Ovarian Brenner tumors and Walthard nests: a histologic and immunohistochemical study

Hum Pathol. 2014 Dec;45(12):2417-22. doi: 10.1016/j.humpath.2014.08.003. Epub 2014 Aug 23.


Brenner tumors are composed of urothelial/transitional-type epithelium and, hence, are morphologically similar to Walthard nests and tubal/mesothelial transitional metaplasia. In this study, we analyzed immunohistochemical markers on Brenner tumors to explore Müllerian as well as Wolffian and germ cell derivation. We also attempted to explore their possible association with tubal/paratubal Walthard nests/transitional metaplasia, using the same immunostains. Thirty-two consecutive cases of Brenner tumors were identified. Thirteen (43%) of the patients had Walthard nests in the tubal/periovarian soft tissue. All Brenner tumors were diffusely positive for GATA3 (strongly positive in 30/32 and weakly positive in the remaining 2) and negative for PAX8, PAX2, and SALL4. Similarly, all Walthard nests were positive for GATA3, whereas only 3 (23%) of 13 showed occasional PAX8 expression; all were negative for PAX2 and SALL4. In our study, more than 40% of Brenner tumors had associated Walthard nests. The similar morphology and immunoprofile of Brenner tumors and Walthard nests suggest a probable link between Brenner tumors and Walthard nests. Two additional cases presented highlight small transitional lesions involving the ovary: a possible precursor lesion or the initial steps of Brenner tumor formation. Brenner tumors and most Walthard nests lacked staining for Müllerian (PAX8 and PAX2) and germ cell tumor markers (SALL4).

Keywords: Brenner tumor; GATA3; Ovarian tumor; PAX8; Walthard nests.

MeSH terms

  • Adult
  • Aged
  • Biomarkers, Tumor / metabolism
  • Brenner Tumor / metabolism
  • Brenner Tumor / pathology*
  • Epithelium / metabolism
  • Epithelium / pathology
  • Female
  • GATA3 Transcription Factor / metabolism
  • Humans
  • Middle Aged
  • Ovarian Neoplasms / metabolism
  • Ovarian Neoplasms / pathology*
  • PAX2 Transcription Factor / metabolism
  • PAX8 Transcription Factor
  • Paired Box Transcription Factors / metabolism
  • Transcription Factors / metabolism


  • Biomarkers, Tumor
  • GATA3 Transcription Factor
  • GATA3 protein, human
  • PAX2 Transcription Factor
  • PAX2 protein, human
  • PAX8 Transcription Factor
  • PAX8 protein, human
  • Paired Box Transcription Factors
  • SALL4 protein, human
  • Transcription Factors