A rare case of giant mucinous cystadenocarcinoma of the right ovary with metastatic deposits and Brenner tumor in the left ovary

Ovarian cancer is the second most common gynecological malignancy. Mucinous tumor accounts for 3% of ovarian tumors and is a challenging task for a surgical pathologist. Association of Brenner tumor, a subtype of epithelial malignancy is a rare entity reported in the literature. Herein, we report a unique case of a 57-years old post-menopausal woman who presented with progressive abdominal distention for 3 years and constipation for 1 year. Clinically, it was suspected as a case of complex ovarian cyst and the patient underwent staging laparotomy. Intraoperatively, a giant mucinous cystadenocarcinoma of the right ovary with deposits in the pouch of Douglas, omentum, umbilical, and the sub-umbilical region was found along with a benign Brenner tumor of the left ovary.

Tumor de Brenner maligno y embarazo. Caso clínico: revisión de la bibliografía / Malignant Brenner tumor and pregnancy. Case report: Literature review

Resumen ANTECEDENTES: La asociación del tumor de Brenner con el embarazo es excepcional: solo hay cuatro casos reportados, ninguno maligno. CASO CLÍNICO: Paciente de 33 años, con antecedente de un embarazo que finalizó mediante parto y sin contratiempos, sin antecedentes médico-quirúrgicos de interés. En la ecografía de la décima segunda semana se registró una imagen sonoluscente de paredes lisas, de 41 mm, dependiente del ovario izquierdo. Durante la cesárea se practicó la tumorectomía. El estudio histológico describió una neoplasia epitelial de células transicionales, con áreas benignas, proliferativas e infiltrativas, compatible con un tumor de Brenner maligno. Se trató con cirugía radical de cáncer de ovario y quimioterapia coadyuvante. CONCLUSIONES: Es importante tener en mente al tumor de Brenner maligno como diagnóstico de exclusión ante tumoraciones de rápido y gran crecimiento durante el embarazo. En todas las ecografías de seguimiento del embarazo es indispensable valorar los anejos.

Abstract BACKGROUND: The association between Brenner tumor and pregnancy is extremely rare. Only four well-documented cases of benign Brenner tumor during pregnancy have been reported but nonmalignant. CLINICAL CASE: A 33-year-old female patient, with a history of a pregnancy that ended in delivery and without setbacks, with no medical or surgical history of interest. In the ultrasound scan of the twelfth week, a 41 mm smooth-walled sonoluscent image was recorded in the left ovary. Lumpectomy was performed during cesarean section. Histological study described a transitional cell epithelial neoplasm, with benign, proliferative and infiltrative areas, compatible with a malignant Brenner tumor. She was treated with radical ovarian cancer surgery and adjuvant chemotherapy. CONCLUSION: It is important to keep malignant Brenner's tumor in mind as a diagnosis of exclusion in the presence of rapidly and rapidly growing tumors during pregnancy. It is very important to evaluate the appendages in all follow-up ultrasounds during pregnancy.

Bilateral Brenner tumor of ovary with associated unilateral mucinous cystadenoma: a case report

Brenner tumors are rare ovarian tumors, which are a subgroup of transitional cell tumors of ovary. Most of these tumors are benign presenting as incidental unilateral masses in postmenopausal age group. Only 5-7% cases are bilateral. These tumors are mostly small, solid and asymptomatic, seen commonly in association with mucinous cystadenomas of ovary. In such cases they may attain a massive size. Specific diagnosis of Brenner tumor is difficult using imaging studies and can be definitely diagnosed only on pathological examination. Surgical removal is usually curative for benign tumors. We present a rare case of bilateral Brenner tumor of ovary with associated unilateral mucinous cystadenoma in which bilateral Brenner tumor was a rare incidental finding on pathological examinatio

Coexistence of both Brenner tumor and cystadenofibroma of ovary in a postmenopausal woman: a rare case

Brenner tumor, and cystadeno fibroma of ovary are rare varieties of ovarian tumor, characterized by presence of solid components. There are very rare instances where both Brenner tumor and cystadenofibroma coexist in a single patient. A 48-year P1L1, postmenopusal woman presented at Guru hospital, Madurai, with chief complaints of on and off postmenopausal bleeding for 6 months. On ultrasonography there were two simple cysts of ovary measuring 6x 6 cm on left side and 4x4 cm on right side. She was managed with total laparoscopic hysterectomy and bilateral salpingoophorectomy.  Intraoperatively there was a right ovarian mass of 6x6 cm size and a left ovarian mass of 4x4 cm size. Left ovarian mass reported as benign cystadenofibroma while the right ovarian mass was reported to be brenners tumor on histopathology. As the preoperative imaging are not completely relied for diagnosing these tumors, awareness of the surgeons of these entities is particularly important. The prognosis of both of these tumors is excellent with suitable treatment. They have a very low recurrence risk on compete removal through surgery.

Benign Brenner tumor of ovary – A rare case report

Ovarian tumors are common forms of neoplasia in women and it accounts for about 30.0% of female genital cancers. Brenner tumors are subgroup of transitional cell tumors. Benign Brenner tumors are usually unilateral, small and solid. But in our case the tumor was very huge though showing all features of benign Brenner tumor on histopathological examination. For the diagnosis of benign Brenner tumor, radiological investigations are not a reliable tool. Therefore histopathological examination remains gold standard method for final diagnosis of this entity. This case report of large benign Brenner tumor is presented here because of its rarity.

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)

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 appearance of ovary Brenner tumor: Five cases report / 中国医学影像技术

Objective To observe the CT features of ovary Brenner tumor. Methods CT manifestations of 5 patients with ovary Brenner tumor confirmed with pathology and clinical follow-up were retrospectively analyzed, and the masses were described for location, size, configuration, enhancement pattern, presence of calcification and metastatic spread. Results There were 7 tumors in 5 patients, 3 patients had unilateral tumors and 2 had bilateral Brenner tumors (left side 3 and right side 4), with tumor size ranging from 1.52 to 16.25 cm (mean 7.36 cm). Five masses in 4 patients were benign, 2 (bilateral tumors in 1 patient) were malignant. All tumors had well-defined margin. One patient with bilateral benign tumors had large pleural effusion and seroperitoneum. Five tumors in 4 patients (5/7, 71.43%) were solid and had calcification, 2 tumors in 1 patients (2/7, 28.57%) were mainly cystic, with septa in the tumors. The solid part of all tumors were inhomogeneous and had mild enhancement. Conclusion CT findings of ovary Brenner tumor have some characteristics. Combining with clinical manifestations, CT is helpful for the diagnosis of ovary Brenner tumor.

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.

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 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.

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 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.

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 Transitional Cell Carcinoma of the Ovary / 대한산부인과학회잡지

Ovarian transitional cell carcinoma (TCC) resembles transitional cell carcinoma of the bladder. As a very rare type of tumor, it accounts for less than 2% of the total incidence of ovarian cancer. 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 ovarian TCC in a menopausal woman with a chief complaint of palpable pelvic mass, who underwent staging operation and platinum based (carboplatin-cyclophosphamide) chemotherapeutic treatment, and herein report the case with a brief review of related literatures.

Primary Transitional Cell carcinoma of the Ovary / 대한부인종양콜포스코피학회잡지

Primary transitional cell carcinoma of the ovary is recently recognized, as one of the main types of ovarian carcinoma. Histologically, it is distinguished from malignant Brenner tumor only in the abscence of benign or proliferative Brenner tumor component. primary transitional cell carcinomas are more aggressive than malignant Brenner tumors. However, Primary transitional cell carcinomas have a better response to chemotherapy than other types of ovarian carcinomas. We report a case of primary transitional cell carcinoma presenting as both ovarian masses that developed in a 60-year-old woman with a brief review of literature.