Introduction:
The tumor comprises transitional or urothelial-like epithelium, usually embedded in the fibromatous stroma. The growth pattern and cytological characteristics of epithelial cells distinguish between benign, borderline, and malignant variations. The majority of them are tiny tumors (<2 cm) discovered in asymptomatic women. Its primarily fibrous material produces a poor signal on T2 weighted imaging, allowing for a differential diagnosis alongside ovarian fibroma and thecoma.
Although their imaging appearances are quite similar, differentiation is dependent on secondary characteristics such as symptoms or indications of estrogen excess and the existence of a second ovarian neoplasm, which have been documented in up to 30 % of Brenner tumor patients. Although Brenner tumors were once assumed to be completely benign, there have been a few instances of borderline and malignant variants in recent decades.
What Is Brenner Tumor?
Brenner tumors (BTs) are sporadic ovarian neoplasms, accounting for just two to three percent of all ovarian tumor cases. Because of their histological similarities to urothelium, they were formerly referred to as transitional cell tumors. They can exceptionally infrequently occur in places such as the testis. They are the most prevalent type of ovarian urothelial-type tumors and typically affect older women.
The vast majority of BT cases occur in individuals between the fifth and seventh decades of life, while they can occur in persons as young as 30 and as old as 80. The World Health Organization (WHO) classifies female vaginal tumors (BT) as benign, borderline, or malignant, depending on their proliferation and invasiveness.
Benign Brenner tumors (BBT), which account for approximately 95 % of occurrences, are frequently incidental observations in asymptomatic females because they typically show tiny neoplasms. Borderline and malignant tumors account for five and one percent of all BT patients, respectively, and are more likely to cause symptoms because of their larger size. Because up to 30 % of BTs show mixed neoplasms, they are frequently discovered accidentally after other tumors are removed.
The most prevalent clinical signs of borderline or malignant BT are an abdominal lump, abdominal discomfort, and postmenopausal hemorrhage. Further signs, such as vomiting, nausea, back pain, intestinal obstruction, tumor-induced anorexia, and weight loss, have been seldom reported. Abdominal discomfort can be attributed to a mass effect on neighboring tissues in larger neoplasms. Borderline and malignant Brenner tumors are typically not functioning. However, the existence of postmenopausal bleeding could imply hormone-secreting components.
What Are the Symptoms of Brenner Tumor?
Brenner tumor symptoms are usually asymptomatic and can be discovered inadvertently during a checkup, imaging, or surgery for a different reason. The most common Brenner tumor symptoms are vaginal bleeding and lower abdominal pain; additional signs include ascites or pleural effusion (Meigs syndrome), abdominal distension, and urine retention. The most common clinical signs are palpable pelvic or abdominal masses.
What Are the Radiological Findings of Brenner Tumor?
This is not the best imaging approach for characterizing ovarian masses. Most ovarian neoplasms are discovered as coincidental observations on CT (computed tomography). BT manifests as a thick, solid, or multilocular cystic mass with variable amplification. CT is the most effective tool for demonstrating calcifications. Brenner tumors resemble similar solid ovarian neoplasms, especially fibromas-thecomas, and are occasionally mistaken for pedunculated leiomyomas. They are predominantly hypoechoic solid masses. Calcifications have been found in 50 percent of Brenner tumor ultrasounds. The gold standard for characterizing ovarian cancers.
What Are the Histopathological and Pathological Findings of Brenner Tumor?
The etiology of BT has yet to be fully discovered. BT exhibits transitional differentiation, most commonly found in the bladder and ureters. They are thought to originate at transitional cell metaplasia sites in the paratubal tissue, referred to as Walthard cell nests. These are more common in females with BT or similar ovarian neoplasms than in controls. Neoplasms typically measure less than 2 cm in diameter and seldom reach 10 cm. They are solid, well-defined masses with a strong, rubbery texture. The sliced area is grayish-white or yellow, and it may be calcified.
Small cysts are prevalent, and the tumor may be mainly cystic on rare occasions. These tumors often comprise a dense fibromatous stroma and tiny, oval to irregular nests of bland transitional or urothelial epithelium, frequently containing microcystic spaces filled with eosinophilic or mucinous material. This lumen may be bordered with transitional, mucinous, ciliated, or cuboidal cells.
Tumors are often big (12 cm), cystic, and have papillary luminal projections. Solid portions frequently exhibit a benign Brenner feature. Less frequently, they may appear as substantial tumors. About 85 percent of Brenner tumors develop calcifications on CT. The solid component may show modest to moderate elevation after contrast.
How Is Brenner Tumor Diagnosed?
An initial checkup with a full physical exam and pelvic ultrasound is advised. Following surgery, a histological examination is required to make a clear diagnosis. Additional imaging, such as a CT scan, an MRI (magnetic resonance imaging), a PET (positron emission tomography) scan, and biopsies, may be required to stage the tumor and determine the appropriate treatment. There is no definitive tumor marker for this syndrome.
How Is Brenner Tumor Treated?
Brenner tumor treatment includes surgical intervention, whether they are benign, borderline, or malignant. Borderline and malignant types require adequate surgical staging. Malignant forms are uncommon, and no conventional adjuvant treatment for this illness exists. Malignant Brenner tumors may spread throughout the abdominal cavity. Metastases were also observed in the pleura, lung, kidneys, liver, liver, urinary bladder, and skeleton.
Conclusion:
BTs are sporadic ovarian neoplasms with non-specific imaging characteristics. Most BTs are benign, however, borderline and malignant variants must also be evaluated. The most common differential diagnoses include ovarian fibroma and thecoma, pedunculated leiomyoma, and cystadenofibroma. Histopathology is finally used to make a diagnosis since imaging characteristics overlap.
