Morphologic alterations of ovarian malignant Brenner tumors following chemotherapy

Interval debulking surgery following neoadjuvant chemotherapy has become an alternative management for patients with advanced ovarian cancer. However, chemotherapy-induced alterations in cellular morphology may cause diagnostic difficulties for pathologists and inappropriate management by clinicians. We investigated the cytomorphological changes produced by chemotherapy in cytologic and tissue specimens of ovarian malignant Brenner tumors (MBTs). To the best of our knowledge, no data are available on the effect of chemotherapy on MBT cytomorphology. We analyzed cytological and histopathological features of MBT using scraping cytologic preparations, routine hematoxylin and eosin staining, and immunohistochemistry. We also described chemotherapy-induced cytomorphological changes of MBT. Histopathological examination revealed one case with a substantially increased cytologic atypia, including extreme nuclear enlargement, marked nuclear pleomorphism, and multiple, prominent nucleoli. Necrosis or degenerative change was not evident. In contrast, another case displayed large coagulative tumor cell necrosis, hemorrhage, and fibrosis. Irregularly distributed islands, tumor cells in sheets or cords or scattered individually were located adjacent to the necrotic areas. The individual tumor cells showed large, bizarre, degenerative-appearing nuclei with smudged or clumped chromatin. These cells had large amounts of dense, eosinophilic cytoplasm with microvesiculation and macrovesiculation. Experiences with chemotherapy-induced cytomorphological changes of MBT have been limited. This study demonstrated the effect of chemotherapy on MBT cytomorphology. Preoperative chemotherapy is increasingly used to manage ovarian cancer. Therefore, pathologists should be aware of the morphological effects of chemotherapy.