卵巢布倫內羅氏瘤轉移至輸尿管
張廷瑞、陳世亮、許智凱
台南市立醫院 泌尿科
Malignant Brenner tumor of ovary with ureter metastasis
Ting-Jui Chang, Shih-Liang Chen, Chih-Kai Hsu
Divisions of Urology, Tainan Municipal Hospital, Tainan, Taiwan

 

Backgraund: Ovarian cancer is the most lethal gynecological malignancy. Efforts at early detection and new therapeutic approaches to reduce mortality have largely been unsuccessful. Transitional cell tumors of the ovary represent about 2% of all ovarian tumors and according to WHO, they are classified as benign, borderline or malignant Brenner tumors, and transitional cell carcinomas. Here we presented the case of ovarian Brenner tumor with left side ureter metastesis.

Case report: The 62 year old female patient visited to our gynecological department due to left side lower abdominal discomfort; pelvis MRI revealed left ovary multiseptated cystic mass without lymph node enlargement. TAH with left salpingo-oophorectomy was performed. Pathology study reported borderline Brenner tumor of ovary. Four months later, she came to our OPD due to left side flank pain. Whole abdomen CT was made and reported left adnexal recurrent tumor with left lower ureter metatesis. URS biopsy was done and pathologist reported hyperplastic urothelial mucosa with extensive infiltrating neoplastic transitonal cell; the tumor is focally similar with previous resected left ovarian lesion. Chemotherapy was performed and after three months treatment CT study showed tumor mass decreases in size; and she preferred continue with chemotherapy treatment.

Discussion: Brenner tumor is a relatively uncommon ovarian neoplasm that is part of the surface epithelial group of ovarian tumors. The average age at presentation is 50 years, with 71% of the patients being more than 40 years. The majority of cases are benign without cell atypia and stromal invasion. Proliferating and borderline tumors account for less than 5% of Brenner tumor. Although Brenner tumors and urothelial carcinomas have many close histologic-morphologic similarities and some studies have considered them as having the same origin and pathophysiology, but on literature review only few cases describing an association between Brenner tumor and urothelial carcinoma in postmenopausal women was found. Malignant Brenner tumors may affect surrounding tissue and metastasize into other structures, but this is so rare that a standard treatment has not been developed. Even malignant Brenner tumors, if diagnosed early, are candidates for complete surgical resection. Adjuvant therapy to surgery for epithelial ovarian cancer varies according to the stage of the disease, but, in most cases, will consist of chemotherapy. The standard regimen is paclitaxel and carboplatin given intravenously every 3 weeks for six cycles.