Cancer thyroïdien sur struma ovarii : généralités et principes de prise en charge

A Case of Papillary Thyroid Carcinoma Arising from Struma Ovarii and Extending into the Bladder

“…Metastatic spread usually follows that of ovarian cancer. Most common sites are controlateral ovary and more distant sites such as bone, liver, brain and lungs [6] [11] [12]. Bladder involvement as described in our case is less common.…”

“…Ultrasound shows a heterogeneous lobulated mass with multilocular cyst and solid components [2] [6]. MRI gives more specific images, showing multi-partitioned mass with variable signals, often with a marked hyposignal on T1 and T2, related to the presence of colloid [6] [7]. For our patient, the clinical presentation was essentially characterized by abdomino-pelvic pain and a right latero-uterine mass on abdominal palpation.…”

“…Since these malignant forms very rarely metastasize, the clinical symptomatology is non-specific and generally associates pelvic pain, abdominal mass, pseudo-Meigs syndrome (ascites, hydrothorax) and more rarely hyperthyroidism [6]. Complications may occur such as infection, torsion, compression, rupture, or even fistula formation into neighboring organs, accompanied by urinary or digestive signs or peritonitis [5] [6]. Imaging studies could not determine the presence or absence of malignant component.…”

“…Imaging studies could not determine the presence or absence of malignant component. Ultrasound shows a heterogeneous lobulated mass with multilocular cyst and solid components [2] [6]. MRI gives more specific images, showing multi-partitioned mass with variable signals, often with a marked hyposignal on T1 and T2, related to the presence of colloid [6] [7].…”

“…However, the presence of associated benign features such as hair follicles and pilo-sebaceous units within the bladder nodule still remains difficult to explain although capsular effraction was not observed. Histopathological analysis could also help assessing tumor aggressiveness, such as: a poorly differentiated architecture (trabecular, solid, insular), high mitotic activity, pattern of tumor necrosis or presence of vascular emboli, carcinoma component > 4 cm, an ovarian capsule rupture, a neuro-endocrine component, ovarian serosal implants, presence of thyroid tissue or neuro-endocrine component on peritoneal samples [6] [9]. Immunohistochemistry can sometimes be helpful to confirm the presence of thyroid tissue (TG, TTF1) or the existence of a neuroendocrine component (chromogranin A, synaptophysin) [6].…”