Article Text

Download PDFPDF
Testosterone Aromatization to Estradiol in Course of Ovarian Functioning Brenner Tumor Associated With Endometrial Carcinoma and Endometriosis (Roncati-Manenti Triad)
  1. Luca Roncati, MD, PhD,
  2. Antonio Manenti, MD, PhD,
  3. Teresa Pusiol, MD, PhD,
  4. Francesco Piscioli, MD, PhD,
  5. Giuseppe Barbolini, MD, PhD and
  6. Antonio Maiorana, MD, PhD
  1. * Department of Diagnostic and Clinical Medicine and of Public Health, University of Modena and Reggio Emilia, Modena;
  2. Provincial Health Care Services, Cervical Cancer Screening Center, Santa Maria del Carmine Hospital, Rovereto; and
  3. Department of Surgery and Surgical Specialities, University of Modena and Reggio Emilia, Modena, Italy.
  1. Address correspondence and reprint requests to Luca Roncati, MD, PhD, Department of Diagnostic and Clinical Medicine and of Public Health, Section of Pathology, University of Modena and Reggio Emilia, Policlinico Hospital, I-41124 Modena, Italy. E-mail: emailmedical{at}


Objective Aromatization 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.

Methods The 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.

Results The 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.

Conclusions This 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.

  • Aromatization
  • Hyperestrogenism
  • Brenner tumor
  • Endometrial endometrioid carcinoma
  • Endometriosis
  • Immunohistochemistry

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • The authors declare no conflicts of interest.