Ovarian Brenner Tumors Revisited: Do We Have Space for Malignant Tumorsvand Methanol

Open access


We present a case of a 75-year-old female who underwent a total abdominal hysterectomy with bilateral salpingooophorectomy for an ovarian tumor. Hematoxylin-eosin- stained slides from tumor specimen revealed 1) focci of benign Brenner tumor; 2) mucinous cysts and 3) intracystic papillary projections resembling low-grade papillary transitional cell carcinoma (Grade 1-2) with squamous differentiation and comedo-type necrosis; 4) focal areas resembling noninvasive papillary transitional cell carcinoma Grade 3. Immunohistochemical investigation with a panel of antibodies (p63, p53, Ki-67, Wilms Tumor 1 - WT1, pi 6) was initiated. Areas resembling urothelial carcinoma showed diffuse nuclear positive reaction for p63 and wild-type expression of p53. Ki-67-nuclear positivity varied from less than 5% up to 30% in areas resembling high-grade urothelial carcinoma. WT1 expression was not seen. Weak but still exceeding background staining was observed in predominantly cytoplasmic fashion with few scattered positive nuclei in transitional cell nest of the benign component. No reactivity, however, was seen within the proliferative component. The histopathological diagnosis was a borderline/atypical proliferative Brenner tumor.

The patient has been regularly followed up and is at present disease-free 5 years after diagnosis. In this paper, the authors describe the morphological characteristics of Brenner tumors and address some debatable issues in the light of recent immunohistochemical and molecular studies.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • 1. Kurman RJ Carcangiu ML Herrington CS Young RH editors. Tumors of the ovary. In: WHO classification of tumors of female reproductive organs. Lyon: IARC; 2014. p. 11-86.

  • 2. Austin RM Norris HJ. Malignant Brenner tumor and transitional cell carcinoma of the ovary: a comparison. Int J Gynecol Pathol. 1987;6(1) 29-39.

  • 3. Riedel I Czemobilsky B Lifechitz-Mercer B Roth LM Wu XR Sun TT et al. Brenner tumors but not transitional cell carcinomas of the ovary show urothelial differentiation: immunohistochemical staining of urothelial markers including cytokeratins and uroplakins. Virchows Arch. 2001 ;438(2): 181-91.

  • 4. Logani S Oliva EAmin MB FolpeAL Cohen C Young Rh. Immunoprohile ofovarian tumors with putative transitional cell urothelial differentiation using novel urothelial markers: histogenetic and diagnostic implications. Am J Surg Pathol. 2003;27:1434-41.

  • 5. Eichhom JH Young RH. Transitional cell carcinoma of the ovary: a morphologic study of 100 cases with emphasis on differential diagnosis. Am J Surg Pathol. 2004;28:453-63.

  • 6. Liao XY Xue WC Shen DH Ngan HY Siu MK Cheung AN. P63 expression in ovarian tumours: a marker for Brenner tumours but not transitional cell carcinomas. Histopathology. 2007;51(4):477-83.

  • 7. Cuatrecasas M Catasus L Palacios J Prat J. Transitional cell tumors of the ovary: a comperative clinicopath o 1 ogical immunohistochemical and molecular genetic analysis of Brenner tumors and transitional cell carcinomas. Am J Surg Pathol. 2009;33:556-67.

  • 8. Ali RH Seidman JD Luk M Kalloger S Gilks CB. Transitional cell carcinoma of the ovary is related to high-grade serous carcinoma and is distinct from malignant brenner tumor. Int J Gynecol Pathol. 2012;31 (6):499-506.

  • 9. KuhnEAyhan A ShihIM Seidman JD Kurman RJ. The pathogenesis of atypical proliferative Brenner tumor: an immunohistochemical and molecular genetic analysis. Mod Pathol. 2014;27(2):231-7.

  • 10. MacNaughton-Jones H. Uterine fibroid with anomalous ovarian tumor. Trans Obstet Soc Lond. 1898;40:154-9.

  • 11. Brenner F. Das Oophoroma folliculaire. Frankfurt ZPathol. 1907;1:150-71.

  • 12. von Numers C. Contribution to the case knowledge and histology of the Brenner tumor. Do malignant forms of the Brenner tumor also occur? Acta Obstet Gynecol Scan. 1945;25(Suppl 2): 114-27.

  • 13. Roth LM Sternberg WH. Proliferating Brenner tumors. Cancer. 1971;27:687-93.

  • 14. Halgrimsson J Scully RE. Borderline and malignant Brenner tumors of the ovary. A report of 15 cases. Acta Pathol Microbiol Immunol Scand. 1972;80(Section A Suppl 233):56-66.

  • 15. Roth LM Dallenbach-Hellweg G Czemobilsky B. Ovarian Brenner tumors. I. Metaplastic proliferating and low malignant potential. Cancer. 1985;56:582-91.

  • 16. Roth LM Czemobilsky B. Ovarian Brenner tumors. II. Malignant. Cancer. 1985;56:592-601.

  • 17. Kurman RJ Shih IM. The origin and pathogenesis of epithelial ovarian cancer: a proposed unifying theory. Am J Surg Pathol. 2010;34:433-43.

  • 18. Kuhn E Ayhan A Shih IM Seidman JD Kurman RJ. Ovarian Brenner tumour a morphologic and immunohistochemical analysis suggesting an origin from fallopian tube epithelium. Eur J Cancer. 2013;49(18):3839^9.

  • 19. Seidman JD Khedmati F. Exploring the histogenesis of ovarian mucinous and transitional cell (Brenner) neoplasms and their relationship with Walthard cell nests: a study of 120 tumors. Arch Pathol Lab Med. 2008; 132:1753-60.

  • 20. Gordon A. Intestinal metaplasiaoftheurinary tract epithelium. J Pathol Bacteriol. 1963 ;85:441 -44.

  • 21. Pejovic T Burki N Odunsi K Fiedler P Achong N Schwartz PE et al. Well-differentiated mucinous carcinoma ofthe ovary and a coexisting Brenner tumor both exhibit amplification of 12q 14-21 by comparative genomic hybridization. Gynecol Oncol. 1999;74:134-7.

Journal information
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 317 96 1
PDF Downloads 122 44 0