Brenner tumors of the ovary. With report of 14 new cases

This paper is based upon the study of 17 cases of Brenner tumor of the ovary, including the 14 new cases herein reported. This brings the total of reported cases to 122, though new instances are being reported more and more frequently. The tumors are benign, and produce no characteristic symptoms. When small they are, therefore, likely to be found only accidentally in operations for other indications. They may, however, reach very large size, in which case they produce discomfort or pain, with perhaps the presence of a mass noticeable to the patient herself. The pathologic characteristics have been described in the paper. The essential elements are (1) the presence of nests or columns, often partially cystic, of rather uniform size and appearance embedded in (2) a matrix of fibromatous tissue which is sharply marked off from the surrounding ovarian stroma though there is no definite capsule. The tumors probably arise from the so-called Walthard islands of indifferent cells which may at times occur in the ovary, though other explanations have been suggested. The most interesting histologic characteristic is the frequently observed transition of the cells into a cylindrical type identical with that characterizing the ordinary pseudomucinous cystadenoma, so that large tumors of the latter variety may be produced, with only small nodular Brenner tumor vestiges in the wall to indicate their origin. There is logic, therefore, in the subdivision of Brenner tumors into the solid and cystic varieties. Three such tumors are included in our series. On the other hand the fibromatous reaction may be so striking as to produce large fibromas of the ovary. In such cases, of which 2 are included in our group of cases, the origin is indicated by the finding of the typical cell nests scattered either sparsely or richly throughout the tumor. There is little or no evidence to indicate that Brenner tumors exert any such endocrine effects upon sex characters as those which characterize granulosa cell carcinoma or arrhenoblastoma.