Ovary
Brenner tumors
Brenner tumor


Minor changes: 15 April 2021

Copyright: 2003-2021, PathologyOutlines.com, Inc.

PubMed Search: Ovarian Brenner tumor [TIAB]

Jutta Huvila, M.D.
C. Blake Gilks, M.D.
Page views in 2020: 16,916
Page views in 2021 to date: 8,170
Cite this page: Huvila J, Gilks CB. Brenner tumor. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/ovarytumorb9brenner.html. Accessed May 11th, 2021.
Definition / general
  • Tumor composed of transitional / urothelial-like epithelium, typically embedded in fibromatous stroma
  • Benign, borderline and malignant variants are recognized, based on the growth pattern and cytological features of the epithelial cells
Essential features
  • Benign Brenner tumor:
    • Adenofibromatous architecture with nests of bland transitional epithelium present within fibromatous stroma
  • Borderline Brenner tumor:
    • Papillary architecture with papillae covered by multilayered transitional epithelium
    • There is variable but usually low grade cytological atypia
  • Malignant Brenner tumor:
    • Stromal invasion by carcinoma with transitional cell features, associated with a benign or borderline Brenner tumor
ICD coding
Epidemiology
  • Brenner tumors are most common in the fifth and sixth decades but can occur across a wide age range
Sites
  • Ovary
  • Rare extraovarian Brenner tumors are reported
Pathophysiology
  • Cell of origin of Brenner tumors is controversial; they may arise from Walthard rests
Etiology
  • Unknown
Clinical features
  • Benign Brenner tumors are usually asymptomatic
  • Borderline and malignant Brenner tumors are larger and usually present with findings secondary to an adnexal mass
Diagnosis
  • Most benign Brenner tumors are an incidental finding in an ovary removed for other reasons
  • Borderline and malignant Brenner tumors are usually diagnosed at the time of removal of an adnexal mass
Radiology description
  • Nonspecific findings of a solid or solid and cystic ovarian mass
Prognostic factors
Case reports
Treatment
  • Oophorectomy
  • No adjuvant treatment for benign or borderline Brenner tumors
  • Adjuvant chemotherapy for advanced stage malignant Brenner tumors
Gross description
  • Benign Brenner tumor:
    • Small (usually < 2 cm), circumscribed, fibrous tumor with a uniform cut surface
    • Calcifications may be present
  • Borderline and malignant Brenner tumor:
    • Smooth surface, larger (usually > 10 cm) with fleshy, polypoid masses projecting into cystic cavity(s)
Gross images

Contributed by Jutta Huvila, M.D. and C. Blake Gilks, M.D. and AFIP images
Solid, uniform cut surface

Solid, uniform cut surface

Fleshy appearance

Fleshy appearance

Sharply demarcated

Fibroma-like appearance

Solid fibroma-like component and two cysts



Images hosted on other servers:
Infarcted tumor

Infarcted tumor

Frozen section description
  • Benign:
    • Adenofibromatous architecture, smooth contoured nests of bland epithelial cells within benign fibromatous stroma
  • Borderline or malignant:
Frozen section images

Contributed by Jutta Huvila, M.D. and C. Blake Gilks, M.D.
Adenofibroma

Benign Brenner tumor

Microscopic (histologic) description
  • Benign:
    • Smooth contoured nests of bland transitional epithelium within fibromatous stroma
    • Transitional cells have uniform oval nuclei and may have a longitudinal nuclear groove
    • There may be mucinous epithelium at the center of the nests, with microcyst formation
    • Ciliated or nondescript glandular epithelium may be present; a coexistent mucinous cystadenoma is present in 10% of cases
    • Calcification is common
  • Borderline:
    • Papillary architecture with papillae covered by multilayered transitional epithelium
    • There is variable cytological atypia; usually low grade but on occasion moderate or marked cytological atypia may be present
    • Benign Brenner tumor component is often present
  • Malignant:
    • Stromal invasion by carcinoma with transitional cell features, with irregular nests of cells and single cells in an infiltrative pattern
    • Squamous or mucinous differentiation may be present
    • Benign or borderline Brenner tumor component is present
  • Reference: Int J Gynecol Pathol 2012;31:499
Microscopic (histologic) images

Contributed by Jutta Huvila, M.D. and C. Blake Gilks, M.D.
Benign transitional nests

Benign transitional nests

Nuclear grooves

Nuclear grooves

Papillary architecture

Papillary architecture

Nuclear atypia

Nuclear atypia

Stromal invasion

Stromal invasion

Malignant nuclear features

Malignant nuclear features



AFIP images
Fibromatous stromal component

Fibromatous stromal component

Resembling coffee beans

Resembling coffee beans

Several lumens

Several lumens

Mucinous epithelium

Mucinous epithelium

Ciliated epithelium<

Ciliated epithelium

Negative stains
  • ER, PR, WT1 (weak / focal positivity may be seen)
  • Wild type p53 staining in benign and borderline Brenner tumors; malignant Brenner tumors may show mutant pattern staining
Sample pathology report
  • Right ovary, oophorectomy:
    • Borderline Brenner tumor (see comment)
    • Comment: This borderline Brenner tumor is associated with a component of benign Brenner tumor. Negative for invasive carcinoma.
Differential diagnosis
Board review style question #1

Which of the following is true about benign Brenner tumors of the ovary?

  1. Composed of both epithelium and fibromatous stroma
  2. Papillary architecture
  3. Typically > 10 cm
  4. Usually presents with abdominal pain
Board review style answer #1
A. Composed of both epithelium and fibromatous stroma

Comment Here

Reference: Brenner tumor
Board review style question #2
Brenner tumors of the ovary typically have which of the following immunophenotypes?

  1. GATA3 and ER positive
  2. GATA3 and p63 positive
  3. GATA3 and WT1 positive
  4. GATA3 positive and mutant pattern p53 expression
Board review style answer #2
B. GATA3 and p63 positive

Comment Here

Reference: Brenner tumor
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