Introduction
Brenner tumour is a rare ovarian surface epithelial tumour. It is usually asymptomatic and often discovered incidentally. The following is a case of benign bilateral Brenner tumour of ovary presenting acutely and treated laparoscopically.
Clinical description
A 45 year old woman presented with acute abdominal pain. A CT scan of her abdomen and pelvis demonstrated bilateral complex, predominantly solid ovarian masses, 15cm diameter on the right and 7cm diameter on the left, with no ascites, abdomino-pelvic lymphadenopathy or omental or peritoneal lesions. Pelvic ultrasound scan confirmed the findings and suggested torsion of the right ovarian mass. Ovarian tumour markers were normal. After consultation with the Gynaecological Oncology team, she was taken to theatre for a laparoscopic bilateral salpingo-oophorectomy. Intraoperatively, the larger, right ovarian mass was found to be torted 360 degrees. It was de-torted and salpingo-oophorectomy was performed. The mass was retrieved with a bag and morcellated manually at the extended umbilical port site within the bag. Frozen section revealed a benign Brenner tumour. Left salpingo-oophorectomy was subsequently performed and retrieved in a similar manner. The patient recovered well post-operatively and was discharged home on Day 2. The final histopathology confirmed bilateral benign Brenner tumour, with an associated right mucinous cystadenoma.
Discussion
Brenner tumour of the ovary is a rare neoplasm, accounting for 1.4-2.5% of all ovarian tumours. It usually occurs in post-menopausal women. Most cases of Brenner tumour are benign and less than 5% are proliferative or borderline, and association with other tumours such as benign serous or mucinous cystadenoma is not uncommon. Due to the large size of this patient’s masses and their complex ultrasound appearances, she was initially considered for midline laparotomy for bilateral salpingo-oophorectomy with frozen section. However, due to multiple co-morbidities (elevated BMI, ischaemic heart disease) and the inability to cease her aspirin due to relatively recent coronary arterial stenting, a laparoscopic approach was employed. Fortunately, the procedure was able to be carried out entirely laparoscopically, with the main difficulty being the need to morcellate the mass within a bag in order to remove from the abdomen.
Conclusion
Although rare, Brenner tumour should be considered in large, well circumscribed complex ovarian masses with a predominantly solid component. Such tumours can be treated effectively via a laparoscopic approach, but consideration needs to be given to safe methods of specimen retrieval in order to prevent dissemination of neoplasm.