Supplementary Material for: Bilateral Malignant Brenner Tumor of the Ovary in an Arab Woman: A Case Report

Introduction
Brenner Tumors (BTs) are rare ovarian neoplasms, with malignant variants constituting 1–5% of cases. Typically occurring in women aged 50–70 years, malignant BTs often manifest with nonspecific symptoms such as abdominal pain and weight loss. Their etiology remains unclear, and a definitive diagnosis requires histopathological confirmation.

Case Presentation
A 54-year-old Arab woman, a long-term smoker, presented with a three-month history of abdominal pain, weight loss, and distension. Imaging revealed bilateral adnexal masses (left: 14 cm; right: 13 cm) with cystic degeneration, while tumor markers (CA-125, CEA) remained normal. Exploratory laparotomy identified bilateral ovarian tumors and omental metastasis. Histopathology confirmed high-grade malignant Brenner tumor, supported by immunohistochemistry. The patient underwent total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and six cycles of carboplatin-paclitaxel chemotherapy. Surveillance imaging at eight months showed no recurrence.

Conclusion
This case illustrates the diagnostic complexity of malignant BTs due to nonspecific symptoms, normal tumor markers, and imaging limitations. Bilateral involvement, though uncommon, underscores tumor aggressiveness. Standard surgical cytoreduction and platinum-based chemotherapy achieved a favorable interim outcome, aligning with epithelial ovarian cancer protocols.