Testosterone Aromatization to Estradiol in Course of Ovarian Functioning Brenner Tumor Associated With Endometrial Carcinoma and Endometriosis (Roncati-Manenti Triad)

Roncati L, Luca Roncati, Manenti A, Antonio Manenti, Pusiol T, Teresa Pusiol, Francesco Piscioli, Piscioli F, Giuseppe Barbolini, Barbolini G, G Barbolini, Antonino Maiorana, Antonio Maiorana
International journal of gynecological cancer : official journal of the International Gynecological Cancer Society · 2016 · vol. 26(8) , pp. 1461–1464 · doi:10.1097/igc.0000000000000779 · PMID:27465894 · W2500386694
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This study identified a rare triad of ovarian Brenner tumor, endometrial carcinoma, and endometriosis in postmenopausal women, finding high testosterone in the tumor and high estrogen/progesterone in the other tissues.

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Abstract

ObjectiveAromatization is the biochemical process in which aromatase catalyzes the conversion of testosterone into estradiol, the fundamental pathway for the synthesis of estrogens. When enhanced, it can lead to hyperestrogenism, a well-known risk factor for gynecological cancers.MethodsThe surgical specimens, coming from 2 postmenopausal women with hyperestrogenism on pap smear and bioptic diagnosis of endometrial endometrioid carcinoma, were fixed in 10% neutral buffered formalin, paraffin embedded, and then submitted for routine hematoxylin/eosin staining and immunohistochemical characterization for antiestrogen, antiprogesterone, antitesterone, anti-MLH1, anti-PMS2, anti-MSH2, and anti-MSH6.ResultsThe presence of an undescribed triad represented by ovarian functioning Brenner tumor, endometrial carcinoma, and pelvic endometriosis has been ascertained. The immunohistochemical investigation proved a normal expression of the DNA mismatch repair proteins and revealed a bimodal hormonal status in the pathological tissues, that is, the Brenner tumor cells showed a high expression of testosterone, contrariwise endometrioid carcinoma and endometriosis a high estrogen and progesterone immunolabeling.ConclusionsThis synchronous triad underlines the importance of aromatization and hyperestrogenism in the development of gynecological malignancies in which the immunohistochemical detection of an active source of hormone production - to always keep in consideration during synchronous diseases - can guide subsequent antihormone chemotherapy based on aromatase inhibitors.

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endometriosis

MeSH descriptors

Brenner Tumor Carcinoma, Endometrioid Endometrial Neoplasms Endometriosis Estradiol Ovarian Neoplasms Testosterone Aromatase Aromatase Brenner Tumor Brenner Tumor Carcinoma, Endometrioid Carcinoma, Endometrioid Endometrial Neoplasms Endometrial Neoplasms Endometriosis Endometriosis Estradiol Female Humans

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