View source for WBR0168

{{WBRQuestion
|QuestionAuthor={{Rim}}
|ExamType=USMLE Step 1
|MainCategory=Pathology
|SubCategory=Head and Neck, Oncology
|MainCategory=Pathology
|SubCategory=Head and Neck, Oncology
|MainCategory=Pathology
|SubCategory=Head and Neck, Oncology
|MainCategory=Pathology
|MainCategory=Pathology
|SubCategory=Head and Neck, Oncology
|MainCategory=Pathology
|SubCategory=Head and Neck, Oncology
|MainCategory=Pathology
|SubCategory=Head and Neck, Oncology
|MainCategory=Pathology
|SubCategory=Head and Neck, Oncology
|MainCategory=Pathology
|MainCategory=Pathology
|SubCategory=Head and Neck, Oncology
|Prompt=A 52 year old woman presents to her gynecologist for her annual check-up. During pelvic examination, the physician palpates a mobile mass on the left side only. Her physical examination is otherwise normal. Ultrasound shows a 7x5 cm well-defined lobulated left-sided ovarian tumor. Laparotomy is performed and the tumor is resected. Grossly, the tumor appears as a well-circumscribed encapsulated yellow-tan solid mass. On pathology, epithelial ovoid nest cells with longitudinal grooves that resemble coffee beans  are found (shown below). What is the most likely diagnosis?

[[Image:WBR0168.jpg|500px]]
|Explanation=The patient is most likely diagnosed with Brenner tumor, an ovarian non-germ cell tumor characterized by the presence of a solid well-circumscribed encapsulated pale yellow-tan colored tumor that shows epithelial ovoid nest cells with longitudinal grooving (coffee beans) on pathology. Brenner tumor is not a common diagnosis. It usually presents as an incidental finding during physical exam, ultrasound, or laparotomy. Other patients might complain of persistent abdominal discomfort of several months duration. Postmenopausal women are more likely to have Brenner tumor. Most tumors are benign and unilateral, with less than 10% being malignant. 

Educational Objective:
Brenner tumor is a well-circumscribed benign unilateral ovarian tumor that appears as epithelial ovoid nest cells with longitudinal grooving (coffee bean appearance) on pathology.

Reference:
Borah T, Mahanta RK, Bora BD, et al. Brenner tumor of ovary: An incidental finding. J Midlife Health. 2011;2(1):40-41.

|AnswerA=Granulosa cell tumor
|AnswerAExp=Granulosa cell tumor is an estrogen-secreting tumor that contains Call-Exner bodies, which are follicles filled with eosinophilic secretions.
|AnswerB=Brenner tumor
|AnswerBExp=Brenner tumor is a unilateral benign ovarian tumor that appears as epithelial ovoid nest cells with longitudinal grooving on pathology (coffee bean appearance).
|AnswerC=Krukenberg tumor
|AnswerCExp=Krukenberg tumor is a tumor characterized by the presence of mucin-secreting signet cells.
|AnswerD=Serous cystadenoma
|AnswerDExp=Serous cystadenoma is most likely a bilateral ovarian tumor lined with fallopian tube-like epithelium.
|AnswerE=Yolk sac tumor
|AnswerEExp=Yolk sac tumor is an ovarian germ cell tumor that is usually malignant. It often contains Schiller-Duval bodies that resemble kidney glomeruli.
|RightAnswer=B
|WBRKeyword=brenner, tumor, tumors, ovarian, germ, non, cell, coffee, bean, appearance, gross, pathology, incidental, finding, yellow, tan, color, ovary, ovaries, benign, unilateral, epithelial, nest, cell, ovoid, groove, grooving
|Approved=No
}}