Proliferative and malignant Brenner tumours (BT) and their differentiation from metastatic transitional cell carcinoma of the bladder: a case report and review of the literature

Transitional Cell Carcinoma of the Renal Pelvis With Symptomatic Ovarian Metastases

A 39-year-old woman underwent nephrectomy and ureterectomy for a transitional cell carcinoma involving the right renal pelvis and upper ureter. Four years later, the patient complained of vaginal spotting and abdominal pain. Bilateral adnexal masses were palpable on pelvic examination and a hysterectomy with bilateral salpingo oophorectomy was performed. The ovaries were both replaced by multicystic neo plasms measuring 10 and 12 cm in maximum dimension. Microscopic examination showed cysts lined by transitional cells, and nests of transitional cells permeated the intervening stroma. Prominent lymphatic and vascular invasion was also present. Tumor also filled the lumens of both fallopian tubes. Although only limited superficial invasion was demonstrated in the nephrectomy specimen, the features of the case strongly suggest that the ovarian tumors represent metastases from the transitional cell carcinoma of the renal pelvis. This represents only the third well documented case of clinically significant ovarian spread of this tumor. Problems that may be encountered in distinguishing between metastasis and an independent primary transitional cell ovarian tumor, (proliferative or malignant Brenner tumor, transitional cell carcinoma) are discussed. Int J Surg Pathol 2(3):231-236, 1995

[Malignant Brenner tumor with very good response after chemotherapy: about a case and review of the literature]

La tumeur de Brenner est une lésion ovarienne rare représentant 1 à 2% de l'ensemble des tumeurs ovariennes. Elle a été décrite pour la première fois par MacNaughton-Jones en 1898. La tumeur de Brenner maligne est une variante exceptionnelle survenant dans 2 à 5% des cas de tumeurs de Brenner. Nous proposons de discuter à partir d'une observation clinique de tumeur de Brenner maligne diagnostiquée chez une patiente de 47 ans traitée par chimiothérapie puis chirurgie radicale, et à travers une revue de la littérature; les différentes particularités cliniques et anatomo-pathologiques de cette entité rare ainsi que leurs implications diagnostiques et thérapeutiques. Le traitement repose principalement sur la chirurgie. L'indication d'une chimiothérapie adjuvante ou néo-adjuvante reste controversée.

Metastatic intestinal carcinomas simulating primary ovarian clear cell carcinoma and secretory endometrioid carcinoma: a clinicopathologic and immunohistochemical study of five cases

Five cases of ovarian metastases of intestinal adenocarcinomas that suggested the diagnosis of clear cell adenocarcinoma or the secretory variant of endometrioid carcinoma of the ovary are reported. Patient age ranged from 27 to 71 years at the time of diagnosis of the ovarian neoplasms. In four, the ovarian and intestinal tumors were discovered synchronously, and, in the fifth, the ovarian metastasis occurred 1 year after the intestinal primary was diagnosed. The ovarian tumors were unilateral in three patients and bilateral in two. They were up to 18 cm (mean, 12 cm) in maximum dimension and were characterized on microscopic evaluation by glands and cysts lined by cells whose most striking feature was abundant clear cytoplasm. In two cases, striking subnuclear or supranuclear vacuoles were present. An important clue to the diagnosis of metastatic intestinal adenocarcinoma was the presence in all cases of "dirty necrosis." The metastatic nature of the ovarian tumors was supported by the immunohistochemical findings. All tumors stained were strongly positive for carcinoembryonic antigen and cytokeratin 20 and failed to stain for CA125, whereas staining for HAM56 and cytokeratin 7 was absent or only focally positive in one case each. Three intestinal primary tumors involved the small bowel. Microscopic evaluation of the intestinal tumors in three cases and metastases in a fourth, in which the intestinal primary was not resected, showed the features of the uncommon clear cell variant of intestinal adenocarcinoma; the fifth was predominantly a conventional intestinal adenocarcinoma with only a focal clear cell component. Although intestinal adenocarcinomas metastatic in the ovary typically simulate endometrioid adenocarcinoma of the usual type or mucinous adenocarcinoma, they may mimic either primary clear cell adenocarcinoma or the secretory variant of endometrioid adenocarcinoma, particularly when the primary tumor is, even focally, the clear cell variant of intestinal adenocarcinoma.

Ovarian metastases from cervical carcinomas other than pure adenocarcinomas. A report of 12 cases

Twelve cases of ovarian metastases from cervical carcinomas, most with clinical manifestations of ovarian involvement, are reported. The patients were 23-73 years of age (average, 43 years). The ovarian and cervical tumors were synchronous in eight patients; in three, ovarian tumors were discovered 10 months, 2.5, and 3 years after the detection of a cervical neoplasm. In one patient, the cervical tumor was not discovered until autopsy 7 months after presentation. Four patients had abdominal swelling or distention, three had vaginal bleeding, three had an abnormal Papanicolaou smear, and two had masses discovered during pelvic examination. The ovarian tumors, six of which were bilateral, ranged from 5-17 cm (average, 9.5 cm) in maximal dimension in 11 patients; in the 12th patient, the involved ovary was not enlarged. The cervical tumors were grossly evident in 10 patients. They were usually deeply invasive, often with extracervical extension. Four were squamous cell carcinomas; two, small cell carcinomas; one, a mixed small cell carcinoma and adenocarcinoma; one, a mixed poorly differentiated carcinoid and adenocarcinoma; two, adenosquamous carcinomas; one, a transitional cell carcinoma; and one, an undifferentiated carcinoma. Various features, including bilaterality of the ovarian tumors, the finding that the histologic features of the ovarian tumors typically were unusual for a primary ovarian neoplasm, and the presence of extensive extracervical disease, led to the conclusion that the ovarian tumors were metastatic from the cervix. Although ovarian metastases of cervical carcinoma are uncommon, this series illustrates that, occasionally striking examples with clinical manifestations of ovarian involvement occur.

Transitional cell carcinoma of the renal pelvis with ovarian metastasis

This article describes the first reported case of a primary transitional cell carcinoma of the renal pelvis metastatic to the ovary. The clinical presentation in our patient was similar to that of a primary ovarian carcinoma. The differential diagnosis of a primary or metastatic transitional cell carcinoma in the ovary is important and has therapeutic as well as prognostic implications.