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Report of a case of bilateral ovarian tumors of the brenner type
3. If repeated at more may not only bring on a If this latter is true, it ing fetal thymus, in utero,
sriile
Eh$m$~,
servat&‘on 901
JOHN
(From
Communication, March 21, 1932. George W. : Personal . : A Study of Thymophysin in First Stage of Labor with Its Effect on Blood Prcssur~. hm. .I. Surg., New Series 19:
WASHINGTON
REPORT M.
frequent intervals or perhaps in larger closes, “nntural” labor but carry il to termination. givcas rise to the supposition that the develop.. may haye somet.hing to do with labor.
(2) DerSome Ob429, 193.1.
AVENUE.
OF A CASE OF RILATERAL OVARIAN OF THE RRENNER TYPE” MAURY,
the Departments
M.D., F.A.C.S., AKD F.S.C.P., MEMPHIS, of Gynecology College
Nanny
TTJMORS
C-1. SCHMEISSER,
M.D.,
TENN.
and Pathology, of Xedicinej
University
of l’emessee,
T
HE purpose of this paper is to add to the published cases of Brenner ‘a tumor of the ovary a bilateral case, apparently the first to be recorded. Photographs and photomicrographs of each tumor are presented. M. G., a colored widow, about seventy years of age, was admitted to the Memphis the chief complaint of tumor of the abGeneral Hospital on April 9, 1930, with domen. Four months before admission she commenced to have frequent urination and constipation and noticed that her abdomen was enlarging. She had had cardiac palpitation on exertion and pain in the lower left abdominal quadrant at times. Her teeth and tonsils were removed some years ago because she had articular rheumatism. Menses began at fourteen years of age, recurring every twenty-eight days, lasting three days, until t.he menopause was established fifteen years ago. Since then she has had no vaginal discharge, bloody or otherwise. Her heart was slightly enlarged but there Patient had a marked areus senilis. was no murmur. The apex beat was a little to the left and below the normal The abdomen presented a smooth symmetrical position. The lungs were normal. enlargement from the ensiform to the pubes, with filling of both flanks. Dullness on percussion was present everywhere except for an arc of resonance below the co&al margin. A fluctuation wave was easily elicited. Temperature was 99” F., pulse 90, blood pressure 130 systolic, and SO diastolic. The external genitals, cervix, and uterus were in a state of senile atrophy. The To the right abdominal tumor could be felt extending well down into the pelvis. of the uterus could be felt a flattened hard mass about 6 cm. in diameter. It was separate from the uterus and apparently not connected with the other tumor. The urine was normal. Red blood cells numbered 4,800,OOO. The hemoglobin was 82 per cent. The white blood cells numbered 5,100, of which 71 per cent were neutrophilic polymorphonuclears. The sedimentation time was two hours. Wassermann test was negative. *Read before the Memphis and Shelby County Medical Society, February -7. 1833. Sectfons from this case were sent to. Dr. Howard C. Taylor, Jr.. of Xew York. -who recomhsed them as of the Brenner tyDe of ovarian tumor and sent them to Professor Robert Meyer of Berlin who ~oonrlrmed the diagnosis.
Operation.-The patient was operated upon April 15, 1932. From the left side was removed a pedunculated pseudomucinous cystadenoma which filled the abdomen. There were no adhesions to Its capsule was smooth and of the typical llenrly hue. The right ovary VTRS the seat of a solid tumor which parietal peritoneum or viscera. macroscopically was thought to 1~ a diI’fus? fihrom. ‘I’hcr~~ was no free fluid in the abdominal
cavity.
Patl&ologic
Ezanrinalion.-~acros~,oylic
very
firm,
Fig.
L-Photograph ovary
Fig. gzos
.
irregular,
bluish
white,
:
translucent
showing pseudomucinous everted. Many cysts are
The
right
mass
ovary
with
was
smooth
glistening
cystoma type of Brenner’s tumor seen, some of which are open.
Z.-Section of tumor shown in Fig. 1. Note and fibrous tissue with two nests of epithelial Photomicrograph x200.
the ovarian type cells. characterlstlc
face resembling in a. general way the ovary in shape. It rncasured and weighed 100 gm. A normal uterine t,ube was partly aMached the mass near the mesovarium. On sectioning the mass, the knife surface consisted of fine, bluish white The surface was everywhere translucent areas (Fig. 1).
converted and
met with considerable fibers enclosing small and very firm with
into
H sur-
of left
?f stroma riC,h of Brenner 8
9 by 6 by 3 cm. to the surface oi’
resistance. The cut areas of pink tissue. several small, gritty
The left ovary was converted into a round, fluctuating nutss with an intact outer membrane, whose surface was sulttoth and glistening. Thr mass measured 20 cm. in diameter and weighed 3,000 am. 9 norm;11 utrrirte tubes was attar~hcd to its surface. On sectioning the mass, it was found to consist of one ? large cavity with many rr from the inner surfa~ of its thick. bluish white, iransluccut smaller cysts projcctin, The large and smaller cysts \vcre filled with a mueoid material and fibrous wall. lined by a pink membrane, mosily smooth but in a few places mosolike (Fig. 1 1.
Fig. 3.-Lower epithelial nest of Brenner’s type shown in Fig. 2, under higher magnification. Note in the periphery the single row of flat cells with dark, elongated nuclei and in the center coalescing, vascular spaces of degeneration partly surrounded by a single layer of flat cells with dark, elongated nuclei. Photomicrograph X753.
Fig. I.--Section of tumor shown in Fig. 1. Note wall of cyst, ing pseudomucin and lined by pseudomucin secreting, columnar stroma are seen epithelial nests and strands of Brenner’s type Fig. 2. Photomicrograph X290.
with lumen Containepithelium. In the similar to those in
M&osq&.--The right ovarian mass consisted mostly of stroma, resembling that of the ovary, rich in cells and fibrous tissue, running in various directions. Scattered through the stroma were. small nests and strands sometimes joined by slender processes, of large, polygonal cells with pale cytoplasm and small, dark, round or eliiptical nuclei. A single row of flat cells with dark, elongated nuclei, surrounded and aepfkrated them from the stroma. No intercellular stroma was demonstrated.
BISKIFD
:
DOUBLE
VAGINA,
CERVIX,
AND
293
UTERUS
These cells sometimes showed small droplet spaces in their cytoplasm. Some of these cell nests showed in their center and at their periphery just visible and larger vacuolar spaces containing cellular and nuclear fragments. These spaces were partly surrounded by a single layer of flat cells with dark, elongated nuclei. Actual cysts were not seen. Blood vessels were scarce. A few small, partly calcified, necrotic areas were present. All tissues appeared benign. There uas no sharp distinction between tumor and ovarian stroma (Figs. 2 and 3). The cavities of the cystic mass of the left ovary contained pseudomucin and were lined by pseudomucin aecrcting eobmmar epit!ielium. This in places was of several layers, in others presented a papillary structure. A few mitotic figures could be seen, but there wa5 no epithelial infiltration of the stroma. Here and there in the stroma were small nests and strands of large, polygonal cells similar to these seen in the right ovarian mass. The tumor was considered benign (Fig. 4). D&xgnosis.-Solid type of Brenner’s tumor of right ovary. Pseudomucinous cystoma type of Brenner’s tumor of left ovary. Progress.-Patient ‘s convalescence was uneventful, and she was discharged improved to the Out-Patient Department on April 29, 1932. DISCUSSION The “Solid
right ovarian tumor tumors of Brenner’s
of our case would be placed under type with or without cysts. ”
The left ovarian tumor of our case would be placed “ Cystomas with nodules of Brenner’s tumor in margins, mucin epithelium. ”
Meyer’s
Group
A,
under Meyer’s Group B, with and without pseudo-
Ours is not only a bilateral case of Brenner ‘s tumor of the ovary but it presents in the same case’ a solid type which stands at the one end and a pseudomucinous cystoma which stands at the other end of Meyer’s series of Brenner ‘s tumor.” We are University 915
indebted for of Tennessee,
MADISON
A CASE
the photographs Pathological
specimens
to Mr.
Joseph
L. Scianni.
AVENUE
OF DOUBLE LEONARD (From
T
of these Institute.
H.
VAGINA, BISKIND,
t7Le Gynecologid
HIS unusual case was observed Braun of the Health Department here with his kind permission.
CERVIX, KD.,
,Seruice,
CLEVELAND, Mt.
Sinai
AND
UTERUSt 0.
Hospital)
by the author through the courtesy of the City of Cleveland, and
of Dr. E. J. is presented
This patient, H. M. B., is an eighteen-year-old Cleveland-born girl, first seen as an institutional inmate May, 1932. The anomaly to be described was discovered on making a routine vaginal examination at the time of her admission to this institution. Menses began at twelve years. After the first two periods these occurred rcgularly at approximately twenty-eight-day intervals and lasted three and one-half to four days. The flow was moderate in amount and no dysmenorrhea was present ‘Meyer, R. : Arch. f. GynBk. 148: 541. 1932. tpresented before the Clinical Pathological Section, January 6. 1933.
Cleveland
Academy
of Medicine,
sriile
Eh$m$~,
servat&‘on 901
JOHN
(From
Communication, March 21, 1932. George W. : Personal . : A Study of Thymophysin in First Stage of Labor with Its Effect on Blood Prcssur~. hm. .I. Surg., New Series 19:
WASHINGTON
REPORT M.
frequent intervals or perhaps in larger closes, “nntural” labor but carry il to termination. givcas rise to the supposition that the develop.. may haye somet.hing to do with labor.
(2) DerSome Ob429, 193.1.
AVENUE.
OF A CASE OF RILATERAL OVARIAN OF THE RRENNER TYPE” MAURY,
the Departments
M.D., F.A.C.S., AKD F.S.C.P., MEMPHIS, of Gynecology College
Nanny
TTJMORS
C-1. SCHMEISSER,
M.D.,
TENN.
and Pathology, of Xedicinej
University
of l’emessee,
T
HE purpose of this paper is to add to the published cases of Brenner ‘a tumor of the ovary a bilateral case, apparently the first to be recorded. Photographs and photomicrographs of each tumor are presented. M. G., a colored widow, about seventy years of age, was admitted to the Memphis the chief complaint of tumor of the abGeneral Hospital on April 9, 1930, with domen. Four months before admission she commenced to have frequent urination and constipation and noticed that her abdomen was enlarging. She had had cardiac palpitation on exertion and pain in the lower left abdominal quadrant at times. Her teeth and tonsils were removed some years ago because she had articular rheumatism. Menses began at fourteen years of age, recurring every twenty-eight days, lasting three days, until t.he menopause was established fifteen years ago. Since then she has had no vaginal discharge, bloody or otherwise. Her heart was slightly enlarged but there Patient had a marked areus senilis. was no murmur. The apex beat was a little to the left and below the normal The abdomen presented a smooth symmetrical position. The lungs were normal. enlargement from the ensiform to the pubes, with filling of both flanks. Dullness on percussion was present everywhere except for an arc of resonance below the co&al margin. A fluctuation wave was easily elicited. Temperature was 99” F., pulse 90, blood pressure 130 systolic, and SO diastolic. The external genitals, cervix, and uterus were in a state of senile atrophy. The To the right abdominal tumor could be felt extending well down into the pelvis. of the uterus could be felt a flattened hard mass about 6 cm. in diameter. It was separate from the uterus and apparently not connected with the other tumor. The urine was normal. Red blood cells numbered 4,800,OOO. The hemoglobin was 82 per cent. The white blood cells numbered 5,100, of which 71 per cent were neutrophilic polymorphonuclears. The sedimentation time was two hours. Wassermann test was negative. *Read before the Memphis and Shelby County Medical Society, February -7. 1833. Sectfons from this case were sent to. Dr. Howard C. Taylor, Jr.. of Xew York. -who recomhsed them as of the Brenner tyDe of ovarian tumor and sent them to Professor Robert Meyer of Berlin who ~oonrlrmed the diagnosis.
Operation.-The patient was operated upon April 15, 1932. From the left side was removed a pedunculated pseudomucinous cystadenoma which filled the abdomen. There were no adhesions to Its capsule was smooth and of the typical llenrly hue. The right ovary VTRS the seat of a solid tumor which parietal peritoneum or viscera. macroscopically was thought to 1~ a diI’fus? fihrom. ‘I’hcr~~ was no free fluid in the abdominal
cavity.
Patl&ologic
Ezanrinalion.-~acros~,oylic
very
firm,
Fig.
L-Photograph ovary
Fig. gzos
.
irregular,
bluish
white,
:
translucent
showing pseudomucinous everted. Many cysts are
The
right
mass
ovary
with
was
smooth
glistening
cystoma type of Brenner’s tumor seen, some of which are open.
Z.-Section of tumor shown in Fig. 1. Note and fibrous tissue with two nests of epithelial Photomicrograph x200.
the ovarian type cells. characterlstlc
face resembling in a. general way the ovary in shape. It rncasured and weighed 100 gm. A normal uterine t,ube was partly aMached the mass near the mesovarium. On sectioning the mass, the knife surface consisted of fine, bluish white The surface was everywhere translucent areas (Fig. 1).
converted and
met with considerable fibers enclosing small and very firm with
into
H sur-
of left
?f stroma riC,h of Brenner 8
9 by 6 by 3 cm. to the surface oi’
resistance. The cut areas of pink tissue. several small, gritty
The left ovary was converted into a round, fluctuating nutss with an intact outer membrane, whose surface was sulttoth and glistening. Thr mass measured 20 cm. in diameter and weighed 3,000 am. 9 norm;11 utrrirte tubes was attar~hcd to its surface. On sectioning the mass, it was found to consist of one ? large cavity with many rr from the inner surfa~ of its thick. bluish white, iransluccut smaller cysts projcctin, The large and smaller cysts \vcre filled with a mueoid material and fibrous wall. lined by a pink membrane, mosily smooth but in a few places mosolike (Fig. 1 1.
Fig. 3.-Lower epithelial nest of Brenner’s type shown in Fig. 2, under higher magnification. Note in the periphery the single row of flat cells with dark, elongated nuclei and in the center coalescing, vascular spaces of degeneration partly surrounded by a single layer of flat cells with dark, elongated nuclei. Photomicrograph X753.
Fig. I.--Section of tumor shown in Fig. 1. Note wall of cyst, ing pseudomucin and lined by pseudomucin secreting, columnar stroma are seen epithelial nests and strands of Brenner’s type Fig. 2. Photomicrograph X290.
with lumen Containepithelium. In the similar to those in
M&osq&.--The right ovarian mass consisted mostly of stroma, resembling that of the ovary, rich in cells and fibrous tissue, running in various directions. Scattered through the stroma were. small nests and strands sometimes joined by slender processes, of large, polygonal cells with pale cytoplasm and small, dark, round or eliiptical nuclei. A single row of flat cells with dark, elongated nuclei, surrounded and aepfkrated them from the stroma. No intercellular stroma was demonstrated.
BISKIFD
:
DOUBLE
VAGINA,
CERVIX,
AND
293
UTERUS
These cells sometimes showed small droplet spaces in their cytoplasm. Some of these cell nests showed in their center and at their periphery just visible and larger vacuolar spaces containing cellular and nuclear fragments. These spaces were partly surrounded by a single layer of flat cells with dark, elongated nuclei. Actual cysts were not seen. Blood vessels were scarce. A few small, partly calcified, necrotic areas were present. All tissues appeared benign. There uas no sharp distinction between tumor and ovarian stroma (Figs. 2 and 3). The cavities of the cystic mass of the left ovary contained pseudomucin and were lined by pseudomucin aecrcting eobmmar epit!ielium. This in places was of several layers, in others presented a papillary structure. A few mitotic figures could be seen, but there wa5 no epithelial infiltration of the stroma. Here and there in the stroma were small nests and strands of large, polygonal cells similar to these seen in the right ovarian mass. The tumor was considered benign (Fig. 4). D&xgnosis.-Solid type of Brenner’s tumor of right ovary. Pseudomucinous cystoma type of Brenner’s tumor of left ovary. Progress.-Patient ‘s convalescence was uneventful, and she was discharged improved to the Out-Patient Department on April 29, 1932. DISCUSSION The “Solid
right ovarian tumor tumors of Brenner’s
of our case would be placed under type with or without cysts. ”
The left ovarian tumor of our case would be placed “ Cystomas with nodules of Brenner’s tumor in margins, mucin epithelium. ”
Meyer’s
Group
A,
under Meyer’s Group B, with and without pseudo-
Ours is not only a bilateral case of Brenner ‘s tumor of the ovary but it presents in the same case’ a solid type which stands at the one end and a pseudomucinous cystoma which stands at the other end of Meyer’s series of Brenner ‘s tumor.” We are University 915
indebted for of Tennessee,
MADISON
A CASE
the photographs Pathological
specimens
to Mr.
Joseph
L. Scianni.
AVENUE
OF DOUBLE LEONARD (From
T
of these Institute.
H.
VAGINA, BISKIND,
t7Le Gynecologid
HIS unusual case was observed Braun of the Health Department here with his kind permission.
CERVIX, KD.,
,Seruice,
CLEVELAND, Mt.
Sinai
AND
UTERUSt 0.
Hospital)
by the author through the courtesy of the City of Cleveland, and
of Dr. E. J. is presented
This patient, H. M. B., is an eighteen-year-old Cleveland-born girl, first seen as an institutional inmate May, 1932. The anomaly to be described was discovered on making a routine vaginal examination at the time of her admission to this institution. Menses began at twelve years. After the first two periods these occurred rcgularly at approximately twenty-eight-day intervals and lasted three and one-half to four days. The flow was moderate in amount and no dysmenorrhea was present ‘Meyer, R. : Arch. f. GynBk. 148: 541. 1932. tpresented before the Clinical Pathological Section, January 6. 1933.
Cleveland
Academy
of Medicine,