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Urogenital Imaging

Brenner tumour

(Fritz Brenner, born 1877, German pathologist), rare, small solid fibroepithelial tumours of the ovary characterized histologically by epithelial cells, which resemble the transitional epithelium of the urinary system, lying in an abundant stroma, which resembles the stroma of an ovarian fibroma or thecoma. Brenner tumours account for approximately 2% of all ovarian neoplasms. The risk of malignant transformation is 1-2%. Most are asymptomatic, and discovered incidentally during gynaecological imaging or surgery performed for other reasons. Some are only found at microscopy, when the ovaries are examined after removal for other co-existent gross pathology. Large tumours may be symptomatic due to pressure effects. Postmenopausal bleeding due to endometrial hyperplasia is occasionally the presenting complaint, and is believed to occur due to stromal luteinization with oestrogen production.

At imaging, CT, ultrasound, or MRI, imaging findings are relatively nonspecific, and consist of a solid ovarian mass of varying size (Fig.1). Most are under 5 cm, although cases measuring up to 20 cm have been reported. Brenner tumours may grow slowly over time. About 10% of cases are bilateral. Calcification may occur, and is best detected by CT. Low signal intensity on T2-weighted MRI sequences is a frequent finding, and may initially suggest the diagnosis of ovarian fibroma. Management of Brenner tumours is similar to ovarian fibromas, with bilateral salpingo-oophrectomy recommended for postmenopausal patients, and simple excision with ovarian preservation being preferred for younger patients who wish to preserve their fertility.

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Fig.1

a. Transabdominal axial ultrasound image shows a hypoechoic well-defined Brenner tumour posterior to the bladder. b. Axial contrast enhancement CT section shows the tumour is well-defined with mildly inhomogenous enhancement
Brenner tumour, Fig.1 (a)
Brenner tumour, Fig.1 (b)