Malignant. Cancer 1985; 56: 592–601.
- Driss M, Mrad K, Dhouib R, Doghri R, Abbes I, Romdhane B. Ascitic fluid cytology in malignant Brenner tumor: A case report. Acta cytologica. 2010;54(4):598–600.
- Oh S, Rha S, Jung S, et al. Transitional cell tumor of the ovary: Computed tomographic and magnetic resonance imaging features with pathological correlation. J Comput Assist Tomogr. 2009;33(1):106–12.
- Severi F, Bocchi C, Vannuccini S, Petraglia F. Ovary and ultrasound: From physiology to disease. Arch Perinatal Med 2012;18:7-19.
- Kim YT, Kim JW, Choe BH. A case of huge ovarian cyst of 21-year-old young woman. J Obstet Gynaecol Res 1999;25:275-9.
- Fobe D, Vandervurst T, Vanhoutte L. Giant ovarian cystadenoma weighing 59 kg. Gynecol Surg 2011;8:177-9.
- Myers ER, Bastian LA, Havrilesky LJ, Kulasingam SL, Terplan MS, Cline KE, et al. Management of adnexal mass. Evid Rep Technol Assess (Full Rep) 2006:1-145.
- Hermanns B, Faridi A, Rath W, Füzesi L, Schröder W. Differential diagnosis, prognostic factors, and clinical treatment of proliferative Brenner tumor of the ovary. Ultrastruct Pathol. 2000;24(3):191–6.
- Yamamoto R, Fujita M, Kuwabara M, Sogame M, Ebina Y, Sakuragi N, et al. Malignant Brenner tumors of the ovary and tumor markers: Case reports. Jpn J Clin Oncol 1999;29:308-13.
- Vranes HS, Klaric P, Benkovik LB, Pirkic A. Brenner tumor of the ovary. Acta Clin Croat 2005;44:271-3.
- Green GE, Mortele KJ, Glickman JN, Benson CB. Brenner tumors of the ovary sonographic and computed tomographic imaging features. J Ultrasound Med. 2006;25:1245–51.
- Anitha B, Letha P, Samith A, Parvathi P. A Rare Presentation of Benign Brenner Tumor of Ovary: A Case Report. J. evid. based med. healthc. (Online). 2015;2(47):8357–8360. doi:10.18410/jebmh/2015/1135.