67868 Clin Pathol 1995;48:678-679 Brenner tumour of the vagina

A-M H Rashid, H Fox J Clin Pathol: first published as 10.1136/jcp.48.7.678 on 1 July 1995. Downloaded from

Abstract The Brenner tumour was first described by Polyps ofthe vagina are rare and are either Fritz Brenner in 1907,' who postulated that it Departent of of inflammatory/reactive or neoplastic was derived from the granulosa cells of the Pathology, Western origin. A case of extraovarian Brenner ovarian follicles. Apart from a few cases pre- Memorial Hospital, a senting outside the ovary, Brenner tumours are P.O. Box 2005, tumour ofthe vagina in postmenopausal Corner Brook, woman, who presented with a vaginal almost exclusively ovarian.2 Here, we report Newfoundland polyp, is described. The polyp was excised such a tumour arising in a vaginal polyp. A2H 6J7, Canada and on histological examination, had the A-M H Rashid triphasic pattern (transitional, glandular Department of and stromal) characteristic of Brenner Case report Pathology, University tumour. The histogenesis of Brenner A 77 year old diabetic white woman presented of Manchester, Manchester tumour is discussed in the context of this with a few months history of vaginal irritation H Fox unusual location and the controversy ofits and soreness. On pelvic examination, there was origin. a polyp, 2 cm in diameter, arising from the Correspondence to: Dr A-M H Rashid. (J7 Clin Pathol 1995;48:678-679) vaginal vault. No bleeding or signs of infection Accepted for publication were noted. A simple polypectomy under local 1 December 1994 Keywords: Brenner tumour, vagina, histogenesis. anaesthesia was carried out. Past medical history revealed that the patient had had a hysterectomy with bilateral salpingo- oophorectomy for dysfunctional uterine bleed- ing 20 years before.

PATHOLOGY The excised specimen consisted of a smooth surfaced polyp measuring 2 x 1-8 cm at max- imum diameter. On sectioning, the cut surface was grey-yellow in colour and had small cystic areas. Microscopically, the polyp was covered by a slightly thickened vaginal mucosa. Em- http://jcp.bmj.com/ bedded in the fibrocellular connective tissue core were numerous rounded solid islands and nests of uniform cells showing clear cytoplasm and oval shaped, grooved, nuclei reminiscent of transitional type epithelium (fig 1). Some of these islands had central lumina with a pink acellular secretion, whereas within others, oc- on September 29, 2021 by guest. Protected copyright. casional small glandular structures lined by Figure 1 Nests of epithelial cells located within the connective tissue stroma. simple columnar cells were noted (fig 2). The (Haematoxylin and eosin; original magnification x 200.) triphasic (transitional, glandular and stromal) appearance of this polyp is characteristic of Brenner tumour. On review of the previous total hysterectomy specimen, there was no evidence of an ovarian Brenner tumour. The patient was followed for 18 months with no recurrence.

Discussion Neoplasms of the vagina are uncommon. Both benign and malignant tumours are composed of pure or mixed epithelial or stromal elements."4 Most vaginal polyps are benign tumours of connective tissue origin-for example, fibroma, leiomyoma, nerve sheath tumours, haem- angioma, and rhabdomyoma. Of the non- neoplastic polypoid lesions, fibroepithelial and inflammatory granulation polyps are the most common. Figure 2 Gland-like structures within the transitional epithelium. (Haematoxylin and Extraovarian Brenner tumours are extremely eosin; original magnification x 400.) rare. To date, they have been reported in the Brenner tumour of the vagina 679 broad ligament,5-7 the uterus,8 the vagina,9 and ovarian coelomic epithelium via a process of the testicular and para-testicular tissues.'0`2 wolffian differentiation has been supported by For a diagnosis of Brenner tumour, both in- serial reconstruction studies, by its coexistence tegral components (the epithelial and me- with other ovarian tumours, and by ultra- senchymal stroma) must be present.278 structural studies.'3 Remnants of the wolffian J Clin Pathol: first published as 10.1136/jcp.48.7.678 on 1 July 1995. Downloaded from There is only one documented case of ex- ductal system are known to occur in the broad traovarian Brenner tumour of the vagina in the ligament, cervix and vagina, and must be ser- literature.9 A similar case, however, has been iously regarded as an alternative source of the reported by Buntine et al3 who called the polyp neoplasm in an extraovarian site.2 This theory "benign mixed mullerian tumour ofthe vagina" is supported by fact that the tumour is biphasic and pointed out its resemblance to Brenner and that it resembles the transitional epithelium tumour. Shevchuk et al,4 in their case of "malig- lining the genitourinary tract. nant mixed tumour of the vagina", were prob- A Brenner tumour of the vagina could there- ably describing a malignant Brenner tumour. fore be derived directly from wolffian remnants The authors commented that the ultra- at this site or could originate from mullerian structural findings of their case confirmed ductal tissue which forms the upper part of the urothelial differentiation and that the tumour vagina, by a process of wolffian metaplasia. appeared to arise from mesonephric remnants. 1 Brenner F. Ds oophoroma folliculare. Frank Zeitschr Path It seems that the reason for the confusion in 1907;1: 150-7 1. the nomenclature of this neoplasm is because 2 Pschera H, Wikstrom B. Extraovarian tumor coexisting with serous cystadenoma. Gynecol Obstet Invest 1991 ;31: 185-7. of its bi- or triphasic nature. 3 Buntine DW, Henderson PR, Biggs JSG. Benign mullerian The histogenesis of Brenner tumour is still mixed tumor of the vagina. Gynecol Oncol 1979;8:21-6. 4 Shevchuk MM, Fenoglio CM, Lattes R, Frick HC, Richart controversial.2613 The important proposed sites RM. Malignant mixed tumor ofthe vagina probably arising of origin include ovarian surface epithelium6'3; in mesonephric rests. Cancer 1978;42:214-23. 5 Robinson TG. Extraovarian Brenner tumor. Obstet Gynecol remnants of embryonic coelomic epithe- 1950;57:890-1. lium248; displaced mesothelium69 12; rests of 6 Hampton HL, Huffman HT, Meeks RG. Extraovarian Bren- ner tumour. Obstet Gynecol 1992;79:844-6. Waltbard's cells612 13; and remnants of mull- 7 Wagner I, BettendorfU. Extraovarian Brenner tumour. Case erian,29-12 mesonephric,27 1 13 or wolffian report and review. Arch Gynecol 1980;229:191-6. 8 Arhelger RB, Bocian JJ. Brenner tumor ofthe uterus. Cancer ducts.49 1011 13 Other less likely possible sources 1976;38:1741-3. are as follows: ovarian stroma2 8 13; rete 9 Chen KTK. Brenner tumor of the vagina. Diagn Gynecol 1 Obstet 1981;3:255-8. ovarii2 13; rete testis 2; germ cell (teratomatous) 10 Goldman RL. A Brenner tumor of the testis. Cancer 1970; derivation7 12 13; granulosa cells'; ectopic (ac- 26:853-6. 11 Ross L. Paratesticular Brenner-like tumor. Cancer 1968;21: cessory) ovarian tissue8; ovotestis'2; and ves- 722-6. tibular glands of the vagina.9 12 Young RH, Scully RE. Testicular and paratesticular tumors and tumor-like lesions of ovarian common epithelial and The presence of the tumour in men and at mullerian types. A report of four cases and review of the sites far away from the ovary indicates that this literature. Am J Clin Pathol 1986;86:146-52. 13 Balasa RW, Adcock LL, Prem KA, Dehner LP. The Brenner neoplasm is not invariably of ovarian origin. tumor: a clinicopathological review. Obstet Gynecol 1976; The concept of this neoplasm originating from 50:120-8. http://jcp.bmj.com/

I Clin Pathol 1995;48:679-681

Departent of on September 29, 2021 by guest. Protected copyright. Haematology, St Luc Hospital, Catholic University of Louvain, Brussels, Belgium P-glycoprotein positive, drug resistant invasive J L Gala J Rodhain lymphoepithelial thymoma: treatment response A Ferrant Department of to chemotherapy with cyclosporin and quinine Pathology H Noel Department of Haematology, Queen J L Gala, H Noel, J Rodhain, D F F Ma, A Ferrant Astrid Military Hospital, Brussels, Belgium J L Gala Abstract therapy without resolution of the tumour. Department of A case ofinvasive drug resistant thymoma, More than 90% ofthe malignant epithelial Haematology, Royal were for North Shore Hospital, expressing P-glycoprotein, which showed cells strongly positive P-gly- Sydney, Australia noticeable clinical response to chemo- coprotein and based on this observation, D FF Ma therapy and the multidrug resistance cyclosporin and quinine were added to the Correspondence to: modulating agents cyclosporin and quin- chemotherapy regimen. The mediastinal Dr J L Gala, Department of ine is reported. A 46 year old man pre- mass completely resolved and the size of Haematology, Laboratory of Clinical Molecular Biology, sented with severe left shoulder pain and the pleural metastasis decreased sub- Cliniques Universitaires St a diagnosis of invasive lymphoepithelial stantially. The patient, however, died of Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium. thymoma was made following chest x ray an intercurrent infection. This case report Accepted for publication and a computed tomography scan. The highlights the feasibility and efficacy of 26 September 1994 patient underwent extensive chemo- using cyclosporin and quinine in com-