Transitional Cell (Brenner) Tumor

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Chapter 143 Transitional Cell (Brenner) Tumor

INTRODUCTION

Description: A transitional cell (Brenner) tumor is an epithelial tumor that is made up of cells that resemble urothelium and Walthard’s cell nests, intermixed with the ovarian stroma. Most are benign.
Prevalence: One percent to 3% of ovarian tumors.
Predominant Age: 40 to 80, average 50.
Genetics: No genetic pattern.

ETIOLOGY AND PATHOGENESIS

Causes: Unknown. Most are derived from ovarian surface epithelium that undergoes metaplasia to form the typical urothelial-like components.
Risk Factors: None known.

CLINICAL CHARACTERISTICS

Signs and Symptoms

• Asymptomatic (often an incidental finding after oophorectomy)
• Adnexal mass, generally solid, most smaller than 2 cm, bilateral in 6% (unilateral lesions are more common in the left ovary)
• Abdominal pain and swelling, with abnormal uterine bleeding (20%) if malignant disease (malignant masses are more likely to be large [10 to 30 cm] and contain cystic areas; when the ovary is palpably enlarged, the risk of malignancy is approximately 5%)

DIAGNOSTIC APPROACH

Differential Diagnosis

• Thecoma (fibroma)
• Stromal and germ cell tumors
• Endometrioma
• Benign cystic teratoma
• Serous or mucinous cystadenoma
• Metastatic tumors
• Pedunculated leiomyomata

Associated Conditions: Malignant tumors are associated with endometrial hyperplasia.

WORKUP AND EVALUATION

Laboratory: No specific evaluation indicated.
Imaging: No imaging indicated. Ultrasonography may be used to differentiate solid and cystic adnexal masses, but it does not establish the diagnosis.
Special Tests: None indicated.
Diagnostic Tests: Histopathologic evaluation.

Pathologic Findings

Cells that resemble transitional epithelium of the bladder and Walthard’s cells of the ovary with abundant stroma. The cut surface of the tumor is generally whorled or lobulated. The nests of cells often demonstrate nuclei with obvious nucleoli-containing longitudinal grooves, giving them a “coffee-bean” appearance. Atypia and mitoses are rare. Occasionally, small transitional cell tumors may be found in the walls of otherwise-typical mucinous cystademonas. Atypical or malignant forms may be associated with similar bladder tumors.

MANAGEMENT AND THERAPY

Nonpharmacologic

General Measures: Evaluation and diagnosis.
Specific Measures: Simple surgical excision. When changes associated with borderline malignant potential are present, bilateral oophorectomy with hysterectomy is sufficient, and unilateral oophorectomy may be considered in younger patients.
Diet: No specific dietary changes indicated.
Activity: No restriction.
Patient Education: Reassurance; American College of Obstetricians and Gynecologists Patient Education Pamphlet AP075 (Ovarian Cysts), AP096 (Cancer of the Ovary).

Drug(s) of Choice

None.

FOLLOW-UP

Patient Monitoring: Normal health maintenance.
Prevention/Avoidance: None.
Possible Complications: The rare malignant form has a poor prognosis despite surgical therapy. Chemotherapy has not been proved to be effective.
Expected Outcome: Most Brenner tumors are benign and are cured by simple oophorectomy.

MISCELLANEOUS

Pregnancy Considerations: No effect on pregnancy.
ICD-9-CM Codes: 220, 236.2 (Borderline or proliferative), 183.0 (Malignant).

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REFERENCES

Level II

de Lima GR, de Lima OA, Baracat EC, et al. Virilizing Brenner tumor of the ovary: case report. Obstet Gynecol. 1989;73:895.

Rufford BD, Jacobs IJ, Menon U. Feasibility of screening for ovarian cancer using symptoms as selection criteria. BJOG. 2007;114:59.

Silverberg SG. Brenner tumor of the ovary. A clinicopathologic study of 60 tumors in 54 women. Cancer. 1971;28:588.

Yang DM, Heller DS, Ganesh V, Gittens L. Brenner tumor of the ovary with extensive stromal luteinization presenting in pregnancy: report of a case and review of the literature. J Matern Fetal Neonatal Med. 2002;12:281.

Yoshida M, Obayashi C, Tachibana M, Minami R. Coexisting Brenner tumor and struma ovarii in the right ovary: case report and review of the literature. Pathol Int. 2004;54:793.

Level III

Austin RM, Norris HJ. Malignant Brenner tumors and transitional cell carcinoma of the ovary. Int J Gynecol Pathol. 1987;6:29.

Chen KT, Hoffmann KD. Malignant Brenner tumor of the ovary. J Surg Oncol. 1988;39:260.

Hampton HL, Huffman HT, Meeks GR. Extraovarian Brenner tumor. Obstet Gynecol. 1992;79:844.

Miles PA, Norris HJ. Proliferative and malignant Brenner tumors of the ovary. Cancer. 1972;30:174.

Outwater EK, Siegelman ES, Kim B, et al. Ovarian Brenner tumors: MR imaging characteristics. Magn Reson Imaging. 1998;16:1147.

Roth LM, Czernobilsky B. Ovarian Brenner tumors. II: Malignant. Cancer. 1985;56:592.

Roth LM, Dallenbach-Hellweg G, Czernobilsky B. Ovarian Brenner tumors. I: Metaplastic, proliferating and of low malignant potential. Cancer. 1985;56:582.

Roth LM, Gersell DJ, Ulbright TM. Ovarian Brenner tumors and transitional cell carcinoma: recent developments. Int J Gynecol Pathol. 1993;12:128.

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