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From 1958 to 1965 thirty-six Brenner tumors were diagnosed in 34 women at Malmo General Hospital, suggesting that the tumor is more common than widely believed. Clinical analysis revealed nothing in support of the conception that the tumor is hormone producing. Histological studies favored Schiller's view that the tumar develops from embroyonic structures in the mesovarium (rete ovarii, wolffian duct).
From 1958 to 1965 thirty-six Brenner tumors were diagnosed in 34 women at Malmo General Hospital, suggesting that the tumor is more common than widely believed. Clinical analysis revealed nothing in support of the conception that the tumor is hormone producing. Histological studies favored Schiller's view that the tumar develops from embroyonic structures in the mesovarium (rete ovarii, wolffian duct).
An unselected series of 57 cases of Brenner tumor is reported. The tumors occurred at a mean age of 49 years. Most were discovered as incidental findings during surgery for other pelvic disorders. A few Brenner tumors were symptomatic due to their large size, but none were diagnosed preoperatively. The incidence of bilateral tumors was 7%. No malignant Brenner tumors occurred in our series. The Brenner tumor is best considered as a tumor composed of epithelium of urinary tract (urothelial) type. In many cases, the tumor appears to arise in close relationship to the coelomic epithelium of the ovary. The tumor may occur either in the cortex or in the medullary region adjacent to the hilus. In the cortex, it may arise from Walthard nests or coelomic inclusion cysts, and, in the hilus, it may arise from the rete ovarii or mesonephric remnants. The ovarian stroma responds to the epithelial proliferation and forms the stroma of the tumor. The tumor stroma may on occasion produce clinically significant quantities of steroid hormones. This function appears to correlate best with stromal luteinization and a large content of doubly refractile lipid.
Two unusual and rare forms of Brenner tumors are reported. T h e first group included seven patients with an unusual proliferation of Brenner epithelium to the degree that their tumors resembled low-grade papillary neoplasms of the bladder, but they nonetheless lacked cytologic characteristics of overt carcinoma. All tumors were clinically Stage I at initial diagnosis, and none extended or metastasized beyond the ovary. T h e second group included seven cases designated as malignant Brenner tumors because they contained histologically malignant epithelium as well as areas of the typical Brenner tumor. Each neoplasm had transitions between the two areas. Six of the seven neoplasms were confined to the ovary at the time of initial diagnosis. Of the seven women, three developed recurrence and metastasis following surgery. The mean age of women with proliferative Brenner tumors was younger than women with malignant ones. A specific designation of malignant and proliferative categories is justified and recommended, since the proliferative tumor is benign and should not be confused with its frankly malignant counterpart. Although from this study there is no proof of origin of Brenner tumors, the concept of origin from pluripotential surface epithelium of the ovary is s u p ported, in view of the urinary tract-like (urothelial) epithelial tumors found. These tumors reflect the capacity of the ovary to produce neoplasms that resemble those arising in other organs in the abdominal cavity, i.e., uterus, peritoneum, adrenal, and kidney, as well as bladder. No conclusions could be drawn regarding a functional effect of these neoplasms. HE TYPICAL BRENNER TUMOR IS A DISTINC-* Present address:
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