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KMID : 0377619680140020133
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Korean Jungang Medical Journal
1968 Volume.14 No. 2 p.133 ~ p.139
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Malignant Brenner Tumor with Hormonal Effect in a Postmenopausal Woman
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金容佑/Kim, Yong Woo
洪性善/洪淳博/金湘辰/최인준/Hong, Sung Sun/Hong, Soon Bak/Kim, Sang Chin/Choi, In Joon
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Abstract
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Malignant Brenner tumor, admittedly of rare occurrence, has been sporadically reported since Dockerty´s first report in 1944. Following Meyer´s classification in 1932, Brenner tumor had been generally considered to be benign, and hormonally inactive, which has been supported by many authors. But through the sporadic reports and case analysis in the literatures, some of Brenner tumor were associated with uterine bleeding, active proliferative and hyperplastic endometrium or endometrial carcinoma, which hay been under discussion probably on the estrogenic activity that was first suggested by Te. Linde in 1930.
A case of malignant Brenner tumor associated with interesting evidence of hormonal effect in a postmenopausal woman, 63 year old, gravida 10, para 8, Korean woman, is reported, because of its rarity in its malignancy and controversial aspect of hormonal activity. The patient complained of a gradually growing abdominal mass for 21 months and irregular uterine bleeding for 2 years since transient 3 months cessation of probable menstrual history at her age of 60 years. Total abdominal hysterectomy, bilateral salpingo-oophorectomy and partial omentectomy were performed under the diagnosis of a suspicious malignant ovarian tumor.
On operation, a huge right ovarian tumor was found, which was 40 X 40 X 30cm. in size, 5,400gm. in weight and contained about 3, 500cc. of yellow milky thick fluid.
Tile tumor was adherent to the lower part of greater omentum and parietal peritoneum.
The uterus and left adnexa were not adherent to the surrounding tissues or organs.
Grossly, the tumor was unilocular, mostly cystic and partly solid. The outer surface
of the tumor was relatively smooth but nodulated. The inner surface of the tumor
showed trabeculations and necrosis, forming multiple, large friable polypoid or papillary protruding masses, which were firm and gray white on their cut sections. The cystic wall was variable in thickness from 0. 5 to 3.5cm., very firm, and yellow-tinged gray white on cut sections. The uterus measured 9X6X5cm. and the thickness of myometrium was 2.0cm. and the endometrium appeared to be thicker than usual.
Histologically, the tumor was composed of typical epithelial cell nests of Brenner tumor surrounded by proliferative neoplastic stromal tissue, particularly in the sections of cystic wall, but polypoid tumor masses were mostly composed of benign appearing transitional type of epithelium forming papillary structures. On several areas, the tumor cells showed malignant nature with mitotic figures. These tumor cells were also found in the serosal lining of the uterus and left ovarian surface, and in the omentum.
Several special stainings were done, such as van Gieson, Trichrome, Aniline blue, P. A. S., Reticulum and Fat stains. Lipid droplets were abundantly found particularly around the -Brenner´s epithelial nests and also occasionally in the papillary transitional formed tumor cells. The uterus showed mild hypertrophy of myometrium, adenomyosis, active hyperplasia of. endometrium, functioning endocervical glands and chronic cervicitis.
The epithelium of endosalpinges was same as that under the effect of estrogenic activity. With these histological findings and uterine bleeding in a postmenopausal woman in accordance with abundant lipid droplets in the tumor, possible hormonal activity of this malignant Brenner tumor, not solely due to active stromal response by the tumor but the tumor itself, may not completely be excluded.
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KEYWORD
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