Comparison of performance between O-RADS, IOTA simple rules risk assessment and ADNEX model in the discrimination of ovarian Brenner tumors.

PURPOSE: To describe the clinical and sonographic features of ovarian benign Brenner tumor (BBT) and malignant Brenner tumor (MBT), and to compare performance of four diagnostic models in differentiating them. METHODS: Fifteen patients with BBTs and nine patients with MBTs were retrospectively identified in our institution from January 2003 and December 2021. One ultrasound examiner categorized each mass according to ovarian-adnexal reporting and data system (O-RADS), international ovarian tumor analysis (IOTA) Simple Rules Risk (SR-Risk) assessment and assessment of different neoplasias in the adnexa (ADNEX) models with/without CA125. Receiver operating characteristic curves were generated to compare diagnostic performance. RESULTS: Patients with MBT had higher CA125 serum level (62.5% vs. 6.7%, P = 0.009) and larger maximum diameter of lesion (89 mm vs. 43 mm, P = 0.009) than did those with BBT. BBT tended to have higher prevalence of calcifications (100% vs. 55.6%, P = 0.012) and acoustic shadowing (93.3% vs. 33.3%, P = 0.004), and lower color scores manifesting none or minimal flow (100.0% vs. 22.2%, P < 0.001). Areas under curves of O-RADS, IOTA SR-Risk and ADNEX models with/without CA125 were 0.896, 0.913, 0.892 and 0.896, respectively. There were no significant differences between them. CONCLUSION: BBTs are often small solid tumors with sparse color Doppler signals, which contain calcifications with posterior acoustic shadowing. The most common pattern of MBT is a large multilocular-solid or solid mass with irregular tumor borders, and most were moderately or richly vascularized at color Doppler. These four models have excellent performance in distinguishing them.

Brenner tumors.

Brenner tumors are rare ovarian neoplasms composed of ovarian transition cells surrounded by dense fibrous tissue. Most of them are small tumors (<2 cm), detected incidentally in asymptomatic women. Its predominantly fibrous content results in relatively low signal on T2 weighted images, establishing differential diagnosis with ovarian fibroma and thecoma. Their imaging features are very similar, the differentiation is based on secondary characteristics, such as signs or symptoms of estrogen excess and the presence of a second ovarian neoplasm, which has been reported in up to 30% of patients with Brenner tumor. Although originally thought to be universally benign, there have been scattered reports in the past decades of borderline and malignant forms of Brenner tumors.

Benign Brenner tumour of the ovary: CT and MRI features.

AIM: To evaluate the computed tomography (CT) and magnetic resonance imaging (MRI) features of benign Brenner tumours (BBT) of the ovary. MATERIAL AND METHODS: This was a retrospective two-centre study comprising 35 female patients with a definitive diagnosis of BBT at histology in whom CT and/or MRI examinations had been performed. Two experienced radiologists reviewed the CT and MRI features of 39 ovarian BBT retrospectively with consensus reading. The morphological appearance and size of each tumour were recorded. The presence or absence of calcifications within the solid portion was noted at CT. The reviewed characteristics at MRI included qualitative assessment of the signal intensity of the solid portion on diffusion sequence and contrast enhancement, compared to that of the myometrium. RESULTS: CT and MRI images were available for 27 and 28 lesions, respectively. Sixteen patients had both CT and MRI examinations. BBT were unilateral in 89% of patients, and 49% of lesions were solid and 51% were mixed. Calcifications were depicted at CT in 70.4% of lesions. When present, the cystic portion was multilocular in 85% of cases and corresponded to a mucinous lesion in 74% of cases. Enhancement of the solid portion at MRI was inferior or equal to that of the myometrium in 89% of cases and signal on high b-values diffusion images was deemed low or moderate in 93% of cases. CONCLUSION: The combined CT and MRI findings of a unilateral fibrous ovarian mass containing punctate calcifications often associated with a multilocular cyst suggest the diagnosis of ovarian BBT.

Mucinous Neoplasms of the Ovary: Radiologic-Pathologic Correlation.

Mucinous neoplasms of the ovary account for 10%-15% of ovarian neoplasms. They may be benign, borderline, or malignant. The large majority are benign or borderline, accounting for 80% and 16%-17%, respectively. Mucinous neoplasms of the ovary most commonly affect women in their 20s to 40s. The clinical manifestation is nonspecific, but most mucinous ovarian neoplasms manifest as large unilateral pelvic masses. At gross pathologic analysis, mucinous ovarian neoplasms appear as large multiloculated cystic masses. The contents of the cyst loculi vary on the basis of differences in internal mucin content. At histologic analysis, mucinous ovarian neoplasms are composed of multiple cysts lined by mucinous epithelium, often resembling gastrointestinal-type epithelium. Imaging evaluation most commonly includes US and/or MRI. The imaging findings parallel the gross pathologic features and include a large, unilateral, multiloculated cystic mass. The cyst loculi vary in echogenicity, attenuation, and signal intensity depending on the mucin content. Mucinous neoplasms of the ovary are staged surgically using the FIGO (International Federation of Gynecology and Obstetrics) staging system. Primary treatment is surgical, with adjuvant chemotherapy considered in the uncommon case of mucinous carcinoma with extraovarian disease. Since most mucinous ovarian neoplasms are benign or borderline, the overall prognosis is excellent.

Brenner tumor of the ovary - ultrasound features and clinical management of a rare ovarian tumor mimicking ovarian cancer.

OBJECTIVES: To describe the ultrasound features of benign Brenner tumor in the background of complex clinical and histopathological pictures. MATERIAL AND METHODS: We retrospectively identified patients with histologically confirmed benign Brenner tumor of the ovary who were treated in our institution in 2003-2016, and for whom complete imaging, clinical, perioperative and histopathological data were available in the database. Ultrasound findings were drawn from images and reports using terms and definitions of the International Ovarian Tumor Analysis group and pattern recognition description was applied. RESULTS: Twenty-three patients were identified, most postmenopausal and asymptomatic. On ultrasound, 19/23 tumors were found unilaterally, 4/23 bilaterally, and 82% of tumors were detected in the left ovary. Most Brenner tumors (16/23) contained solid components and revealed no or minimal blood flow by subjective color score upon Doppler examination (19/23, 83%). Calcifications with shadowing were observed in 57% of all Brenner tumors and in 81% of tumors containing solid components. The complex appearance of the tumor misled the sonographers to describe the mass as malignant in 9 cases (39%), and frozen section was performed perioperatively. Surgery was performed via laparoscopy in 11 (48%) and via laparotomy in 12 (52%) cases. CONCLUSIONS: The complexity of the ultrasound picture, consisting of features like calcifications with acoustic shadowing, a poorly vascularized solid mass, and a left-sided localization could be signs of a benign Brenner tumor and could preop-eratively help to differentiate between benign and malignant tumor.

Tumor de Brenner fronterizo / Borderline Brenner Tumor

El tumor de Brenner es derivado de la superficie del ovario, que guarda similitud con epitelio transicional de la vejiga. Es un tumor raro debido a que representa 1,5 por ciento de las neoplasias de ovario. El objetivo del trabajo es presentar el caso de una paciente con tumor de Brenner fronterizo confirmado histopatológicamente y realizar una revisión de la literatura respecto al diagnóstico clínico e histopatológico de la entidad y compararla con otras entidades. Se presenta el caso de una mujer de 88 años, a quien se la practicó laparotomía por sospecha de un quiste complejo; se describe la historia clínica y su diagnóstico, y se realiza una revisión de la literatura con énfasis en el diagnóstico. Se realizó una búsqueda de literatura utilizando las bases de datos Medline, vía PubMed, OMIM y SciELO, con los términos tumor de Brenner y tumor de Brenner fronterizo en español e inglés sin límite por año de publicación. Se encontraron 10 artículos, que corresponden a reportes de casos y revisión de la literatura, los cuales describen las características en cuanto a presentación clínica, diagnóstico clínico basándose en estudios de histopatología, y aspectos genéticos de la entidad. El tumor de Brenner fronterizo es infrecuente en México debe tenerse en cuenta como diagnóstico diferencial de tumores de ovario(AU)

Brenner tumor derives from the ovary surface and is similar to the transitional epithelium of the bladder. It is a rare tumor representing just 1.5 percent of ovary neoplasies. The objective of this paper was to present a patient with histologically-confirmed borderline Brenner tumor and to make a literature review on the clinical and histopathological diagnosis of this disease and compare it with others. Here is a 88 years-old women who was performed laparatomy because of suspected complex cyst; her medical history and diagnosis was described and a literature review with emphasis on diagnosing process. A literature search was made by using Medline,OMIM y SciELO and terms Brenner tumor¨ and ¨bordeline Brenner tumor in Spanish and English regardless of year of publication. Ten articles were found about case reports and literature review; they describe the characteristics of clinical presentation, clinical diagnosis based on histopathological studies and general aspects of the disease. Borderline Brenner tumor is infrequent in Mexico and should be considered in the differential diagnosis of ovary tumors(AU)

Borderline Brenner tumor of the ovary: a case report with immunohistochemical and molecular study.

BACKGROUND: Borderline Brenner tumor of the ovary is a rare entity characterized by papillary structures with a fibro-vascular core, covered by a transitional epithelium, and by the absence of stromal infiltration. It is associated, by definition, with a benign component of Brenner tumor. CASE: We report a case of a 68-year-old woman, with a right ovarian mass, whose morphology and immuno-profile were consistent with the diagnosis of a borderline Brenner tumor. Immunohistochemistry carried out on selected markers may help to formulate the diagnosis, more than the molecular analyses.

FDG PET/CT of a benign ovarian Brenner tumor.

We present a case of an ovarian benign Brenner tumor identified in an 85-year-old woman. During an observation period of over 1 year, the tumor increased in size and showed newly appeared solid component. Magnetic resonance imaging was typical of a Brenner tumor; fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) findings revealed mild FDG uptake and calcification in the solid component. These findings of PET/CT are often found in ovarian mucinous carcinomas. Our case suggests that magnetic resonance imaging is superior to FDG PET/CT for the differential diagnosis of ovarian Brenner tumors from other malignant tumors.

Imaging in gynecological disease (7): clinical and ultrasound features of Brenner tumors of the ovary.

OBJECTIVES: To describe clinical and ultrasound features of Brenner tumors of the ovary. METHODS: In this retrospective study, the databases of the International Ovarian Tumor Analysis (IOTA) studies and one tertiary center were searched to identify patients who had undergone an ultrasound scan before surgery for an adnexal mass that proved to be a Brenner tumor. Twenty-eight patients with 29 Brenner tumors were included, most of which had been collected within the framework of the IOTA studies. An experienced ultrasound examiner reviewed available ultrasound images (available for 14 tumors), searching for a pattern specific to Brenner tumors. RESULTS: Most patients were postmenopausal and asymptomatic. Twenty-four (83%) tumors were benign, two (7%) were borderline and three (10%) were malignant. Most benign tumors (17/24, 71%) contained solid components and manifested no or minimal blood flow on Doppler examination (19/24, 79%). Information about calcifications was available for 15 benign tumors, and in 13 (87%) calcifications were present. The five borderline and invasively malignant tumors contained solid components less often than did the benign ones (3/5, 60%) and were more richly vascularized on Doppler examination. Information about calcifications was available for four borderline or invasively malignant tumors, and in three (75%) calcifications were present. CONCLUSION: We failed to demonstrate ultrasound features specific to Brenner tumors. A prospective study is needed to determine if ultrasound features of calcifications can discriminate between Brenner tumors and other types of ovarian tumor.

Prediction of benignity of solid adnexal masses.

OBJECTIVE: The aim of this study was to identify the sonographic features of solid ovarian masses and to determine whether they may be managed conservatively. STUDY DESIGN: Sixty-three patients from September 1999 to September 2008 with solid adnexal masses demonstrating acoustic attenuation, absent Doppler vascularity and minimal or no cystic component were retrospectively reviewed. 20 patients without pathologic results or follow-up studies were excluded. The remaining 43 patients had follow-up imaging studies and/or surgical treatment. The median age of the study group was 52 years (range 16-80 years). RESULTS: Twenty-nine patients with solid adnexal masses were managed non-surgically. Their age range was 26-80 years (median 56). The size of the masses ranged from 0.7 to 8.3 cm (median 2.2). The follow-up time ranged from 3 to 76 months (median 30). 19 masses (65.5%) showed no change on the follow-up exam. Two masses showed an increase in size (6.9%), and eight masses (27.6%) showed a decrease in size or complete resolution. All these masses had well-circumscribed margins, were homogeneous, with increased attenuation, and had minimal or no vascular flow or cystic component. Normal ovarian tissue was detected in the margins of 24 of the masses (85.7%). These patients exhibited no subsequent evidence of malignancy, such as development of metastases, local invasion, or ascites. 14 patients with solid adnexal masses underwent surgical treatment. Their age range was 16-72 years (median 40). The size of the excised masses ranged from 1.8 to 12.3 cm (median 3.2 cm). Normal ovarian tissue was sonographically demonstrated in ten of these masses (71.4%). All 14 patients (100%) had benign results at pathology. Four patients showed no ovarian neoplasm. Ten patients had benign ovarian neoplasms, including four fibromas, three fibrothecomas, one Brenner tumor, one granulosa cell tumor, and one mature teratoma. CONCLUSION: We present a retrospective study of both surgical and nonsurgical management of solid ovarian masses. None of the sonographically diagnosed benign-appearing solid adnexal masses were subsequently proved to be malignant either at pathology or by clinical course, suggesting that ultrasound can accurately predict benignity in these masses and that conservative management is an option in these patients.

A singular observation of a giant benign Brenner tumor of the ovary.

INTRODUCTION: Brenner tumors are rare transitional cell tumors of the ovary. They are usually benign neoplasms, of solid or solid-cystic structure and small size. We describe the case of a benign, predominantly cystic Brenner tumor measuring 39 cm in diameter. CASE REPORT: A 62-year-old woman presented to the outpatient visit complaining about vague abdominal symptoms such as constipation and meteorism. Ultrasonography and CT scan showed the presence of a voluminous cystic mass, with fluid content, displacing other intra-abdominal organs. The patient underwent elective surgical excision, and there were no complications. Definitive pathological examination showed a metaplastic benign Brenner tumor. CONCLUSION: The largest benign Brenner tumors reported in literature have been up to 30 cm in size, and greater size has been thought to be a predictor of malignancy. We have seen, however, that it is possible for larger lesions of this type to have a completely benign behavior; consequently, a benign nature should not be excluded even in the event of a large ovarian lesion.

[CT features of ovarian Brenner tumor and a report of 9 cases].

OBJECTIVE: In order to improve the preoperative diagnostic accuracy, the computed tomographic (CT) features of ovarian Brenner tumor were described and analyzed. METHODS: CT image and clinical data of nine patients with pathologically confirmed Brenner tumor were collected and analyzed retrospectively. There were 8 benign lesions and 1 borderline lesion. RESULTS: All lesions in the nine cases were unilateral, round, lobulated or irregular in shape and well defined, in a mean diameter of 7.8 cm. Among the nine cases, 5 were benign tumors with uniform structure, 3 were benign tumors accompanied with other pathological components, and 1 was borderline tumor. On the CT images, the 5 uniform benign lesions showed to be solid tumor of low density (lower than that of muscle) or with small cyst inside, two of the 5 lesions had calcification, and other 2 lesions showed slightly heterogeneous enhancement after enhanced scanning. The 3 benign Brenner tumors accompanied with other pathological structures were solid-cystic or cystic, with a clear demarcation of solid and cystic components. The density of solid parts was lower than that of muscle, and slight enhancement, and one of them had calcification. The one borderline tumor was a heterogeneous solid one and its density was higher than that of muscle, with a large proportion of low density and large calcification, and moderately enhanced after enhancing. None of the 9 cases had metastasis or effusion. CONCLUSION: Ovarian Brenner tumors are usually unilateral and often accompanied with other type of tumor components. When a tumor is of uniform component, the CT imaging often shows a homogeneous solid tumor with homogeneous or heterogeneous density. When a tumor is accompanied with other tumor components, it may be solid-cystic or cystic and has partial calcification. After enhancing, a benign Brenner tumor is slightly enhanced, while the borderline one is moderately/highly enhanced.

Brenner tumors of the ovary: sonographic and computed tomographic imaging features.

OBJECTIVE: The purpose of this study was to describe the sonographic appearance of ovarian Brenner tumors with computed tomographic (CT) correlation. METHODS: Twenty-two female patients (age range, 32-78 years; mean, 58 years) with 25 ovarian Brenner tumors were identified from pathologic records from 1990 to 2005. Corresponding pathologic reports and images (17 sonographic and 14 CT) were reviewed independently. RESULTS: Tumors ranged in size from 0.3 to 12 cm (mean, 2.5 cm); all were benign. Sixteen (64%) of 25 were found incidentally. Eight (36%) of 22 patients had a total of 12 associated benign ovarian neoplasms (1 was contralateral); 3 patients had bilateral Brenner tumors. Eight (47%) of 17 tumors were not seen on sonography, and 5 (36%) of 14 were not seen on CT. Of the tumors seen on imaging, most were solid (67% on sonography and 78% on CT). Four tumors appeared at least partially cystic, of which 3 had coexistent cystic ovarian lesions. CONCLUSIONS: Brenner tumors are most often solid neoplasms found incidentally and frequently seen in association with other benign ovarian epithelial neoplasms.

A case of estrogen-producing Brenner tumor with a stromal component as a potential source for estrogen.

BACKGROUND: Although Brenner tumors with endocrine activities have been reported, the source or mechanisms for hormone production is poorly known at present. CASE REPORT: A 66-year-old Japanese woman presented with atypical vaginal bleeding. A left ovarian tumor was detected on ultrasonography and CT scanning. Her serum estradiol level was elevated (73.5 pg/ml). We performed total hysterectomy, bilateral salpingo-oophorectomy and partial omentectomy. The ovarian tumor was diagnosed as a benign Brenner tumor associated with simple hyperplasia of the endometrium. Postoperatively, the serum estradiol level decreased. Immunoreactivity of cytochrome P-450 aromatase was detected in stromal cells. CONCLUSION: Stromal contribution to the secretion of estrogen was shown in this case. Considering the known source of estrogen production being tumor cells in certain cases of Brenner tumor, there seem to be two types of estrogen-producing Brenner tumors depending on the source of estrogen, i.e. tumor cells or stromal cells.