Transitional Cell Tumors of the Ovary

Background

Transitional cell tumors (TCC) of the ovary bear a striking histologic resemblance to transitional cell tumors found in the urinary tract. For many years, these group of tumors were collectively known as Brenner tumors. The tumors have been divided into three main categories:

Benign Transitional Cell Tumor (Brenner Tumor)
Atypical Proliferating Transitional Cell Tumors (Borderline or Low Malignant Potential)
Malignant Transitional Cell Tumors (Malignant Brenner Tumors)

Only the malignant tumor may present with any significant symptoms and abdominal pain and swelling with uterine bleeding may occur in 20%. Before a diagnosis of a primary malignant transitional cell tumor of the ovary is made, the pathologist and treating physician must a transitional cell carcinoma in other organs, especially the urinary bladder and urogenital tract. In these cases, the possibility of a metastatic tumor should be excluded.

OUTLINE

Epidemiology

Pathogenesis

Gross Appearance and Clinical Variants

Histopathological Features and Variants

Special Stains/Immunohistochemistry/Electron Microscopy

Differential Diagnosis

Prognosis

Treatment

Commonly Used Terms

Internet Links

EPIDEMIOLOGY CHARACTERIZATION

SYNONYMS Brenner tumor

INCIDENCE

Benign 1-2% of all primary ovarian tumors

Atypical Proliferating Transitional cell tumors (Low malignant potential) Rare

Malignant transitional cell tumor Rare

AGE RANGE-MEDIAN

Benign Mean 50 years
4-8th decades range

Atypical Proliferating Transitional cell tumors (Low malignant potential) Mean 60 years

Malignant transitional cell tumor Mean age 55 years

PATHOGENESIS CHARACTERIZATION

Derived from ovarian surface epithelium

GROSS APPEARANCE/CLINICAL VARIANTS CHARACTERIZATION

General

Benign
6-7% bilateral
Unilateral tumors more common in left ovary

Usually between 2-10 cm
Well circumscribed with lobulated surface which is gray, white or yellow

Atypical Proliferating Transitional cell tumors (Low malignant potential) Usually unilateral, multilocular cysts
10-25 cm in diameter

Friable papillary masses projecting into cyst lumens similar to low grade papillary carcinomas of the urinary bladder

Malignant transitional cell tumor
Mean 20 cm
Range 10-30 cm
Rarely bilateral

Cystic spaces lined by friable, polypoid mural nodules
Hemorrhage and necrosis common
50% with calcifications

VARIANTS

ECTOPIC Rare tumors have occurred in ectopic accessory ovaries

PARATUBAL

Parafallopian tube transitional cell carcinoma.

Paner GP, Gonzalez M, Al-Masri H, Smith DM, Husain AN.

Department of Pathology, Room 2233, Bldg. 110, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA.

Gynecol Oncol 2002 Sep;86(3):379-83 Abstract quote
BACKGROUND: Transitional cell carcinoma (TCC) has recently been acknowledged as a distinct histologic pattern of the uncommon primary fallopian tube carcinoma. However, rare cases of TCC that are closely associated to the extraluminal portion of the tube remain widely unrecognized.

CASE: We present a left adnexal high-grade TCC in a 56-year-old postmenopausal woman with an elevated serum CA-125 level. The tumor was attached by a small stalk to the serosal surface of the left fallopian tube and was completely separate from the uninvolved uterus and ipsilateral ovary. Histologic examination of the tubal lumen epithelium revealed neither atypia nor involvement by the neoplasm. Immunohistochemistry showed the tumor cells to be positive for pankeratin, calretinin, progesterone and estrogen receptors, and cytokeratin 7, and negative for cytokeratin 20, consistent with a Mullerian derivation.

CONCLUSION: Our case represents the fourth reported instance of a primary paratubal TCC. Perhaps, this entity falls under a previously unrecognized category of carcinomas that collectively may arise from Walthard's rest, paratubal cyst, or directly from the tubal serosa.

HISTOLOGICAL TYPES CHARACTERIZATION

Benign
Sharply demarcated nests of transitional epithelial cells in a fibrous stroma

Cells are round to polygonal with well defined cell borders and eosinophilic to clear cytoplasm

Nuclei have nucleoli and longitudinal grooves giving the cells a coffee bean appearance

Nuclear atypia and mitotic figures are rare

Mucinous tumors are frequent and cystic change is frequent-if the cysts lining has more than 10% mucinous epithelium, the term metaplastic Brenner tumor is occasionally used

Dystrophic calcifications may be present in 50% of cases along with focal ossification and stromal edema

Atypical Proliferating Transitional cell tumors (Low malignant potential)
Papillary fronds lined by multilayered epithelium
Mitotic figures up to 1 mf/10 hpf

NO stromal invasion

Transitional cell carcinoma
By definition, if there are areas of typical benign or atypical proliferating transitional cell tumor are absent, it is a transitional cell caricinoma

Multilayered epithelium with papillary folds and solid nests invading into the stroma

Hyperchromatic, pleomorphic nuclei and numerous mitotic figures

Transitional cell carcinoma of the ovary: a morphologic study of 100 cases with emphasis on differential diagnosis.

Eichhorn JH, Young RH.

James Homer Wright Pathology Laboratories of the Massachusetts General Hospital, and the Department of Pathology, Harvard Medical School, Boston, MA 02114, USA.

Am J Surg Pathol. 2004 Apr;28(4):453-63. Abstract quote

Transitional cell carcinoma (TCC) of the ovary is a recently recognized subtype of ovarian surface epithelial-stromal cancer, and studies of its morphology are few. As a result, the criteria for its diagnosis and spectrum of its morphology are not clearly established.

One hundred consecutive consultation cases of ovarian carcinoma with a pure or partial transitional cell pattern (excluding malignant Brenner tumor) diagnosed between 1989 and 2001 were evaluated for the frequency of various pathologic features and the relation of TCC to other surface epithelial-stromal carcinomas. The women were 33 to 94 years of age (mean, 56 years). A total of 47 tumors were stage I, 21 stage II, 31 stage III, and 1 stage IV; 13% of the stage I tumors and 41% of tumors of all stages were bilateral. The tumors ranged from 3.0 to 30 cm in greatest dimension (mean, 10 cm); 60% of them were solid and cystic, 24% solid, and 16% cystic.

TCC was the exclusive or predominant component in 93% of the tumors and showed undulating (93%), diffuse (57%), insular (55%), and trabecular (43%) patterns. In four tumors with an insular growth, the pattern focally mimicked a Brenner tumor. Necrosis was present in 57% of the cases. Features that were seen in the tumors that in aggregate produced a relatively consistent appearance were "punched out" microspaces (87%), often the size of Call-Exner bodies, large cystic spaces (73%), and large blunt papillae (63%). Features that were sometimes seen, usually as a focal finding, included slit-like fenestrations (49%), bizarre giant cells (35%), small filiform papillae (18%), gland-like tubules (17%), squamous differentiation (13%), and psammoma bodies (4%). In 23 cases, TCC was a component of a mixed epithelial carcinoma, the additional components being serous adenocarcinoma in 16, endometrioid in 5, mucinous in 1, and clear cell carcinoma in 1. The tumor cells of the TCC component often were relatively monomorphic; 6% of the tumors were grade 1, 43% grade 2, and 51% grade 3. The nuclei were oblong or round and often had large single nucleoli (69%) or longitudinal grooves (48%). The cytoplasm was typically pale and granular but was rarely strikingly clear or oxyphilic.

TCC of the ovary usually occurs in pure form but is also common as a component of a surface epithelial carcinoma of mixed cell type. In either situation, TCC has a constellation of architectural and cytologic features that readily distinguish it in most cases from other types of ovarian cancer. Recognition of these features will lead to a more consistent diagnosis of this tumor and aid in determining whether it has distinctive clinical features, particularly with regard to its behavior.

Malignant Brenner tumor By definition, if there are areas of typical benign or atypical proliferating transitional cell tumor are present, it is a malignant Brenner tumor

SPECIAL STAINS/
IMMUNOPEROXIDASE
CHARACTERIZATION

Immunoprofile of ovarian tumors with putative transitional cell (urothelial) differentiation using novel urothelial markers: histogenetic and diagnostic implications.

Logani S, Oliva E, Amin MB, Folpe AL, Cohen C, Young RH.

Emory University School of Medicine, Atlanta, Georgia 30322, USA.

Am J Surg Pathol. 2003 Nov;27(11):1434-41. Abstract quote

Ovarian tumors containing cells with transitional cell morphology are recognized in the 1999 World Health Organization classification of ovarian tumors and include benign Brenner tumor, borderline and malignant Brenner tumor, and transitional cell carcinoma.

Recent immunohistochemical investigations have reached conflicting conclusions regarding true urothelial differentiation in ovarian Brenner tumors. We evaluated a panel consisting of antibodies to uroplakin III (UROIII), thrombomodulin (THR), cytokeratin 7 (CK7), cytokeratin 20 (CK20), and Wilms' tumor protein (WT1) to study urothelial differentiation in ovarian transitional cell tumors. Additionally, we compared the immunohistochemical profile of transitional cell carcinoma of the ovary (TCC-O) with that of transitional cell carcinoma of the bladder (TCC-B), to ascertain if immunohistochemistry may aid in distinguishing primary from metastatic TCC-O. Seventeen benign Brenner tumors and 17 TCC-O were stained with antibodies to UROIII, THR, CK7, CK20, and WT1.

Additionally, 6 Brenner tumors of borderline malignancy were stained with antibodies to UROIII, THR, CK7, and CK20. The immunohistochemical results were compared with those of 30 cases of noninvasive TCC-B (low malignant potential n=14, low grade n=16) and 36 cases of invasive TCC-B stained with a similar panel of antibodies as part of another study. Twenty-one nontransitional cell ovarian carcinomas (9 serous, 4 clear cell, 5 endometrioid, 2 mixed endometrioid/serous, and 1 mucinous) were used as controls. Most Brenner tumors showed positivity with UROIII (82%) and THR (76%), supporting true urothelial differentiation in these tumors. Although TCC-O has considerable morphologic overlap with TCC-B, they had only partial immunophenotypic overlap. TCC-O rarely expressed UROIII (6%) and THR (18%) and none expressed CK20. In contrast, nearly 40% of invasive TCC-B expressed UROIII, 61% expressed THR, and 50% expressed CK20. Nearly 82% of TCC-O expressed WT1, which was negative in all TCC-B.

Our results may have diagnostic value in distinguishing TCC-O (CK20-, UROIII-/+, WT1+) and invasive TCC-B (CK20+, UROIII+/-, WT1-) metastatic to the ovary. They also indicate that the morphologic similarity between TCC-O and TCC-B does not indicate any histogenic similarity and, as others have noted, TCC-O is a variant morphology in the spectrum of surface epithelial carcinomas.

DIFFERENTIAL DIAGNOSIS KEY DIFFERENTIATING FEATURES

ADENOSQUAMOUS CARCINOMA, OVARY Must see a benign or atypical proliferating component in transition with the malignant transitional cell tumor, otherwise distinction may be impossible

URINARY BLADDER CARCINOMA

Transitional cell carcinomas of the ovary and bladder are immunophenotypically different.

Ordonez NG.

The University of Texas, M.D. Anderson Cancer Center, Houston, TX 77030, USA.

Histopathology 2000 May;36(5):433-8 Abstract quote
AIMS: Transitional cell carcinoma (TCC) of the ovary is a subtype of ovarian cancer whose main characteristic is its histological resemblance to TCC of the bladder. Thrombomodulin (TM), a surface glycoprotein commonly expressed in normal and neoplastic urothelium, has been proven to be a good marker for TCC of the bladder.

To better define the phenotype of TCC of the ovary, we investigated TM, cytokeratin 20 and carcinoembryonic antigen (CEA) expression in 15 TCCs of the ovary and compared their phenotype with that of 20 TCCs of the bladder, and 20 serous and 10 endometrioid carcinomas of the ovary.

METHODS AND RESULTS: Immunostaining was performed on formalin-fixed, paraffin-embedded tissue sections using the avidin-biotin-peroxidase complex method. All 20 TCCs of the bladder stained for TM and cytokeratin 20, and 13 stained for CEA. None of the TCCs of the ovary reacted for TM or cytokeratin 20, and only two expressed CEA. All of the serous and endometrioid carcinomas were negative for TM and cytokeratin 20. CEA positivity was observed in two of the serous carcinomas, but in none of the endometrioid carcinomas.

CONCLUSION: The immunophenotype of TCC of the ovary is similar to that of other surface carcinomas of the ovary, but differs from that of TCC of the bladder. Since immunohistochemical procedures are often used in the diagnosis and classification of both primary and metastatic tumours, it is important to be aware of these differences in immunophenotype.

PROGNOSIS AND TREATMENT CHARACTERIZATION

PROGNOSTIC FACTORS
Transitional cell carcinomas are more advanced at stage of presentation and have a more aggressive clinical course than malignant Brenner tumors

Greater likelihood of response to chemotherapy with transitional cell carcinoma than nontransitional cell carcinoma 83% vs 33%

GENERAL

Advanced stage transitional cell carcinoma of the ovary.

Hollingsworth HC, Steinberg SM, Silverberg SG, Merino MJ.

National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA.

Hum Pathol 1996 Dec;27(12):1267-72 Abstract quote
Primary transitional cell carcinoma (TCC) of the ovary has been recently recognized as a separate subtype of epithelial cancer. It has been proposed that recognition of such tumors is important on clinical grounds because of a favorable response to chemotherapy and an improved patient survival.

The authors reviewed the histological and clinicopathologic findings of 58 patients with advanced stage (stages III and IV) ovarian cancer with a view to determining the frequency of TCC and confirming the favorable prognosis. Of these cases, 15 (26%) were reclassified as TCC; 13 were predominantly TCC, and 2 had a mixed pattern with approximately 50% of the tumor being TCC. TCC patients ranged in age from 44 to 70 years of age (mean, 57). Ten of the patients had stage III disease, and five were stage IV. The tumor was unilateral in 2 cases and bilateral in 11 (2 unknown). Tumor size varied between 3 and 23 cm. Of the stage III patients, five were optimally debulked, and five had residual disease.

All patients received the same type of chemotherapy. The median overall survival was 28 months. There was no significant difference in the clinical outcome of patients with TCC compared with that of patients with serous carcinomas.

These data suggest that TCC does not confer a favorable prognosis or better response rate to chemotherapy.

Malignant Brenner tumor and transitional cell carcinoma of the ovary: a comparison.

Austin RM, Norris HJ.
Int J Gynecol Pathol 1987;6(1):29-39 Abstract quote
The clinical and pathologic features of 16 malignant Brenner tumors (MBT) having an associated benign Brenner component were compared with 29 primary ovarian transitional cell carcinomas (TCC), neoplasms differing from MBT only in that a benign Brenner component was absent.

Transitional cell carcinoma represented a more aggressive neoplasm. Twenty of twenty-nine (69%) presented in advanced stages (II-IV) compared with only three of sixteen (19%) MBT. Among stage IA tumors, only three of seven (43%) patients with TCC were well at last contact, compared with nine of eleven (88%) patients with Stage IA MBT. In addition to not having a benign Brenner component, TCC lacked the prominent stromal calcification common in most benign and malignant Brenner tumors.

Transitional cell carcinoma is sufficiently different from MBT in that it is reasonable to suppose that ovarian TCC arises directly from pluripotential surface epithelium of the ovary and from cells with urothelial potential, rather than from a benign or proliferative Brenner tumor precursor.

RECURRENCE

Benign
None

Atypical Proliferating Transitional cell tumors (Low malignant potential)
1/50 with local recurrence

SURVIVAL

Benign
100% survival

Atypical Proliferating Transitional cell tumors (Low malignant potential)
100% survival

Malignant transitional cell tumor

TREATMENT

Benign
Local excision of ovary

Atypical Proliferating Transitional cell tumors (Low malignant potential)

Total hysterectomy with bilateral adnexectomy in older patient

Younger patient may have local excision

Malignant transitional cell carcinoma and malignant Brenner tumor
TAH-BSO with postoperative chemotherapy

CHEMOTHERAPY

Salvage chemotherapy for refractory transitional cell carcinoma of the ovary (TCC).

Sweeten KM, Gershenson DM, Burke TW, Morris M, Levenback C, Silva EG.

Department of Gynecologic Oncology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
Gynecol Oncol 1995 Nov;59(2):211-5 Abstract quote
OBJECTIVE: Transitional cell carcinoma (TCC) of the ovary is reportedly more sensitive to first-line chemotherapy and has a better prognosis than the more common serous carcinoma. The purpose of this study was to determine the responsiveness of refractory ovarian TCC to salvage chemotherapy.

METHODS: Thirty-three patients with refractory TCC who received either platinum drugs or taxanes as salvage chemotherapy at our institution were identified through a retrospective review. Clinical information was abstracted from the medical records, and patient characteristics and response rates were determined. Pathologic sections from all cases were reviewed.

RESULTS: The median age of the 33 patients was 53 years (range, 39-71 years). FIGO stage distribution among patients included 1 stage II and 32 stage III. Twenty-six tumors (79%) were classified as TCC-predominant (> 50% of the tumor having the TCC pattern), and seven tumors (21%) were classified as non-TCC predominant (< 50% of the tumor having the TCC pattern). Twenty-four platinum-sensitive patients received salvage platinum therapy (cisplatin, carboplatin, or other platinum analogs) on 27 separate occasions (three patients were treated twice) either as single agents (n = 20) or in combination (n = 7). In 21 of the 27 instances, patients had measurable disease and were evaluable for response. There were nine (43%) complete responses and six (29%) partial responses; in six instances, no response was observed. The overall response rate was therefore 72%. Thirteen patients, of whom 12 had measurable disease, received taxanes (paclitaxel in 10, docetaxel in 2, and paclitaxel+cisplatin in 1). There were partial responses in six (50%) and no response in six. Only one of the responders received high-dose paclitaxel (250 mg/m2).

CONCLUSIONS: Our findings suggest that TCC may remain more chemosensitive than more common epithelial tumors in the refractory setting. The relative influences of tumor biology and treatment, however, remain undetermined.

Blaustein's Pathology of the Female Genital Tract-Fourth Edition. Springer-Verlag. 1994.

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Last Updated 4/28/2004

Epidemiology
Pathogenesis
Gross Appearance and Clinical Variants
Histopathological Features and Variants
Special Stains/Immunohistochemistry/Electron Microscopy
Differential Diagnosis
Prognosis
Treatment
Commonly Used Terms
Internet Links

EPIDEMIOLOGY	CHARACTERIZATION
SYNONYMS	Brenner tumor
INCIDENCE
Benign	1-2% of all primary ovarian tumors
Atypical Proliferating Transitional cell tumors (Low malignant potential)	Rare
Malignant transitional cell tumor	Rare
AGE RANGE-MEDIAN
Benign	Mean 50 years 4-8th decades range
Atypical Proliferating Transitional cell tumors (Low malignant potential)	Mean 60 years
Malignant transitional cell tumor	Mean age 55 years

PATHOGENESIS	CHARACTERIZATION
Derived from ovarian surface epithelium

GROSS APPEARANCE/CLINICAL VARIANTS	CHARACTERIZATION
General
Benign	6-7% bilateral Unilateral tumors more common in left ovary Usually between 2-10 cm Well circumscribed with lobulated surface which is gray, white or yellow
Atypical Proliferating Transitional cell tumors (Low malignant potential)	Usually unilateral, multilocular cysts 10-25 cm in diameter Friable papillary masses projecting into cyst lumens similar to low grade papillary carcinomas of the urinary bladder
Malignant transitional cell tumor	Mean 20 cm Range 10-30 cm Rarely bilateral Cystic spaces lined by friable, polypoid mural nodules Hemorrhage and necrosis common 50% with calcifications
VARIANTS
ECTOPIC	Rare tumors have occurred in ectopic accessory ovaries
PARATUBAL
Parafallopian tube transitional cell carcinoma. Paner GP, Gonzalez M, Al-Masri H, Smith DM, Husain AN. Department of Pathology, Room 2233, Bldg. 110, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA.	Gynecol Oncol 2002 Sep;86(3):379-83 Abstract quote BACKGROUND: Transitional cell carcinoma (TCC) has recently been acknowledged as a distinct histologic pattern of the uncommon primary fallopian tube carcinoma. However, rare cases of TCC that are closely associated to the extraluminal portion of the tube remain widely unrecognized. CASE: We present a left adnexal high-grade TCC in a 56-year-old postmenopausal woman with an elevated serum CA-125 level. The tumor was attached by a small stalk to the serosal surface of the left fallopian tube and was completely separate from the uninvolved uterus and ipsilateral ovary. Histologic examination of the tubal lumen epithelium revealed neither atypia nor involvement by the neoplasm. Immunohistochemistry showed the tumor cells to be positive for pankeratin, calretinin, progesterone and estrogen receptors, and cytokeratin 7, and negative for cytokeratin 20, consistent with a Mullerian derivation. CONCLUSION: Our case represents the fourth reported instance of a primary paratubal TCC. Perhaps, this entity falls under a previously unrecognized category of carcinomas that collectively may arise from Walthard's rest, paratubal cyst, or directly from the tubal serosa.

DIFFERENTIAL DIAGNOSIS	KEY DIFFERENTIATING FEATURES
ADENOSQUAMOUS CARCINOMA, OVARY	Must see a benign or atypical proliferating component in transition with the malignant transitional cell tumor, otherwise distinction may be impossible
URINARY BLADDER CARCINOMA
Transitional cell carcinomas of the ovary and bladder are immunophenotypically different. Ordonez NG. The University of Texas, M.D. Anderson Cancer Center, Houston, TX 77030, USA.	Histopathology 2000 May;36(5):433-8 Abstract quote AIMS: Transitional cell carcinoma (TCC) of the ovary is a subtype of ovarian cancer whose main characteristic is its histological resemblance to TCC of the bladder. Thrombomodulin (TM), a surface glycoprotein commonly expressed in normal and neoplastic urothelium, has been proven to be a good marker for TCC of the bladder. To better define the phenotype of TCC of the ovary, we investigated TM, cytokeratin 20 and carcinoembryonic antigen (CEA) expression in 15 TCCs of the ovary and compared their phenotype with that of 20 TCCs of the bladder, and 20 serous and 10 endometrioid carcinomas of the ovary. METHODS AND RESULTS: Immunostaining was performed on formalin-fixed, paraffin-embedded tissue sections using the avidin-biotin-peroxidase complex method. All 20 TCCs of the bladder stained for TM and cytokeratin 20, and 13 stained for CEA. None of the TCCs of the ovary reacted for TM or cytokeratin 20, and only two expressed CEA. All of the serous and endometrioid carcinomas were negative for TM and cytokeratin 20. CEA positivity was observed in two of the serous carcinomas, but in none of the endometrioid carcinomas. CONCLUSION: The immunophenotype of TCC of the ovary is similar to that of other surface carcinomas of the ovary, but differs from that of TCC of the bladder. Since immunohistochemical procedures are often used in the diagnosis and classification of both primary and metastatic tumours, it is important to be aware of these differences in immunophenotype.

PROGNOSIS AND TREATMENT	CHARACTERIZATION
PROGNOSTIC FACTORS	Transitional cell carcinomas are more advanced at stage of presentation and have a more aggressive clinical course than malignant Brenner tumors Greater likelihood of response to chemotherapy with transitional cell carcinoma than nontransitional cell carcinoma 83% vs 33%
GENERAL
Advanced stage transitional cell carcinoma of the ovary. Hollingsworth HC, Steinberg SM, Silverberg SG, Merino MJ. National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA.	Hum Pathol 1996 Dec;27(12):1267-72 Abstract quote Primary transitional cell carcinoma (TCC) of the ovary has been recently recognized as a separate subtype of epithelial cancer. It has been proposed that recognition of such tumors is important on clinical grounds because of a favorable response to chemotherapy and an improved patient survival. The authors reviewed the histological and clinicopathologic findings of 58 patients with advanced stage (stages III and IV) ovarian cancer with a view to determining the frequency of TCC and confirming the favorable prognosis. Of these cases, 15 (26%) were reclassified as TCC; 13 were predominantly TCC, and 2 had a mixed pattern with approximately 50% of the tumor being TCC. TCC patients ranged in age from 44 to 70 years of age (mean, 57). Ten of the patients had stage III disease, and five were stage IV. The tumor was unilateral in 2 cases and bilateral in 11 (2 unknown). Tumor size varied between 3 and 23 cm. Of the stage III patients, five were optimally debulked, and five had residual disease. All patients received the same type of chemotherapy. The median overall survival was 28 months. There was no significant difference in the clinical outcome of patients with TCC compared with that of patients with serous carcinomas. These data suggest that TCC does not confer a favorable prognosis or better response rate to chemotherapy.
Malignant Brenner tumor and transitional cell carcinoma of the ovary: a comparison. Austin RM, Norris HJ.	Int J Gynecol Pathol 1987;6(1):29-39 Abstract quote The clinical and pathologic features of 16 malignant Brenner tumors (MBT) having an associated benign Brenner component were compared with 29 primary ovarian transitional cell carcinomas (TCC), neoplasms differing from MBT only in that a benign Brenner component was absent. Transitional cell carcinoma represented a more aggressive neoplasm. Twenty of twenty-nine (69%) presented in advanced stages (II-IV) compared with only three of sixteen (19%) MBT. Among stage IA tumors, only three of seven (43%) patients with TCC were well at last contact, compared with nine of eleven (88%) patients with Stage IA MBT. In addition to not having a benign Brenner component, TCC lacked the prominent stromal calcification common in most benign and malignant Brenner tumors. Transitional cell carcinoma is sufficiently different from MBT in that it is reasonable to suppose that ovarian TCC arises directly from pluripotential surface epithelium of the ovary and from cells with urothelial potential, rather than from a benign or proliferative Brenner tumor precursor.
RECURRENCE
Benign	None
Atypical Proliferating Transitional cell tumors (Low malignant potential)	1/50 with local recurrence
SURVIVAL
Benign	100% survival
Atypical Proliferating Transitional cell tumors (Low malignant potential)	100% survival
Malignant transitional cell tumor
TREATMENT
Benign	Local excision of ovary
Atypical Proliferating Transitional cell tumors (Low malignant potential)	Total hysterectomy with bilateral adnexectomy in older patient Younger patient may have local excision
Malignant transitional cell carcinoma and malignant Brenner tumor	TAH-BSO with postoperative chemotherapy
CHEMOTHERAPY
Salvage chemotherapy for refractory transitional cell carcinoma of the ovary (TCC). Sweeten KM, Gershenson DM, Burke TW, Morris M, Levenback C, Silva EG. Department of Gynecologic Oncology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.	Gynecol Oncol 1995 Nov;59(2):211-5 Abstract quote OBJECTIVE: Transitional cell carcinoma (TCC) of the ovary is reportedly more sensitive to first-line chemotherapy and has a better prognosis than the more common serous carcinoma. The purpose of this study was to determine the responsiveness of refractory ovarian TCC to salvage chemotherapy. METHODS: Thirty-three patients with refractory TCC who received either platinum drugs or taxanes as salvage chemotherapy at our institution were identified through a retrospective review. Clinical information was abstracted from the medical records, and patient characteristics and response rates were determined. Pathologic sections from all cases were reviewed. RESULTS: The median age of the 33 patients was 53 years (range, 39-71 years). FIGO stage distribution among patients included 1 stage II and 32 stage III. Twenty-six tumors (79%) were classified as TCC-predominant (> 50% of the tumor having the TCC pattern), and seven tumors (21%) were classified as non-TCC predominant (< 50% of the tumor having the TCC pattern). Twenty-four platinum-sensitive patients received salvage platinum therapy (cisplatin, carboplatin, or other platinum analogs) on 27 separate occasions (three patients were treated twice) either as single agents (n = 20) or in combination (n = 7). In 21 of the 27 instances, patients had measurable disease and were evaluable for response. There were nine (43%) complete responses and six (29%) partial responses; in six instances, no response was observed. The overall response rate was therefore 72%. Thirteen patients, of whom 12 had measurable disease, received taxanes (paclitaxel in 10, docetaxel in 2, and paclitaxel+cisplatin in 1). There were partial responses in six (50%) and no response in six. Only one of the responders received high-dose paclitaxel (250 mg/m2). CONCLUSIONS: Our findings suggest that TCC may remain more chemosensitive than more common epithelial tumors in the refractory setting. The relative influences of tumor biology and treatment, however, remain undetermined.