Brenner tumor

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shanshan Cen, M.D. [2] Maria Fernanda Villarreal, M.D. [3]

Synonyms and Keywords: Brenner tumor of ovary; Brenner tumor of the ovary; Transitional cell tumour of the ovary; Ovarian transitional cell tumour

Overview

Brenner tumor is a uncommon benign subtype of the surface epithelial-stromal tumor of the ovary. Brenner tumor was first discovered by Fritz Brenner, a German pathologist, in 1907. The majority of Brenner tumors are most frequently found incidentally on pelvic examination or at laparotomy. The pathogenesis of Brenner tumor is characterized by epithelial proliferation without stromal invasion. Brenner tumors arise from the Walthard cell rest, which is normally involved in the supportive tissue of the Fallopian tubes. Brenner tumours account for approximately 3.2% of ovarian epithelial neoplasms. Brenner tumor is more commonly observed among post-menopausal women. The majority of patients with Brenner tumor remain asymptomatic for years. Early clinical features include pelvic fullness, and dyspareunia. On CT scan, Brenner tumor is characterized by calcifications and solid component may show mild to moderate enhancement post contrast. Surgery is the mainstay of therapy for Brenner tumor. Laparotomy in conjunction with surgical staging is the most common approach to the treatment of Brenner tumor.

Historical Perspective

  • Brenner tumor was first discovered by Fritz Brenner, a German pathologist, in 1907.

Classification

  • Brenner tumor belongs to borderline ovarian tumors.
  • Borderline ovarian tumors may be classified into 2 groups:[1]
  • Serous borderline tumors
  • Mucinous borderline tumors

Pathophysiology

  • The pathogenesis of Brenner tumor is characterized by epithelial proliferation without stromal invasion.
  • Brenner tumors arise from the Walthard cell rest, which is normally involved in the supportive tissue of the Fallopian tubes.
  • The majority of Brenner tumors are unilateral.
  • Genes involved in the pathogenesis of Brenner tumor, include EGFR, RAS, Cyclin D1, p16, Rb, and p53.
  • On gross pathology characteristic findings of Brenner tumor, include:[2]
  • Solid, well-circumscribed
  • Light yellow mass
  • The tumors can vary in size from less than 1cm to 30cm
  • May be cystic
  • On microscopic histopathological analysis characteristic findings of Brenner tumor, include:[2]
  • Nests of transitional epithelium cells
  • Coffee bean nucleus
  • Elliptical shape
  • Nuclear grooves
  • Distinct nucleoli
  • Moderate-to-abundant gray or pale cytoplasm
  • Dense fibrous stroma around nests
  • The image below demonstrates microscopic histopathological findings of Brenner tumor.

Causes

  • The most important cause of Brenner tumor is benign borderline ovarian tumor.

Differentiating Brenner Tumor from Other Diseases

  • Brenner tumor must be differentiated from other diseases that cause pelvic or abdominal pain, and dyspareunia, such as:[1]

Epidemiology and Demographics

  • Brenner tumours account for approximately 3.2% of ovarian epithelial neoplasms.[1]

Age

  • Brenner tumor is more commonly observed among patients aged 55 to 75 years old.
  • Brenner tumor is more commonly observed among post-menopausal women.

Race

  • There is no racial predilection for Brenner tumor.

Risk Factors

  • There are no risk factors for Brenner tumor.[1]

Natural History, Complications and Prognosis

  • The majority of patients with Brenner tumor remain asymptomatic for years.
  • Early clinical features include pelvic fullness, and dyspareunia.
  • If left untreated, the minority of patients with Brenner tumor may progress to develop local invasion, lymphadenopathy, ascites, or metastases.
  • Common complications of Brenner tumor include peritoneal metastases, or ovarian torsion.
  • Prognosis is generally good, and the 5-year survival rate of patients with Brenner tumor is approximately 95%

Diagnosis

Diagnostic Criteria

  • The diagnosis of Brenner tumor is made with the following criteria:[1]
  • Unilateral
  • No signs of malignant invasion
  • Histological finding of transitional cells

Symptoms

  • Brenner tumor is usually asymptomatic.
  • Symptoms of Brenner tumor may include the following:

Physical Examination

  • Patients with Brenner tumor are usually well-appearing.
  • Pelvic and abdominal examination may be remarkable for:

Laboratory Findings

  • There are no specific laboratory findings associated with Brenner tumor.
  • In some cases, laboratory findings consistent with the diagnosis and follow-up of Brenner tumor, include:[1]

Imaging Findings

  • Enhanced CT scan is the imaging modality of choice for Brenner tumor.
  • On CT scan, Brenner tumor is characterized by the following findings:
  • Calcifications
  • Solid component may show mild to moderate enhancement post contrast.
  • MRI may be helpful in the diagnosis of Brenner tumor
  • Findings on MRI suggestive of Brenner tumor, include:
  • Hypointense on T2 weighted sequences
  • On ultrasound, findings of Brenner tumor, include:[1]
  • Hypoechoic solid mass
  • Calcification

Treatment

Medical Therapy

  • There is no treatment for Brenner tumor; the mainstay of therapy is supportive care.

Surgery

  • Surgery is the mainstay of therapy for Brenner tumor.
  • Laparotomy in conjunction with surgical staging is the most common approach to the treatment of Brenner tumor.

Prevention

  • There are no primary preventive measures available for Brenner tumor.
  • Once diagnosed and successfully treated, patients with Brenner tumor are followed-up every 6 or 12 months.
  • Follow-up testing for Brenner tumor, include: ultrasound and pelvic examination.

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Brenner tumor. Wikipedia 2015. https://en.wikipedia.org/wiki/Brenner_tumour
  2. 2.0 2.1 Brenner tumor. Librepathology 2015. http://librepathology.org/wiki/index.php/Brenner_tumour

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