WBR0168
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| Author | [[PageAuthor::Serge Korjian M.D. (Reviewed by Serge Korjian)]] |
|---|---|
| Exam Type | ExamType::USMLE Step 1 |
| Main Category | MainCategory::Pathology |
| Sub Category | SubCategory::Genitourinary, SubCategory::Oncology |
| Prompt | [[Prompt::A 52-year-old woman presents to her gynecologist for her annual check-up. On pelvic examination, the physician palpates a mobile mass in the left adnexa. Her physical examination is otherwise unremarkable. Ultrasound reveals a well-defined, 7x5 cm, lobulated, left-sided ovarian tumor. Laparotomy is performed and the tumor is resected. On gross inspection, the tumor is a well-circumscribed, encapsulated, yellow-tan solid mass. Pathologic examination reveals epithelial ovoid nest cells with longitudinal grooves that resemble coffee beans (shown below). Which of the following is the most likely diagnosis?
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| Answer A | AnswerA::Granulosa cell tumor |
| Answer A Explanation | [[AnswerAExp::A granulosa cell tumor is an estrogen-secreting tumor that contains Call-Exner bodies, follicles filled with eosinophilic secretions.]] |
| Answer B | AnswerB::Brenner tumor |
| Answer B Explanation | [[AnswerBExp::Brenner tumor is usually a unilateral, benign ovarian tumor that appears on histopathological analysis as epithelial ovoid nest cells with longitudinal grooving that have a coffee bean appearance.]] |
| Answer C | AnswerC::Krukenberg tumor |
| Answer C Explanation | [[AnswerCExp::A Krukenberg tumor is characterized by the presence of mucin-secreting signet cells.]] |
| Answer D | AnswerD::Serous cystadenoma |
| Answer D Explanation | [[AnswerDExp::A serous cystadenoma is most likely a bilateral ovarian tumor lined with fallopian tube-like epithelium.]] |
| Answer E | AnswerE::Yolk sac tumor |
| Answer E Explanation | [[AnswerEExp::Frequently malignant, a yolk sac tumor is an ovarian germ cell tumor, often containing Schiller-Duval bodies resembling kidney glomeruli.]] |
| Right Answer | RightAnswer::B |
| Explanation | [[Explanation::Brenner tumor is a rare non-germ cell ovarian tumor characterized by a solid, well-circumscribed, encapsulated, pale yellow-tan morphology. On histopathological analysis, epithelial ovoid nest cells with longitudinal grooving (coffee beans) are important features of Brenner tumor. The diagnosis of Brenner tumor is often made incidentally, with the detection of an adnexal mass during routine physical exam, ultrasound, or laparotomy. The minority of patients present are symptomatic and present with persistent abdominal discomfort of several months duration. Postmenopausal women are more likely to have Brenner tumors. Most tumors are benign and unilateral, with less than 10% being malignant. Educational Objective: Brenner tumor is usually a well-circumscribed benign ovarian tumor that appears on histopathological analysis as epithelial ovoid nest cells with longitudinal grooving that have a coffee bean appearance. |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::Brenner tumor, WBRKeyword::Tumor, WBRKeyword::Tumors, WBRKeyword::Cancer, WBRKeyword::Ovarian cancer, WBRKeyword::Ovary, WBRKeyword::Coffee bean appearance, WBRKeyword::Abdominal mass, WBRKeyword::Histology, WBRKeyword::Gynecology, WBRKeyword::Abdomen, WBRKeyword::Ovary |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |
