Brenner Tumors of Ovary

This interesting neoplasm was described in 1907 by Brenner under the designation of
eiiphoroma folliculare; however, in his original communication he considered the tumo r
to be related to granulosa cell lesions. It was Robert Meyer who in 1932 sharply
distinguished between the two, describing clearly the pathologic characteristics of the
Brenner tumor, and suggesting the explanation of its histogenesis which was the generally
accepted one until the past decade. In the light of more recent studies, particularly those of
Greene and Reagan, it appears likely that there is more than a single histogenetic pattern.
Pathology

A.Gross Characteristics
The size of the tumors varies between very wide limits. Some are of microscopic size,
although others may assume enormous proportions, even when not associated with
cystadenoma. The largest solid Brenner tumor recorded appears to be that of Averbach et
al. which weighed over 19 pounds, and which, judging from the description and illustation',
is a genuine tumor of this variety. The gross appearance of the solid tumors is quite similar
to that of fibroma, although there is frequently a yellow tint to the cut surface. There is
very little tendency to necrosis or cystic degeneration in the solid variety, and hemorrhage
is uncommon. The capsule is poorly defined, although the surrounding ovarian stroma is
more or less compressed. In rare instances Brenner tumors may be bilateral, and some 25
such cases are on record, although a recent study from our clinic of 90 cases, many from
the files of the Ovarian Tumor Registry, showed no bilaterality.

B.Microscopic Characteristics
From a microscopic standpoint there are two essential constituents, viz., the characteristic
nests of epithelian cells and the fibromatous connective tissue groundwork surrounding the
epithelial islands. Both of these must be present to justify the diagnosis of Brenner tumor,
a fact overlooked by some authors, who apply the term to the epithelial rests themselves.
Why the fibromatous reaction occurs with someptests and not others can be explained only
on the general basis of the cytogenous influence exerted by epithelium not only in Brenner
tumors but also in other conditions, such as endometriosis. The epithelial nests may be
round or cylindrical, very small or extremely bulky. A striking characteristic is the
uniformity of the cells. Danforth and Arey have called attention to a peculiar longitudinal
grooving of some of the cells. This same grooving is found in the cells of the Walthard
islands which are sequelae of squamous metaplasia in pre-existing peritoneal inclusions. In
many islands even the cells close to the connective tissue margin lack the compactness and
the intensity of nuclear staining seen in ordinary epithelial neoplasms, malignant or
benign. In others they do seem slightly more closely packed. The cells are rather large and
polyhedral, with small nuclei of ovoid shape and striking uniformity, and with no suggestion
of overactivity, so that they do not in any way suggest malignancy.