Brenner tumor of ovary with associated torsion
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Acute onset of abdominal pain and distension for past 2 days, with three episodes of vomiting.
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Well defined large predominantly cystic abdominopelvic lesion noted arising from the right adnexa, extending into the left side of abdomen. The lesion has a solid-cystic component containing multiple enhancing septa. Right ovary not visualized separately. The lesion displaces bowel loops laterally. Right fallopian tube appears bulky, with twisting of vascular pedicle. Minimal free fluid in pelvis. Left ovary not well visualized.
Uterus is displaced towards the right. Small myoma noted in its posterior wall.
Additional findings includes simple cyst in left lobe of liver and mildly bulky left adrenal gland.
A diagnosis of benign ovarian neoplasm with associated torsion and minimal ascites was provided.
Patient underwent emergency laparotomy with right salpingo-oophorectomy.
Intraoperative findings: Right ovarian cyst identified. Hemorrhage noted. Twisted pedicle noted, which was double-clamped and transfixed. 300 ml of clots evacuated. Sample sent for histopathological evaluation.
Samples received - Right ovarian cyst and right fallopian tube.
Microscopic findings - Sections showed thinned out cyst wall lined by denuded epithelium. Complete transection of right fallopian tube noted with eroded lumen, filled with hemorrhagic material. Sections from ovary shows tumor tissue arranged in epithelial nests surrounded by dense fibrous stroma. The epithelial cell nests contain uniform cells with prominent cell borders, pale to eosinophilic cytoplasm. Oval nuclei with inconspicuous nucleoli and longitudinal nuclear grooves and eosinophilic debris in the center. Occasional spiculated calcifications noted.
Impression - Ovarian mass: benign Brenner tumor
Brenner tumors are uncommon surface epithelial tumor of the ovary, found incidentally in women of 50-70 years age group. These tumors have a non-specific appearance on ultrasound and appear as solid hypoechoic lesions, with or without calcifications. On CT, these lesions appear as solid or mixed solid-cystic tumors. Extensive wall calcifications are characteristic features. The calcifications appear hypointense on T2-weighted image on MR study. Associated ovarian torsion is one of the complications of ovarian neoplasms. Ultrasound with color Doppler evaluation usually reveals unilateral ovarian enlargement or ovarian mass, free pelvic fluid and a twisted vascular pedicle. CT and MRI are performed for the confirmation of diagnosis.
- 1. Dhanda S, Thakur M, Kerkar R, Jagmohan P. Diffusion-Weighted Imaging of Gynecologic Tumors: Diagnostic Pearls and Potential Pitfalls. Radiographics. 2014;34(5):1393-416. doi:10.1148/rg.345130131 - Pubmed
- 2. Lee J, Park S, Shin S et al. Value of Intra-Adnexal and Extra-Adnexal Computed Tomographic Imaging Features Diagnosing Torsion of Adnexal Tumor. J Comput Assist Tomogr. 2009;33(6):872-6. doi:10.1097/rct.0b013e31819e41f3 - Pubmed
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