Difference between revisions of "Brenner tumour"

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#redirect [[Ovarian tumours#Brenner tumour]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Brenner tumour high mag cropped.jpg
| Width      =
| Caption    = Brenner tumour. [[H&E stain]].
| Synonyms  =
| Micro      = nests cells that have a "[[coffee bean nucleus]]" (nucleus = elliptical shape, nuclear groove along long axis), distinct nucleoli, moderate-to-abundant gray/pale cytoplasm, dense fibrous stroma around nests
| Subtypes  = benign (most common), borderline, malignant
| LMDDx      = [[granulosa cell tumour]], [[ovarian fibroma]], [[thecoma]], [[Walthard cell rest]]
| Stains    =
| IHC        = AR +ve, calretinin -ve
| EM        =
| Molecular  =
| IF        =
| Gross      = classically solid (may be cystic), usu. well-circumscribed, light yellow colour
| Grossing  =
| Site      = [[ovary]] (see ''[[ovarian tumours]]''), [[fallopian tube]]
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      =
| Symptoms  =
| Prevalence = uncommon
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = usu. good, may be poor
| Other      =
| ClinDDx    =
| Tx        =
}}
The '''Brenner tumour''', abbreviated '''BT''', is an [[ovarian tumour]] in the epithelial group of ovarian tumours.
 
==General==
*Considered to be rare<ref>{{Cite journal  | last1 = Bilici | first1 = A. | last2 = Inanc | first2 = M. | last3 = Ulas | first3 = A. | last4 = Akman | first4 = T. | last5 = Seker | first5 = M. | last6 = Babacan | first6 = NA. | last7 = Inal | first7 = A. | last8 = Bal | first8 = O. | last9 = Koral | first9 = L. | title = Clinical and pathologic features of patients with rare ovarian tumors: multi-center review of 167 patients by the anatolian society of medical oncology. | journal = Asian Pac J Cancer Prev | volume = 14 | issue = 11 | pages = 6493-9 | month =  | year = 2013 | doi =  | PMID = 24377556 }}</ref> - 1-2% of ovarian neoplasms.<ref>{{Cite journal  | last1 = Arnogiannaki | first1 = N. | last2 = Grigoriadis | first2 = C. | last3 = Zygouris | first3 = D. | last4 = Terzakis | first4 = E. | last5 = Sebastiadou | first5 = M. | last6 = Tserkezoglou | first6 = A. | title = Proliferative Brenner tumor of the ovary. clinicopathological study of two cases and review of the literature. | journal = Eur J Gynaecol Oncol | volume = 32 | issue = 5 | pages = 576-8 | month =  | year = 2011 | doi =  | PMID = 22053680 }}</ref>
*Traditionally, BT has been grouped within the ''transistional cell tumours'' category in the surface epithelial group of ovarian tumours.
**Recently, [[transistional cell carcinoma of the ovary]] has been related to [[serous carcinoma]]; TCC of the ovary is probably distinct from the malignant Brenner tumour.<ref>{{Cite journal  | last1 = Ali | first1 = RH. | last2 = Seidman | first2 = JD. | last3 = Luk | first3 = M. | last4 = Kalloger | first4 = S. | last5 = Gilks | first5 = CB. | title = Transitional cell carcinoma of the ovary is related to high-grade serous carcinoma and is distinct from malignant brenner tumor. | journal = Int J Gynecol Pathol | volume = 31 | issue = 6 | pages = 499-506 | month = Nov | year = 2012 | doi = 10.1097/PGP.0b013e31824d7445 | PMID = 23018212 }}</ref>
*May arise from the [[fallopian tube]].<ref name=pmid24012099>{{Cite journal  | last1 = Kuhn | first1 = E. | last2 = Ayhan | first2 = A. | last3 = Shih | first3 = IeM. | last4 = Seidman | first4 = JD. | last5 = Kurman | first5 = RJ. | title = Ovarian Brenner tumour: a morphologic and immunohistochemical analysis suggesting an origin from fallopian tube epithelium. | journal = Eur J Cancer | volume = 49 | issue = 18 | pages = 3839-49 | month = Dec | year = 2013 | doi = 10.1016/j.ejca.2013.08.011 | PMID = 24012099 }}</ref>
*Can be seen in the [[testis]].<ref name=pmid15502808>{{cite journal |author=Amin MB |title=Selected other problematic testicular and paratesticular lesions: rete testis neoplasms and pseudotumors, mesothelial lesions and secondary tumors |journal=Mod. Pathol. |volume=18 Suppl 2 |issue= |pages=S131–45 |year=2005 |month=February |pmid=15502808 |doi=10.1038/modpathol.3800314 |url=}}</ref>
 
===Epidemiology===
*Mostly benign clinical course - 99% of Brenner tumours benign.<ref name=Ref_GP437>{{Ref GP|437}}</ref>
*Thought to arise from [[Walthard cell rest]].
*Frequently an incidental finding, i.e. oophorectomy was done for another reason.
*May be malignant - rarely (~1% of Brenner tumours<ref>{{Cite journal  | last1 = Gezginç | first1 = K. | last2 = Karatayli | first2 = R. | last3 = Yazici | first3 = F. | last4 = Acar | first4 = A. | last5 = Çelik | first5 = Ç. | last6 = Çapar | first6 = M. | last7 = Tavli | first7 = L. | title = Malignant Brenner tumor of the ovary: analysis of 13 cases. | journal = Int J Clin Oncol | volume = 17 | issue = 4 | pages = 324-9 | month = Aug | year = 2012 | doi = 10.1007/s10147-011-0290-7 | PMID = 21796330 }}</ref>).
 
==Gross==
Features:<ref name=pmid21897739>{{Cite journal  | last1 = Borah | first1 = T. | last2 = Mahanta | first2 = RK. | last3 = Bora | first3 = BD. | last4 = Saikia | first4 = S. | title = Brenner tumor of ovary: An incidental finding. | journal = J Midlife Health | volume = 2 | issue = 1 | pages = 40-1 | month = Jan | year = 2011 | doi = 10.4103/0976-7800.83273 | PMID = 21897739 |PMC = 3156501}}</ref>
*Classically solid, well-circumscribed, light yellow.
*May be cystic.
 
Note:
*Borderline tumours classically solid and cystic with papillary projections into the cystic component.<ref name=pmid21897739/>
 
==Microscopic==
Features:
*Nests of transitional epithelium with cells that have:<ref name=Ref_PBoD1098>{{Ref PBoD|1098}}</ref>
**A "[[coffee bean nucleus]]".
***Elliptical shape (nucleus).
***Nuclear grooves.
***Distinct nucleoli.
**Moderate-to-abundant gray/pale cytoplasm.
*Dense fibrous stroma around nests.
 
Notes:
*Main DDx of Coffee bean nucleus = [[granulosa cell tumour]].
*Stromal component may be predominant.
 
Subclassification:
*Benign.
*Borderline.
*Malignant <5% of tumour.<ref>{{cite journal |authors=Zhang Y, Staley SA, Tucker K, Clark LH |title=Malignant Brenner tumor of the ovary: Case series and review of treatment strategies |journal=Gynecol Oncol Rep |volume=28 |issue= |pages=29–32 |date=May 2019 |pmid=30815527 |pmc=6378317 |doi=10.1016/j.gore.2019.02.003 |url=}}</ref>
 
DDx:<ref name=Ref_GP437>{{Ref GP|437}}</ref>
*Benign:
**Endometrioid adenofibroma.
**[[Ovarian fibroma]].
*Borderline:
**Benign Brenner tumour.
**Malignant Brenner tumour.
**Metastatic papillary urothelial carcinoma.
*Malignant:
**Undifferentiated carcinoma - no Brenner tumour component.
**Granulosa cell tumour.
**Serous carcinoma.
**Metastatic urothelial carcinoma.
*[[Walthard cell rest]] - typically one nest of cells, lacks the surrounding fibromatous stroma.
 
===Images===
<gallery>
Image:Brenner tumour high mag cropped.jpg | BT - cropped - high mag. (WC)
Image:Brenner tumour high mag.jpg | BT - high mag. (WC)
Image:Brenner tumour intermed mag.jpg | BT - intermed. mag. (WC)
</gallery>
 
==IHC==
Features:<ref name=pmid24012099>{{Cite journal  | last1 = Kuhn | first1 = E. | last2 = Ayhan | first2 = A. | last3 = Shih | first3 = IeM. | last4 = Seidman | first4 = JD. | last5 = Kurman | first5 = RJ. | title = Ovarian Brenner tumour: a morphologic and immunohistochemical analysis suggesting an origin from fallopian tube epithelium. | journal = Eur J Cancer | volume = 49 | issue = 18 | pages = 3839-49 | month = Dec | year = 2013 | doi = 10.1016/j.ejca.2013.08.011 | PMID = 24012099 }}</ref>
*[[Androgen receptor|AR]] +ve.
*Calretinin -ve.
**Surrounding stroma +ve.
*Inhibin +ve.<ref name=pmid24012099>{{Cite journal  | last1 = Kuhn | first1 = E. | last2 = Ayhan | first2 = A. | last3 = Shih | first3 = IeM. | last4 = Seidman | first4 = JD. | last5 = Kurman | first5 = RJ. | title = Ovarian Brenner tumour: a morphologic and immunohistochemical analysis suggesting an origin from fallopian tube epithelium. | journal = Eur J Cancer | volume = 49 | issue = 18 | pages = 3839-49 | month = Dec | year = 2013 | doi = 10.1016/j.ejca.2013.08.011 | PMID = 24012099 }}</ref>
 
==See also==
*[[Ovarian tumours]].
*[[Walthard cell rest]].
*[[Testis]].
 
==References==
{{Reflist|2}}
 
[[Category:Ovarian tumours]]
[[Category:Diagnosis]]

Latest revision as of 18:21, 31 October 2024

Brenner tumour
Diagnosis in short

Brenner tumour. H&E stain.
LM nests cells that have a "coffee bean nucleus" (nucleus = elliptical shape, nuclear groove along long axis), distinct nucleoli, moderate-to-abundant gray/pale cytoplasm, dense fibrous stroma around nests
Subtypes benign (most common), borderline, malignant
LM DDx granulosa cell tumour, ovarian fibroma, thecoma, Walthard cell rest
IHC AR +ve, calretinin -ve
Gross classically solid (may be cystic), usu. well-circumscribed, light yellow colour
Site ovary (see ovarian tumours), fallopian tube
Prevalence uncommon
Prognosis usu. good, may be poor

The Brenner tumour, abbreviated BT, is an ovarian tumour in the epithelial group of ovarian tumours.

General

Epidemiology

  • Mostly benign clinical course - 99% of Brenner tumours benign.[6]
  • Thought to arise from Walthard cell rest.
  • Frequently an incidental finding, i.e. oophorectomy was done for another reason.
  • May be malignant - rarely (~1% of Brenner tumours[7]).

Gross

Features:[8]

  • Classically solid, well-circumscribed, light yellow.
  • May be cystic.

Note:

  • Borderline tumours classically solid and cystic with papillary projections into the cystic component.[8]

Microscopic

Features:

  • Nests of transitional epithelium with cells that have:[9]
    • A "coffee bean nucleus".
      • Elliptical shape (nucleus).
      • Nuclear grooves.
      • Distinct nucleoli.
    • Moderate-to-abundant gray/pale cytoplasm.
  • Dense fibrous stroma around nests.

Notes:

Subclassification:

  • Benign.
  • Borderline.
  • Malignant <5% of tumour.[10]

DDx:[6]

  • Benign:
  • Borderline:
    • Benign Brenner tumour.
    • Malignant Brenner tumour.
    • Metastatic papillary urothelial carcinoma.
  • Malignant:
    • Undifferentiated carcinoma - no Brenner tumour component.
    • Granulosa cell tumour.
    • Serous carcinoma.
    • Metastatic urothelial carcinoma.
  • Walthard cell rest - typically one nest of cells, lacks the surrounding fibromatous stroma.

Images

  • BT - cropped - high mag. (WC)

  • BT - high mag. (WC)

  • BT - intermed. mag. (WC)

IHC

Features:[4]

  • AR +ve.
  • Calretinin -ve.
    • Surrounding stroma +ve.
  • Inhibin +ve.[4]

See also

References

  1. ↑ Bilici, A.; Inanc, M.; Ulas, A.; Akman, T.; Seker, M.; Babacan, NA.; Inal, A.; Bal, O. et al. (2013). "Clinical and pathologic features of patients with rare ovarian tumors: multi-center review of 167 patients by the anatolian society of medical oncology.". Asian Pac J Cancer Prev 14 (11): 6493-9. PMID 24377556.
  2. ↑ Arnogiannaki, N.; Grigoriadis, C.; Zygouris, D.; Terzakis, E.; Sebastiadou, M.; Tserkezoglou, A. (2011). "Proliferative Brenner tumor of the ovary. clinicopathological study of two cases and review of the literature.". Eur J Gynaecol Oncol 32 (5): 576-8. PMID 22053680.
  3. ↑ Ali, RH.; Seidman, JD.; Luk, M.; Kalloger, S.; Gilks, CB. (Nov 2012). "Transitional cell carcinoma of the ovary is related to high-grade serous carcinoma and is distinct from malignant brenner tumor.". Int J Gynecol Pathol 31 (6): 499-506. doi:10.1097/PGP.0b013e31824d7445. PMID 23018212.
  4. ↑ 4.0 4.1 4.2 Kuhn, E.; Ayhan, A.; Shih, IeM.; Seidman, JD.; Kurman, RJ. (Dec 2013). "Ovarian Brenner tumour: a morphologic and immunohistochemical analysis suggesting an origin from fallopian tube epithelium.". Eur J Cancer 49 (18): 3839-49. doi:10.1016/j.ejca.2013.08.011. PMID 24012099.
  5. ↑ Amin MB (February 2005). "Selected other problematic testicular and paratesticular lesions: rete testis neoplasms and pseudotumors, mesothelial lesions and secondary tumors". Mod. Pathol. 18 Suppl 2: S131–45. doi:10.1038/modpathol.3800314. PMID 15502808.
  6. ↑ 6.0 6.1 Nucci, Marisa R.; Oliva, Esther (2009). Gynecologic Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 437. ISBN 978-0443069208.
  7. ↑ Gezginç, K.; Karatayli, R.; Yazici, F.; Acar, A.; Çelik, Ç.; Çapar, M.; Tavli, L. (Aug 2012). "Malignant Brenner tumor of the ovary: analysis of 13 cases.". Int J Clin Oncol 17 (4): 324-9. doi:10.1007/s10147-011-0290-7. PMID 21796330.
  8. ↑ 8.0 8.1 Borah, T.; Mahanta, RK.; Bora, BD.; Saikia, S. (Jan 2011). "Brenner tumor of ovary: An incidental finding.". J Midlife Health 2 (1): 40-1. doi:10.4103/0976-7800.83273. PMC 3156501. PMID 21897739. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3156501/.
  9. ↑ Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 1098. ISBN 0-7216-0187-1.
  10. ↑ Zhang Y, Staley SA, Tucker K, Clark LH (May 2019). "Malignant Brenner tumor of the ovary: Case series and review of treatment strategies". Gynecol Oncol Rep 28: 29–32. doi:10.1016/j.gore.2019.02.003. PMC 6378317. PMID 30815527. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6378317/.
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