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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}
|QuestionAuthor= {{SSK}} (Reviewed by Serge Korjian)
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Pathology
|MainCategory=Pathology
Line 8: Line 8:
|MainCategory=Pathology
|MainCategory=Pathology
|SubCategory=Genitourinary, Oncology
|SubCategory=Genitourinary, Oncology
|MainCategory=Pathology
|MainCategory=Pathology
|MainCategory=Pathology
|MainCategory=Pathology
|MainCategory=Pathology
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|MainCategory=Pathology
|MainCategory=Pathology
|SubCategory=Genitourinary, Oncology
|SubCategory=Genitourinary, 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?
|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?<br>


[[Image:WBR0168.jpg|500px]]
[[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.
|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 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
|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.
|AnswerAExp=A [[granulosa cell tumor]] is an estrogen-secreting tumor that contains Call-Exner bodies, follicles filled with eosinophilic secretions.
|AnswerB=Brenner tumor
|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).
|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.
|AnswerC=Krukenberg tumor
|AnswerC=Krukenberg tumor
|AnswerCExp=Krukenberg tumor is a tumor characterized by the presence of mucin-secreting signet cells.
|AnswerCExp=A [[Krukenberg tumor]] is characterized by the presence of mucin-secreting signet cells.
|AnswerD=Serous cystadenoma
|AnswerD=Serous cystadenoma
|AnswerDExp=Serous cystadenoma is most likely a bilateral ovarian tumor lined with fallopian tube-like epithelium.
|AnswerDExp=A [[serous cystadenoma]] is most likely a bilateral ovarian tumor lined with fallopian tube-like epithelium.
|AnswerE=Yolk sac tumor
|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.
|AnswerEExp=Frequently malignant, a [[yolk sac tumor]] is an ovarian germ cell tumor, often containing Schiller-Duval bodies resembling kidney glomeruli.
|EducationalObjectives=[[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.
|References=Borah T, Mahanta RK, Bora BD, et al. Brenner tumor of ovary: An incidental finding. J Midlife Health.2011;2(1):40-41.<br>
First Aid 2014 page 582
|RightAnswer=B
|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
|WBRKeyword=Brenner tumor, Tumor, Tumors, Cancer, Ovarian cancer, Ovary, Coffee bean appearance, Abdominal mass, Histology, Gynecology, Abdomen, Ovary
|Approved=No
|Approved=Yes
}}
}}

Latest revision as of 23:34, 27 October 2020
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?

]]

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.
References: Borah T, Mahanta RK, Bora BD, et al. Brenner tumor of ovary: An incidental finding. J Midlife Health.2011;2(1):40-41.
First Aid 2014 page 582]]

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
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