Masa anexial complicada en mujer postmenopáusica: tumor de Brenner de ovario izquierdo torcido / Dough adnexal complicated in woman postmenopausal: ovarian Tumor Brenner left twisted Case Report And Review

Los tumores anexiales representan una patología ginecológica frecuente e importante. El tumor de Brenner es una neoplasia poco frecuente que constituye 1.5-2.5% del total de neoplasias ováricas. Se presenta una paciente de sexo femenino de 62 años que acude por dolor intenso en flanco izquierdo, indicándose estudios complementarios, entre ellos, ecografía abdominal que informa masa de contenido mixto. Se realiza laparotomía exploradora, se constata tumor de ovario izquierdo, torcido, procediéndose a anexo ooforectomía izquierda. Posteriormente, estudio de biopsia informa diagnóstico de tumor de Brenner. Los tumores anexiales pueden representar un verdadero desafío, y requieren un diagnóstico certero y manejo adecuado. Es fundamental sospechar malignidad. El presente caso manifestó numerosos rasgos de malignidad, resultando fortuitamente ser benigno. Se optó por cirugía de laparotomía exploradora más anexo ooforectomia izquierda, decisión bastante controversial debido a la falta de un diagnóstico anatomopatólogico, pero necesaria por la presentación complicada del cuadro.

The adnexal tumors represent a frequent and important gynecological pathology. The Brenner tumor is a rare neoplasm constituting 1.5-2.5% of all ovarian neoplasms. A 62-year-old female patient is presents intense pain in the left flank, and complementary studies are indicated, including abdominal ultrasound that reports mass of mixed content. Exploratory laparotomy is performed, left ovary tumor is twisted, and left oophorectomy is performed. Subsequently, biopsy study reports diagnosis of Brenner's tumor. Adnexal tumors can be a real challenge, requiring accurate diagnosis and proper management. It is fundamental to suspect malignancy.The present case manifested numerous traits of malignancy, being fortuitously benign.We opted for exploratory laparotomy surgery plus left oophorectomy, a rather controversial decision due to the lack of an anatomopathological diagnosis, but necessary due to the complicated presentation of the picture.

Tumor de Brenner fronterizo / Borderline Brenner Tumor

El tumor de Brenner es derivado de la superficie del ovario, que guarda similitud con epitelio transicional de la vejiga. Es un tumor raro debido a que representa 1,5 por ciento de las neoplasias de ovario. El objetivo del trabajo es presentar el caso de una paciente con tumor de Brenner fronterizo confirmado histopatológicamente y realizar una revisión de la literatura respecto al diagnóstico clínico e histopatológico de la entidad y compararla con otras entidades. Se presenta el caso de una mujer de 88 años, a quien se la practicó laparotomía por sospecha de un quiste complejo; se describe la historia clínica y su diagnóstico, y se realiza una revisión de la literatura con énfasis en el diagnóstico. Se realizó una búsqueda de literatura utilizando las bases de datos Medline, vía PubMed, OMIM y SciELO, con los términos tumor de Brenner y tumor de Brenner fronterizo en español e inglés sin límite por año de publicación. Se encontraron 10 artículos, que corresponden a reportes de casos y revisión de la literatura, los cuales describen las características en cuanto a presentación clínica, diagnóstico clínico basándose en estudios de histopatología, y aspectos genéticos de la entidad. El tumor de Brenner fronterizo es infrecuente en México debe tenerse en cuenta como diagnóstico diferencial de tumores de ovario(AU)

Brenner tumor derives from the ovary surface and is similar to the transitional epithelium of the bladder. It is a rare tumor representing just 1.5 percent of ovary neoplasies. The objective of this paper was to present a patient with histologically-confirmed borderline Brenner tumor and to make a literature review on the clinical and histopathological diagnosis of this disease and compare it with others. Here is a 88 years-old women who was performed laparatomy because of suspected complex cyst; her medical history and diagnosis was described and a literature review with emphasis on diagnosing process. A literature search was made by using Medline,OMIM y SciELO and terms Brenner tumor¨ and ¨bordeline Brenner tumor in Spanish and English regardless of year of publication. Ten articles were found about case reports and literature review; they describe the characteristics of clinical presentation, clinical diagnosis based on histopathological studies and general aspects of the disease. Borderline Brenner tumor is infrequent in Mexico and should be considered in the differential diagnosis of ovary tumors(AU)

Combinación poco frecuente de neoplasias múltiples sincrónicas / A rare combination of multiple synchronous neoplasms

Se presenta el caso de una paciente portadora de tres neoplasias sincrónicas diagnosticadas simultáneamente: un tumor de Brenner calcificado del ovario izquierdo, un carcinoma urotelial papilar de alto grado de la vejiga urinaria y un adenocarcinoma moderadamente diferenciado del pulmón derecho. Se practicó el tratamiento quirúrgico exerético de todos los tumores. Se administró un tratamiento de radioterapia más quimioterapia concurrente adyuvante para el tumor urotelial de la vejiga urinaria y otro esquema quimioterápico adyuvante para el adenocarcinoma pulmonar. No se presentaron complicaciones trans ni posoperatorias, ni como consecuencia de los tratamientos adyuvantes. Al momento de la presente publicación la paciente está viva y controlada de su enfermedad(AU)

The case of a patient with three simultaneously diagnosed synchronous neoplasms is presented: a calcified Brenner tumor of the left ovary, an advanced stage papillary urothelial carcinoma in the bladder, and a moderately differentiated adenocarcinoma to the right lung. The excisional surgical treatment of all tumors was performed. She had radiation treatment and concurrent adjuvant chemotherapy for transitional cell carcinoma of the urinary bladder and other adjuvant chemotherapy plan for lung adenocarcinoma. No intraoperative or postoperative complications occurred, or any other derivative effects of adjuvant treatments. At the time of this publication, the patient is alive and her disease is under control(AU)

Clinicopathologic features observation of ovarian transitional cell tumors / 中华病理学杂志

<p><b>OBJECTIVE</b>To assess clinical and pathological features of ovarian transitional cell tumors.</p><p><b>METHODS</b>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).</p><p><b>RESULTS</b>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.</p><p><b>CONCLUSIONS</b>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.</p>

Tumor de Brenner maligno: caso clínico / Malignant Brenner tumor: clinical case

El tumor de Brenner es una neoplasia rara, que representa el 1-2 por ciento de las neoplasias de ovario. La mayoría son benignas, pero existe un pequeño porcentaje de casos de tumor de Brenner maligno, entre ellos el caso que se presenta. Se trata de una mujer de 41 años que presentó una tumoración ovárica cuyo resultado anatomopatológico fue de carcinoma pobremente diferenciado, con asociación de tumor tipo Brenner maligno. A pesar de ser diagnosticado en estadio precoz, este caso destaca por su mal pronóstico.

Brenner tumor is a rare neoplasia, accounting for 1-2 percent of ovarian cancer. Most of them are benign, but there are a small percentage of malignant Brenner tumors, including the case presented. This is a 41-year-old woman who presented an ovarian tumor. Definitive histological result showed a poorly differentiated carcinoma, with association of malignant Brenner tumor. Despite being diagnosed in early stages, this case stands out for its poor prognosis.

Cytologic Distinctive Features of Brenner Tumor

Herein, we present two cases of Brenner tumor, a rarely occurring neoplasm in the ovaries, obtained via intraoperative fine needle aspiration. The borderline Brenner tumor exhibited marked squamous metaplasia, characterized by individually distributed atypical squamous cells. A benign Brenner tumor associated with mucinous cystadenoma evidenced typical mucinous metaplastic features and transitional foci. These distinctive features may prove helpful in differential diagnosis of varied ovarian tumors, and particularly for intraoperative consultation.

CT features of ovarian Brenner tumor and a report of 9 cases / 中华肿瘤杂志

<p><b>OBJECTIVE</b>In order to improve the preoperative diagnostic accuracy, the computed tomographic (CT) features of ovarian Brenner tumor were described and analyzed.</p><p><b>METHODS</b>CT image and clinical data of nine patients with pathologically confirmed Brenner tumor were collected and analyzed retrospectively. There were 8 benign lesions and 1 borderline lesion.</p><p><b>RESULTS</b>All lesions in the nine cases were unilateral, round, lobulated or irregular in shape and well defined, in a mean diameter of 7.8 cm. Among the nine cases, 5 were benign tumors with uniform structure, 3 were benign tumors accompanied with other pathological components, and 1 was borderline tumor. On the CT images, the 5 uniform benign lesions showed to be solid tumor of low density (lower than that of muscle) or with small cyst inside, two of the 5 lesions had calcification, and other 2 lesions showed slightly heterogeneous enhancement after enhanced scanning. The 3 benign Brenner tumors accompanied with other pathological structures were solid-cystic or cystic, with a clear demarcation of solid and cystic components. The density of solid parts was lower than that of muscle, and slight enhancement, and one of them had calcification. The one borderline tumor was a heterogeneous solid one and its density was higher than that of muscle, with a large proportion of low density and large calcification, and moderately enhanced after enhancing. None of the 9 cases had metastasis or effusion.</p><p><b>CONCLUSION</b>Ovarian Brenner tumors are usually unilateral and often accompanied with other type of tumor components. When a tumor is of uniform component, the CT imaging often shows a homogeneous solid tumor with homogeneous or heterogeneous density. When a tumor is accompanied with other tumor components, it may be solid-cystic or cystic and has partial calcification. After enhancing, a benign Brenner tumor is slightly enhanced, while the borderline one is moderately/highly enhanced.</p>

Tumor de Brenner bilateral benigno / Bilateral benign Brenner tumor

El tumor de Brenner es un tumor raro que representa aproximadamente el 1,5 por ciento de los tumores de ovario. Se define como un tumor de células transicionales compuesto por células uroteliales dispuestas en agregados sólidos o quísticos embebidos en un estroma fibroso. Se clasifica en tumor de Brenner benigno (95 por ciento), borderline (3-4 por ciento) y maligno (1 por ciento). Presentamos el caso clínico de una paciente de 91 años intervenida por una tumoración anexial gigante en la que el estudio anatomopatológico reveló la presencia de un tumor de Brenner bilateral benigno asociado a dos cistoadenomas serosos de ovario derecho.

Brenner's tumor is a rare tumor that represents approximately 1.5 percent of the tumors of ovary. It is defined as a tumor of transitional cells composed by cells uroteliales arranged in solid or cystic acccumulations absorbed in a fibrous estroma. It qualifies in tumor of benign Brenner (95 percent), borderline (3-4 percent) and malignantly (1 percent). We present the clinical case of a 91-year-old patient controlled by a giant anexial mass in whom the pathology study (biopsy) revealed the presence of a tumor of bilateral benign Brenner associated with two cistoadenomas serous of right ovary.

A case of primary transitional cell carcinoma of the ovary / 대한산부인과학회지

Primary ovarian transitional cell carcinoma (TCC) is extremely rare type of tumor and resembles transitional cell carcinoma of the bladder. Primary ovarian TCC has been classified as a different subtype from malignant Brenner tumor for it's histologic and clinical characteristics. It usually presents at an advanced stage .Though more aggressive than malignant Brenner tumor, it shows more favorable prognosis because of better response to the chemotherapy than other epithelial ovarian carcinomas. We experienced a case of primary ovarian transitional cell carcinoma in a premenopausal woman who underwent staging operation and chemotherapeutic treatment, and herein report the case with a brief review of related literatures.

Coexisting brenner tumor and struma ovarii in the unilateral ovary; A case report / 대한산부인과학회지

Co-existing Brenner tumor and struma ovarii in the unilateral ovary is very rare. The present case, which is the first case in Korea, and to our knowledge only nine cases had been reported in other countries. We report a case of 42-year-old woman who had co-existing Brenner tumor and struma ovarii in the unilateral ovary with a brief review of the literature.

A case of malignant Brenner tumor developed at an ovary after contralateral oophorectomy / 부인종양

The Brenner tumors of the ovary are uncommon and constitute 1.5-2.5% of all ovarian neoplasms. And their malignant counterparts are rare. Although the first malignant Brenner tumor was described by Von Numers in 1945, only a few malignant Brenner tumors have been reported. The definition and its biologic behavior, and the optimal treatment has not been established. We present a patient who had total abdominal hysterectomy with unilateral salpingooophorectomy due to adenomyosis. The resected ovary had only follicular cysts and the remained ovary was grossly normal . Malignant Brenner tumor developed at the remained ovary 15 years after operation. Operation and adjuvant chemotherapy was applied and patient is alive without evidence of disease. We have experienced a case of malignant Brenner tumor developed at the remained ovary after contralateral oophorectomy with a brief review of literature.

A case of large cell neuroendocrine carcinoma accompanied with malignant brenner tumor and serous adenocarcinoma of the ovary / 부인종양

Large cell neuroendocrine carcinoma of the ovary is rare, aggressive neoplasm frequently accompanied with surface epithelial tumor. A 47-year old woman with asymptomatic pelvic mass which showed malignant on frozen biopsy underwent total hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy, partial omentectomy, appendectomy. Pathologically, size of the pelvic mass was 11 cm in greatest diameter with surface rupture. Histology and immunohistochemical staining revealed that large cell neuroendocrine carcinoma accompanied with malignant brenner tumor and serous adenocarcinoma. Under the diagnosis of Ic ovarian cancer, patient received six cycles of taxol and cisplatin. After a follow-up 2 years, she shows no evidence of disease.

A clinical study of borderline malignant tumors of the ovary / 부인종양

OBJECTIVE: The purpose of this study was to evaluate the clinical and histopathological features, and to find relationship between treatment modality and prognosis of borderline ovarian tumors. METHODS: Ninety-three cases of borderline ovarian tumors that had been treated were reviewed retrospectively. RESULTS: Histologic types of this study group composed of 67 cases of mucinous borderline tumor, 23 cases of serous borderline tumor, 2 cases of mixed type, and 1 case of Brenner tumor. The mean age was 41.6 years (range 14 to 83), and 41 (44.1%) patients were nullipara. The most common chief complaint was palpable mass (39.8%) and asymptomatic cases were presented in 23 patients (24.7%). The cases of elevated serum CA125 (< or =35 IU/ml) were 25.8% in mucinous type and 61.9% in serous type. Surgical staging was completed in 57 cases and other 36 cases were incompletely staged. 45 cases were managed by conservative surgery. There were 4 cases with recurrence, and all of them were related to conservative surgery. Chemotherapy was given to 40 cases. Mean follow-up period was 27.3 months. One patient expired during follow-up, and overall 5-year survival rate was 95.2%. CONCLUSION: Borderline ovarian tumors have a good prognosis. But recurrence rate was high in conservative surgery. In conclusion, careful preoperative evaluations, complete surgical exploration and long-term follow-up after treatment are needed.

A case of Pseudo-Meigs' syndrome with Brenner tumor / 부인종양

Meigs' syndrome is defined by the presence of ascites and hydrothorax in association with an ovarian fibroma, which spontaneously resolve soon after the removal of the tumor. Pseudo-Meigs' syndrome is rare syndrome associated with struma ovarii, yolk sac tumor, ovarian carcinoma, leiomyoma, Brenner tumor and tuberculosis which is combined with the same clinical feature. The cause and pathophysiology of Pseudo-Meigs' syndrome are uncertain. The diagnosis is done by characteristic clinical finding. We present a case of Pseudo-Meigs' syndrome with Brenner tumor with brief review of the literatures.

A case of Pseudo-Meigs' syndrome with Brenner tumor / 부인종양

Meigs' syndrome is defined by the presence of ascites and hydrothorax in association with an ovarian fibroma, which spontaneously resolve soon after the removal of the tumor. Pseudo-Meigs' syndrome is rare syndrome associated with struma ovarii, yolk sac tumor, ovarian carcinoma, leiomyoma, Brenner tumor and tuberculosis which is combined with the same clinical feature. The cause and pathophysiology of Pseudo-Meigs' syndrome are uncertain. The diagnosis is done by characteristic clinical finding. We present a case of Pseudo-Meigs' syndrome with Brenner tumor with brief review of the literatures.

Malignant Brenner tumour--a case report.

Malignant Brenner tumour is a rare pathological entity. Apart from identification of typical benign, metaplastic and/or proliferating components, stromal invasion must be observed for diagnosis of Brenner tumour. A case of malignant Brenner tumour is described along with a brief review of strict criteria of diagnosis and its biological behaviour.

Presurgical cytologic diagnostic test of uterine cavity in ovarian malignant tumor.

There are several methods for diagnosing ovarian carcinoma, such as gynecological examination, ultrasonographic examination, and tumor marker examination. However, all these combinations have not yielded high specificity antl sensitivity results. For this reason, it is necessary to perform other examinations to enhance both specificity and sensitivity, and one of them which is of interest to be studied is cytological examination of uterine cavity. By cytological examination of uterine cavity, it is hope that malignant cells originating from ovarian malignant tumor can be found. Discovery of ovarian malignant cells is possible because of peristaltic mechanism in the fallopian tube and negative pressure from uterine cavity, that makes possible the transportation of ovarian malignant cells into uterine cavity through the tube. The objective of this study is to understand the sensitiviry and specificity of cytological examination of uterine cavity in detecting ovarian malignancy. This stucty was a diagnostic test with histological examination as the gold standard, to understand sensitivity, specificity, positive prediction value, and negative prediction value of cytological examination of uterine cavity. A total of 30 cases were included in the study. A nurnber of factors enhanced positive results in cytology of uterine cavity. Those factors were stage and ascites. The more advanced the stage, the greater the positive results, and the presence of ascites increased positive results. On diagnostic test, sensitivity of uterine cavity cytology was 48%, specificity 60, positive predictive value 85.7%, and negative predictive value 18.8% respectively. In conclusion, cytological examination of uterine cavity could be used as one of the methods in assistirtg the diagnosis of ovarian carcinoma.

A Case of Pseudo-Meigs' Syndrome with Elevated Serum CA 125 levels / 대한산부인과학회지

Meigs' syndrome is defined by the presence of ascites and hydrothorax in association with an ovarian fibroma, which spontaneously resolve soon after the removal of the tumor. Pseudo-Meigs' syndrome refers to the same clinical features associated with other ovarian tumors; thecoma, granulosa cell tumor, Brenner tumor, struma ovarii, etc. Elevated serum CA 125 levels have a strong correlation with ovarian malignancy, but several benign ovarian tumors have been found to cause a rise in CA 125 levels. We present a case of Pseudo-Meigs' syndrome with an elevated CA 125 resulting from thecoma with a brief review of the literatures.

Establishment of a novel malignant Brenner tumer cell line / 대한산부인과학회지

OBJECTIVE: Ovarian cancer is the most lethal disease among gynecologic malignancies. Although many efforts have been made to explore the mechanisms involved in its development, the genetic events in the pathogenesis of ovarian cancer are still unclear. We characterized a cell line (designated OHK) established from a malignant Brenner tumor cell. METHODS: The cells were obtained during the operation of a 43-year-old Korean woman with ovarian cancer. The OHK cells continuously propagated in vitro over a period of about 36 months and, to date, have undergone over 200 passages, without being infected by either Mycoplasma or any bacteria. We measured the doubling time of OHK cells. To investigate the tumorigenecity of OHK, cells were inoculated subcutaneously into the back of nude mice. Several tumor markers were analyzed using culture media and lysates of cytosol. Morphology and ultrastructure were analyzed by phase-contrast microscopy and electron microscopy. OHK was also analyzed for gene mutation, the typing of human leukocyte antigen and Flow cytometric cell cycle analysis and DNA index. RESULTS: They proliferated in a monolayered sheet showing a pavement-like arrangement without suppression by intercellular contacts. They also formed epithelial cell lining in shapes of polymorphism and polygons. Doubling time was 38.4 hour which was relatively slow compared to other cancer cells. Microscopic view revealed intranuclear infoldings which are typical in malignant Brenner tumors. The OHK cells secreted significantly high level of CA 125 into the culture medium. A 215th codon at exon 4 of p53 was mutated to C/C in OHK. BRCA 1 was a wild type and polymorphisms were detected in exons 2, 10, 11, 14 and 17 of BRCA 2. The cells showed aneuploidy with DNA index of 1.589 measured by flow cytometry. When transplanted into nude mice, OHK cells successfully induced tumor which was histopathologically resembled malignant Brenner tumor. CONCLUSION: These results strongly suggest that OHK is a typical cell line of malignant Brenner tumor. This may provide a useful cellular resource for studying the pathogenesis of malignant Brenner tumor.

A Case of Pure Primary Squamous Cell Carcinoma of the Ovary / 대한산부인과학회지

The squamous cell carcinoma of ovary is very rare in the ovarian malignancy. The majority of squamous cell carcinomas of ovary are considered to be associated with mature cystic teratoma, Brenner tumor and malignant degenerated endometriosis. Therefore, pure ovarian squamous cell carcinoma is extremely rare. The pathogenesis, prognosis and proper treatment guideline of this malignancy are still unknown, because of it's rarity. Recently we experienced a case of primary squamous cell carcinoma without previously commented disease condition. After nearby cytoreductive surgery, postoperative chemotherapy with radiotherapy has been undergoing. We report this malignancy with a brief review of literature.