ONCOLOGY LETTERS 16: 1141-1146, 2018 Computed tomography imaging features of benign ovarian Brenner tumors YUYING ZHAO, XINFENG MAO, LIDI YAO and JIAN SHEN Department of Radiology, Huzhou Central Hospital, Huzhou, Zhejiang 313003, P.R. China Received October 27, 2017; Accepted April 13, 2018 DOI: 10.3892/ol.2018.8766 Abstract. The present study aimed to describe the computed itself is very small or visually inseparable from the coexisting tomography (CT) imaging features of ovarian Brenner tumor cystic neoplasm (1). There is little information regarding their for diagnostic accuracy and disease understanding. The appearance on computed tomography (CT) examination (1,2). CT imaging features of 9 cases of ovarian Brenner tumor Although ovarian tumors have similar clinical and radiological confirmed by surgery and pathology were retrospectively features, predominant or specific imaging features may be analyzed and compared. Of the 9 cases of ovarian Brenner present in certain types of ovarian tumors. Characterization tumor, 3 were right located and 6 were left located with clear of an ovarian mass is of the utmost importance by CT in the borders; 7 with round or oval shapes, while 2 were with preoperative evaluation of an ovarian neoplasm (3). It enables irregular and lobulated morphology; 5 solid lesions presented the surgeon to anticipate carcinoma of the ovary prior to surgery with multiple scattered calcification shadows inside with so that adequate procedures are planned. Therefore, familiarity moderate enhancement, while 3 cystic lesions were presented with the clinical and imaging features of various ovarian with mixed solid and cystic composition, and significant tumors is important in determining the likelihood of a tumor enhancement was identified in the solid component, but not being benign or malignant. The aim of the present study was to in the cystic component. Furthermore, papillary projections describe the clinical and CT characteristics of Brenner tumors. inside and mild nodular enhancement were observed in one case of cystic lesion. The pathological analysis demonstrated Materials and methods that an epithelium nest composed the tumors with urothelial like cells and fibrous matrix. Of the 9 cases, 5 epithelial nests Patients. Patients with a histological diagnosis of a Brenner exhibited adeno-like cystic lumen without cell mitosis phase. tumor of the ovary who had undergone preoperative CT exam- All cases were diagnosed with benign ovarian Brenner tumor. ination prior to surgical removal of the mass between June Specific CT imaging features of ovarian Brenner tumor can 2003 and December 2012 from the clinical databases of the be identified and pathological examinations are required for Department of Obstetrics and Gynecology, Huzhou Central diagnosis confirmation. Hospital (Huzhou, China) were retrospectively analyzed. The study protocol was approved by the Institutional Review Board Introduction of Ethics Committee of Huzhou Central Hospital and written informed consent was obtained from all the patients. Brenner tumors are uncommon surface epithelial-stromal tumors of the ovary, frequently presented in women between CT examinations. CT examinations were performed with their fifth and seventh decades of life. The majority of Brenner Toshiba Aquilionor (Toshiba Medical Systems, Otawara, tumors are benign, and these tumors predominantly present as Japan) or Philips Brilliance 16-slice CT scanners (Philips solid on imaging and pathological examination, although in Medical Systems, Amsterdam, The Netherlands). All patients <30% of cases, serous and mucinous-associated cystadenomas were placed in the supine position and given an appropriate may account for the cystic appearance when the Brenner tumor amount of water to drink to fill the bladder prior to the scan. The CT scan covered the entire primary lesion from the illum attachment and ischial tuberosity attachment, and the scan range was adjusted according to the lesion size in certain cases. Contrast-enhanced CT images were obtained following the Correspondence to: Dr Xinfeng Mao, Department of Radiology, Huzhou Central Hospital, 198 Hongqi Road, Huzhou, injection of 80-100 ml of a nonionic iodinated contrast mate- Zhejiang 313003, P.R. China rial at a concentration of 370 mg/ml [iopamidol (Iopamiron E-mail: [email protected] 370; Bayer AG, Leverkusen, Germany)] or 300 mg/ml [iohexol (Omnipaque 300; Daiichi‑Sankyo Health Care, Tokyo, Japan)] Key words: ovarian tumor, Brenner tumor, computed tomography, at a rate of 2.5-3.0 ml/sec. The parameters of the CT scan were X-ray 120-150 kV, 120 mAs, slice thickness of 1.0-2.0 mm. Arterial and venous phase images were obtained during 25-30 sec and 65-80 sec delay, respectively. 1142 ZHAO et al: CT OF OVARIAN BRENNER TUMORS Figure 1. Bilateral ovarian Brenner tumor. (A-C) Left ovarian Brenner tumor. Round-like solid mass with clear border and multiple scattered amorphous calci- fication focus inside (indicated by the arrow). Moderate enhancement was observed following contrast medium administration. (A) Plain scan; (B) Arterial phase following enhancement; (C) Venous phase following enhancement. (D,E) Right ovarian Brenner tumor. Mass with cystic solid changes and oval shape. Moderate enhancement was observed following contrast medium administration in the solid part, but not in the cystic mass. (D) Plain scan; (E) Enhanced scan. Table I. Clinical features of the 9 cases of ovarian Brenner were 57.2 years, range, 24-80 years. The clinical manifestations tumor. were as follows: 2 cases were postmenopausal and presented Characteristics No. of patients (n=9) with irregular vaginal bleeding; 2 cases presented with abdom- inal swelling pain; 3 cases exhibited uterine leiomyomas; and Postmenopausal 2 2 were detected at the time of physical examination. Postmenopausal bleeding 2 Clinical features of ovarian Brenner tumors. All 9 cases Abdominal swelling pain 2 of ovarian Brenner tumor were unilateral lesions with clear Uterine leiomyomas 3 borders (Table II). Among these cases, 3 were located to the The mean age of patients was 57.2 years (range, 24-80 years). right and 6 were located to the left. Seven cases presented with round- or oval-shaped tumors, and 2 cases presented with irregular- and lobulated-shaped tumors. The largest and smallest size of lesions was 8.1x7.2x3.2 and 1.5x1.2x0.8 cm, respectively, and the mean size was 4.3 cm. Upon morpho- Pathological examination. Pathological samples were stored logical analysis, 2 cases presented with uterine enlargement in 4% paraformaldehyde solution at 4˚C overnight, dehydrated and endometrium thickening, 3 were combined with uterine through a series of graded ethanol solutions (70, 90, 95 and leiomyomas, 1 with uterine leiomyomas and endometrium 100% ethanol and each for 5 min at room temperature), thickening, 2 combined with an adeno-cystic mass, and cleared in xylene (3 times for 5-10 min each), embedded in 1 combined with an ovarian cyst. paraffin and cut into 5 µm thickness sections. Sections were then stained with hematoxylin (1% w/v; 1-2 min at room CT manifestation. The masses were classified according to the temperature) and eosin (0.5% w/v; 2-5 sec at room tempera- cystic and solid ratio inside the lesion as follows: i) 5 cases were ture) for general examination under a Leica microscope (Leica solid mass (Fig. 1). A small amount of low-density necrosis DMI3000 B; Leica, Solms, Germany; x100 magnification). All region was observed inside the lesions. Multiple scattered or the pathological sections were reviewed by a senior pathologist dot‑like calcification with evident enhancement was observed for diagnosis confirmation. The following histological param- in 3 cases of lesions. ii) Cystic-solid lesion in 3 cases (Fig. 1). eters were recorded on the basis of histological analysis and Similar ratios of the cystic and solid component were observed review of the original pathologic reports: Gross configuration in these cystic-solid mixed lesions. The CT value of the (solid or cystic); tumor size (in centimeters); gross tumor color; cystic part was 18‑20 HU and no enhancement was identified microscopic calcifications; and the presence of coexisting following contrast medium administration, whereas moderate ovarian neoplasms or tumor-like lesions. enhancement was observed in the solid part. iii) Cystic lesion in 1 case (Fig. 2). The CT manifestations included single cystic Results lesion with papillary projections and slight enhancement was observed following contrast medium administration. The Patient demographical data. Details of the demographical data detailed CT features of each case of ovarian Brenner tumor of these 9 patients are listed in Table I. The mean age of patients are listed in Table II. Table II. Detailed clinical features and computed tomography manifestation of the ovarian Brenner tumor. CT value of the solid mass (HU) ------------------------------------------------------------- Patient no. Age (years) Location Morphology Size (cm) Type Plain scan Arterial Venous Calcification Comorbidity 1 54 Left Oval 6.5x5 Solid 55 64 73 Multiple and Intramural and subserous uterine scattered shape leiomyomas combined with ONCOLOGY LETTERS 16: 1141-1146, 2018 ONCOLOGY LETTERS 1141-1146, 16: adenomyosis 2 51 Right Round 1.5x1.2x0.8 Solid 48 67 86 None Uterine leiomyomas 3 80 Left Oval 6x5x4.5 Solid 50 89 90 Dot-like shape Intramural leio leiomyomas, post menopausal endometrial hyperproliferation response 4 48 Left Lobulated 4.5x3.8x2.7 Solid 53 75 83 Multiple and Uterine adenomyosis and scattered shape endometrial hyperplasia 5 81 Right Oval 8.1x7.2x3.2 Cystic-solid 56 80 91 Dot- and Endometrial hyperproliferation disk-like shape response 6 41 Left Oval 6.1x5.3x4.7 Cystic-solid 46 68 73 None Left ovarian mucinous cystic adenoma 7 24 Right Lobulated 3.7x2.2x2.0 Cystic-solid 52 69 78 Dot-like shape Ovarian simple cyst 8 66 Left Oval 7.5x3.2x4.4 Cystic 30 38 60 None Right ovarian mucinous cystic adenoma 9 70 Left Oval 6.2x4.2x3.8 Solid 45 63 81 None Intramural uterine leiomyomas combined with adenomyosis HU, Hounsfield unit.