A rare case of polyneoplasia of giant Brenner's tumour and pancreatic adenocarcinoma
DOI:
https://doi.org/10.15574/PP.2024.4(100).140147Keywords:
polyneoplasia, Brenner tumor, hysterectomy, pancreatic adenocarcinomaAbstract
Brenner's tumours (mucoid fibroadenomas) are rare ovarian epithelial tumours, the incidence of which among ovarian epithelial neoplasms is 1-5%, and among all ovarian tumours - 1.4-2.5%. Their histogenetic origin is not fully understood, but it is believed that they originate from parovarian Walthard's nests. In 30% of cases, mucoid fibroadenomas are associated with other ovarian tumours. Malignant Brenner's tumours, characterised by decreased cellular differentiation, uncontrolled growth with invasion and destruction of neighbouring structures, are an even rarer and more unpredictable scenario faced by gynaecologists and oncologists. The diagnosis of this disease is difficult due to the lack of specific clinical, laboratory and imaging signs. As with any other epithelial ovarian tumours, the main treatment for Brenner's tumours is surgery.
Aim - to analyze a clinical case of polyneoplasia of Brenner's tumour and pancreatic adenocarcinoma
Clinical case. The clinical case of surgical intervention for right ovarian cyst in a 55-year-old patient is described. Pathological examination revealed that the removed neoplasm was a Brenner's tumour with the formation of a multicompartmental smooth-walled cyst lined with a single-layer metaplastic mucinous epithelium without signs of proliferation. The malignant nature of the tumour was diagnosed on the basis of morphological confirmation of implantation metastasis of the glandular component of the ovarian tumour into the parietal peritoneum of the anterior abdominal wall. The peculiarity of this case is polyneoplasia, namely the development of pancreatic tail adenocarcinoma and abdominal carcinomatosis, diagnosed 17 months after the initial surgical intervention for Brenner's tumor.
Conclusions. Brenner's tumour is a rare clinical entity in gynaecological oncology practice. Despite the fact that the vast majority (93-95%) of such mucoid fibroadenomas are benign, the likelihood of malignancy should be carefully assessed and tumor markers should be used in preoperative examination of patients, surgical staging should be performed during surgery, immunohistochemical examination should be used, especially in cases of large tumours. It should also be remembered that Brenner's tumours can be associated with malignant neoplasia of other localisation.
This study did not involve any experiments on animals or humans. Written informed consent for treatment and publication of this case was obtained from the patient.
No conflict of interests was declared by the authors.
References
Alamer LA, Almukhadhib OY, Al Zahrani KA, Adham M, AlMousa RA. (2023). Ovarian Brenner Tumor: A Report of Two Cases and Literature Review. Cureus. 15(10): e46613. https://doi.org/10.7759/cureus.46613
Alloush F, Bahmad HF, Lutz B, Poppiti R, Recine M et al. (2023). Brenner Tumor of the Ovary: A 10-Year Single Institution Experience and Comprehensive Review of the Literature. Med Sci (Basel). 11(1): 18. https://doi.org/10.3390/medsci11010018; PMid:36810485 PMCid:PMC9944520
Balasa RW, Adcock LL, Prem KA, Dehner LP (1977). The Brenner tumor: a clinicopathologic review. Obstet Gynecol. 50(1): 120-128.
Borah T, Mahanta RK, Bora BD, Saikia S. (2011). Brenner tumor of ovary: An incidental finding. J Midlife Health. 2(1): 40-41. https://doi.org/10.4103/0976-7800.83273; PMid:21897739 PMCid:PMC3156501
Costeira FS, Félix A, Cunha TM. (2022). Brenner tumors. Br J Radiol. 95(1130): 20210687. https://doi.org/10.1259/bjr.20210687; PMid:34928171 PMCid:PMC8822556
Cuatrecasas M, Catasus L, Palacios J, Prat J (2009). Transitional cell tumors of the ovary: a comparative clinicopathologic, immunohistochemical, and molecular genetic analysis of Brenner tumors and transitional cell carcinomas. Am J Surg Pathol. 33(4): 556-567. https://doi.org/10.1097/PAS.0b013e318188b84c; PMid:19033864
Gaur JH, Hassan MJ, Elahi AA, Khetrapal S, Khan S, Jetley S. (2019). Synchronous benign Brenner's tumor of ovary with leiomyoma and endometrial adenocarcinoma in a postmenopausal female. J Cancer Res Ther. 15(6): 1418-1420. https://doi.org/10.4103/jcrt.JCRT_109_18; PMid:31898686
Ge WS, Lu B, Yang HY, Li MP. (2024). Brenner tumor of the vagina: report of a case. Zhonghua Bing Li Xue Za Zhi. 53(9): 953-955. doi: 10.3760/cma.j.cn112151-20240531-00358.
Gezginç K, Karatayli R, Yazici F, Acar A, Çelik Ç et al. (2012). Malignant Brenner tumor of the ovary: analysis of 13 cases. Int J Clin Oncol. 17(4): 324-329. https://doi.org/10.1007/s10147-011-0290-7; PMid:21796330
Green GE, Mortele KJ, Glickman JN, Benson CB (2006). Brenner tumors of the ovary: sonographic and computed tomographic imaging features. J Ultrasound Med. 25(10): 1245-1251. https://doi.org/10.7863/jum.2006.25.10.1245; PMid:16998096
Heimbigner AM, Davaro EP, Schwetye K. (2021). Benign Brenner Tumor in an Ectopic Ovary: A Case Report and Review of Literature. Int J Gynecol Pathol. 40(4): 376-378. https://doi.org/10.1097/PGP.0000000000000716; PMid:32947329
Hu RY, Deng YJ, Zhu HH, Zhou J, Hu M, Liang XQ et al. (2020). Extraovarian Brenner tumor in the uterus: a case report and review of literature. Diagn Pathol. 15(1): 22. https://doi.org/10.1186/s13000-019-0906-1; PMid:32164751 PMCid:PMC7066756
Klasa L, Wydra D, Biernat W. (2014). Recurrence of Brenner ovary borderline tumor in the abdominal wall postoperative scar--a case report and research of the literature. Ginekol Pol. 85(11): 873-876. https://doi.org/10.17772/gp/1916; PMid:25675807
Kourda N, Elloumi H, Chérif K, Ben Jilani S, Zermani R (2008). Proliferating Brenner tumor: case report. Gynecol Obstet Fertil. 36(3): 292-295. https://doi.org/10.1016/j.gyobfe.2007.11.021; PMid:18325813
Kurniadi A, Anfasa MK, Agustina H, Dewayani BM, Kireina J. (2023). A Rare Case of Ruptured Malignant Ovarian Brenner Tumor. Am J Case Rep. 24: e938680. https://doi.org/10.12659/AJCR.938680; PMid:36775948 PMCid:PMC9939847
Logani S, Oliva E, Amin MB, Folpe AL. (2003). Cohen C, Young RH. Immunoprofile of ovarian tumors with putative transitional cell (urothelial) differentiation using novel urothelial markers. Am J Surg Pathol. 27(11): 1434-1441. https://doi.org/10.1097/00000478-200311000-00005; PMid:14576476
Lou Z, Mei L, Wan Z, Zhang W, Gao J. (2024). A report of twenty cases of ovarian Brenner tumor and literature review: a case series study. BMC Womens Health. 24(1): 471. https://doi.org/10.1186/s12905-024-03316-4; PMid:39192213 PMCid:PMC11348730
Montoriol PF, Hordonneau C, Boudinaud C, Molnar I, Abrial C, Kossai M. (2021). Benign Brenner tumour of the ovary: CT and MRI features. Clin Radiol. 76(8): 593-598. https://doi.org/10.1016/j.crad.2021.03.018; PMid:33933275
Moon WJ, Koh BH, Kim SK, Kim YS, Rhim HC, Cho OK et al. (2000). Brenner tumor of the ovary: CT and MR findings. J Comput Assist Tomogr. 24(1): 72-76. https://doi.org/10.1097/00004728-200001000-00015; PMid:10667663
Nasioudis D, Sisti G, Holcomb K, Kanninen T, Witkin SS. (2016). Malignant Brenner tumors of the ovary; a population-based analysis. Gynecol Oncol. 142(1): 44-49. https://doi.org/10.1016/j.ygyno.2016.04.538; PMid:27130406
Parcesepe P, Coppola L, Remo A, D'Andrea MR, Coppola G, Simbolo M et al. (2021). Molecular and Clinical Insights in Malignant Brenner Tumor of the Testis With Liver Metastases: A Case Report. Front Oncol. 11: 663489. https://doi.org/10.3389/fonc.2021.663489; PMid:33912469 PMCid:PMC8072450
Park S, Cho MS. (2017). Vaginal Brenner tumor with literature review: does this tumour originate from Walthard nests? Malays J Pathol. 39(1): 89-93.
Roth LM, Czernobilsky B. (1985). Ovarian Brenner tumors II. Malignant. Cancer. 56(3): 592-601. https://doi.org/10.1002/1097-0142(19850801)56:3<592::AID-CNCR2820560328>3.0.CO;2-A; PMid:4005816
Ruggiero S, Ripetti V, Bianchi A, La Vaccara V, Alloni R, Coppola R. (2011). A singular observation of a giant benign Brenner tumor of the ovary. Arch Gynecol Obstet. 284(2): 513-516. https://doi.org/10.1007/s00404-011-1930-x; PMid:21594602
Salibay CJ, Zanfagnin V, Miller H, Walia S, Brunette LL, Wang T. (2021). Borderline Brenner Tumor of the Ovary Coexisting With an Ovarian Mucinous Cystadenoma With Focal Atypical Epithelial Proliferation: A Rare Case With Review of the Literature. Int J Surg Pathol. 29(7): 788-793. https://doi.org/10.1177/1066896921999459; PMid:33635096
Timmerman D, Planchamp F, Bourne T, Landolfo C, du Bois A, Chiva L et al. (20210. ESGO/ISUOG/IOTA/ESGE Consensus Statement on pre-operative diagnosis of ovarian tumors. Int J Gynecol Cancer. 31(7): 961-982. https://doi.org/10.1136/ijgc-2021-002565; PMid:34112736 PMCid:PMC8273689
Zhang Q, Tian C, Wang K, Xin Q, Shen Y et al. (2020). A case of a vaginal Brenner tumor without a gland mimicking a borderline tumor: unusual morphology and diagnostic pitfalls. J Int Med Res. 48(8): 300060520946536. https://doi.org/10.1177/0300060520946536; PMid:32809866 PMCid:PMC7436852
Zheng R, Heller DS. (2019). Borderline Brenner Tumor: A Review of the Literature. Arch Pathol Lab Med. 143(10): 1278-1280. https://doi.org/10.5858/arpa.2018-0285-RS; PMid:30779594
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