WBR0168

Author	[[PageAuthor::Serge Korjian M.D. (Reviewed by Alison Leibowitz) (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 observed to be a well-circumscribed, encapsulated, yellow-tan solid mass. Pathologic examination reveals epithelial ovoid nest cells with longitudinal grooves, resembling 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::A Brenner tumor is a unilateral, benign ovarian tumor that manifests as epithelial ovoid nest cells with longitudinal grooving on pathology (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::The patient is most likely diagnosed with a Brenner tumor, an ovarian non-germ cell tumor characterized by the presence of a solid, well-circumscribed, encapsulated pale yellow-tan 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 tumors. Most tumors are benign and unilateral, with less than 10% being malignant. Educational Objective: A 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. References: Borah T, Mahanta RK, Bora BD, et al. Brenner tumor of ovary: An incidental finding. J Midlife Health. 2011;2(1):40-41.]]
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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