Proliferative and malignant Brenner tumors of ovary. Report of two cases, one with Meigs' Syndrome, review of literature, and ultrastructural comparisons

Malignant Brenner tumor of the ovary: two cases of unusual histologic features of relapsed tumors

This study focused on unusual histologic features observed in 2 relapsed Brenner tumors. Case 1: A 67-year-old woman had a malignant Brenner tumor. The tumor relapsed was squamous-cell carcinoma. Case 2: A 51-year-old woman had a proliferating and malignant Brenner tumor with mucinous metaplasia. The relapsed tumor was a well-differentiated mucinous adenocarcinoma. These cases suggest that: (1) the relapsed tumor cells survived chemotherapy; and (2) the relapsed tumor cells transformed.

Age contrast in ovarian pathology

BACKGROUND. Ovarian cancer accounts for approximately 23% of all gynecologic tumors and is the most common fatal gynecologic malignancy. These tumors can occur in women of all ages, but there are differences in the histologic types during various decades of life. CONCLUSIONS. During infancy and childhood, the predominant type of neoplasms are those of germ cell origin, such as teratomas, dysgerminomas, and endodermal sinus tumors. In adults, epithelial neoplasms, or tumors that originate from the epithelium that covers the ovarian surface, are the most common, accounting for almost 85% of all neoplasms after the age of 50 years. The peak incidence of benign epithelial tumors occurs between the ages of 20 and 40 years. Young women (30 to 40 years of age) are frequently affected by the so-called "tumors of low malignant potential," which have excellent prognosis. Older women, on the other hand, usually have the most aggressive forms of ovarian cancer, present with advanced disease, and have a dismal prognosis.

Malignant Brenner tumor of the ovary

Three cases of stage III malignant Brenner tumor of the ovary in which chemotherapy or radiotherapy favorably altered the clinical courses are reported, and the literature is reviewed.

Malignant Brenner tumor with peritoneal metastasis

A case of malignant Brenner tumor with peritoneal metastasis in a 67-year-old woman was reported. The multilocular cystic tumor of right ovary was 420 g in weight, and their cystic walls were covered with multilayered tumor cells showing papillary pattern very frequently. The tumor was histologically transitional cell carcinoma with occasional glandular structures but no squamous differentiation corresponding to grade 2 or 3 urinary bladder carcinoma. The pattern of benign Brenner tumor was not identified, but there was some area of proliferating Brenner tumor. Immunohistochemically, carcinoembryonic antigen was detected in several tumor cells, especially in the intercellular spaces among them, and cytokeratin was detected only in some tumor cells. Ultrastructurally, the malignant Brenner tumor shared many common features with the benign one and also bladder tumor. Intercellular spaces with microvilli were frequently found and thought to be important for diagnosis. The morphologic criteria of this rare tumor are discussed.

Brenner tumours of the ovary: a study of the histology, immunohistochemistry and cellular DNA content in benign, borderline and malignant ovarian tumours

Brenner tumours are now generally regarded as being of ovarian epithelial origin. Most have a limited growth potential and are benign. For this reason they are usually found incidentally at hysterectomy. In common with other epithelial ovarian tumours there is a histopathological spectrum of appearances ranging from benign through borderline to invasive malignancy. In this series all 54 tumours were graded according to the degree of cytological atypia, presence of mitoses and tumour necrosis. Heterogeneity of DNA content was observed in the higher grade tumours, two of the four being diploid and two being aneuploid (all benign tumours being diploid). The presence of aneuploidy correlated with the histological features and a poor clinical prognosis. Immunohistochemical staining for keratoprotein was found to be of limited value in the diagnosis of Brenner tumours and their metastases.

Ovarian Brenner tumors. II. Malignant

In this study, nine malignant Brenner tumors were reviewed and divided into well and poorly differentiated types. To meet the criteria for malignancy, stromal invasion must be observed. A component of typical benign, metaplastic, and/or proliferating Brenner tumor should be identified. The presence of these latter elements is necessary because the malignant component is often too poorly differentiated to be identified as a Brenner tumor, and a metastatic lesion cannot otherwise be ruled out on pathologic grounds. Well-differentiated tumors often occurred in close relationship to proliferating and occasionally to metaplastic areas, and poorly differentiated ones in relationship to low malignant potential areas. The malignant component may consist of transitional cell, squamous, or undifferentiated carcinoma or an admixture of these. A component of adenocarcinoma may be associated with other malignant elements, but pure mucinous or serous adenocarcinomas would be regarded as separate neoplasms. Although the number of cases is small, the well-differentiated tumors appear to have a better prognosis than the poorly differentiated ones.

Ovarian Brenner tumors. I. Metaplastic, proliferating, and of low malignant potential

In several studies, attempts were made to establish criteria for distinguishing malignant Brenner tumors from proliferating and low malignant potential ones. Although these criteria can be applied to the majority of cases, there still exist tumors that present problems in classification. In applying the World Health Organization (WHO) criteria for Brenner tumors, the most important feature for distinguishing the intermediate forms from the malignant ones is the presence of stromal invasion in the latter. This feature has generally been considered difficult to employ because of the fundamental fibroepithelial nature of Brenner tumors, the stroma being derived from the ovarian stroma. A logical and relatively easily applicable classification of Brenner tumors is presented in this report. Although more complex than the WHO classification, it includes newly recognized variants of the Brenner tumor and avoids using the same terminology to describe different types and degrees of epithelial abnormalities. Fourteen unusual Brenner tumors were studied, intermediate between typical benign and frankly malignant ones, and were classified into 3 categories representing progressive epithelial abnormalities. These include metaplastic, proliferating, and tumors of low malignant potential. In none of these does stromal invasion occur. Each of these categories corresponds to a particular urothelial abnormality or neoplasm. Through this classification, a better understanding of the morphology and biologic behavior of unusual types of Brenner tumors can be expected.

Bilateral malignant Brenner tumor of the ovary

The clinicopathologic features of a case of malignant Brenner tumor with bilateral ovarian involvement are described. The tumor was apparently confined within the ovaries at initial laparotomy. However, multiple skeletal metastases developed 4 months later and the patient died of the disease 6 months after diagnosis.

Malignant Brenner tumor of the ovary. Electron microscopic study of a case responsive to radiation and chemotherapy

A patient with malignant Brenner tumor of the ovary is presented. The tumor responded to combined therapy with radiation plus doxorubicin + cyclophosphamide despite earlier failure on a single alkylating agent (levophenylalanine mustard). The patient next exhibited a brief response to chemotherapy with hexamethylmelamine + cyclophosphamide + amethopterin + 5-fluorouracil. The histologic findings and ultrastructure of the tumor are discussed in detail. The morphologic features are consistent with the proposed origin of Brenner tumors from coelomic epithelium through a process of secondary urothelial metaplasia.

Atypical endometrioid cystadenofibroma with Meigs' syndrome: ultrastructure and S-phase fraction

A case of an ovarian endometrioid cystadenofibroma with epithelial atypia and Meigs' syndrome is described. The patient had a large pleural effusion that resolved rapidly after extirpation of the tumor. The S-phase fraction, measured by in vitro incorporation of tritiated thymidine, was extremely low, suggesting that this unusual tumor has a limited growth potential despite its atypical features. Ultrastructurally, the epithelial component has few features described in other ovarian endometrioid tumors. The cells have deeply clefted nuclei and numerous secondary cytolysosomes, features more commonly seen in Brenner tumors; the morphologic similarities may reflect a low epithelial turnover rate. Despite a review of the literature and an analysis of the case, the authors were unable to determine the pathogenetic mechanism of Meigs' syndrome.

Bilateral malignant Brenner tumor: report of a case with ultrastructural study

An unusual case of bilateral malignant Brenner tumor with liver and omental metastases is reported. The tumor was histologically a transitional cell carcinoma comparable to a grade III bladder carcinoma. A benign component was not identified, but there were a few nests of malignant epithelial cells distributed in a dense stroma, a pattern identical to that seen in a benign Brenner tumor. Whether this represents malignant change in a previously benign focus or a well differentiated part of a de novo carcinoma is unclear. Nevertheless it is suggested that the current histologic criteria for malignant Brenner tumor be modified to exclude the requirement of an intimately associated benign Brenner tumor. Ultrastructurally the malignant Brenner tumor has many features of the benign Brenner tumor. Some features, notably the basal lamina, micropinocytotic vesicles, nd intracytoplasmic microfibrils, are herein described for the first time in a malignant Brenner tumor.

Histogenesis of Brenner tumors, I: histology and ultrastructure

The histology of 36 benign and four proliferative Brenner tumors is reviewed, and the ultrastructural features of benign Brenner tumors are described. Evidence is presented for the origin of these tumors from celomic inclusion cysts through transitional metaplasia of the cyst lining and progressive growth of branching cords of transitional epithelium. Ovarian lesions associated with the Brenner tumor are described, particularly those containing mucinous epithelia, and their significance is discussed.