Coexistence of Papillary Thyroid Carcinoma and Strumal Carcinoid Arising from Struma Ovarii in Pregnant Women: a Case Report and Review

Abstract

Mature cystic teratomas (MCTs) of the ovary can occur at any age; however, the most common period is childbearing age, accounting for 10-20% of ovarian tumors and 85-97% of germ cell tumors. Differentiated thyroid cancers from MCTs in pregnant women are rare. A 32-year-old pregnant women presented with left ovarian mass revealed following a transabdominal ultrasonography performed to confirm pregnancy. After delivery, left ovarian cystectomy was performed and mass was examined by pathologists. The result of pathological examination was a combined papillary thyroid carcinoma (PTC) and stromal carcinoid from a mature teratoma. Thyroid ultrasonography was performed to check for accompanying thyroid cancer. Two nodules with no suspected malignancy were observed in both lobes and no other adjuvant therapy was administered. We would like to report this extremely rare case along with a literature review.

Struma Ovarii during Pregnancy

“…Thyroid cancer risk is temporarily influenced by pregnancy and lactation, metabolic, hormonal, or other specific factors [ 46 , 47 ]. There have only been seven case studies reported with malignant struma ovarii during pregnancy [ 8 , 10 , 11 , 15 , 24 , 48 , 49 ]. One explanation could be the estrogenic stimulation of benign and malignant thyroid cells [ 22 ].…”

“…One explanation could be the estrogenic stimulation of benign and malignant thyroid cells [ 22 ]. In this regard, the diagnosis of malignant struma ovarii in a pregnant woman can be related to the stimulatory effect of pregnancy on the malignant thyroid tissue, and thus, in this context, the increased size of the tumor can be detected clinically [ 8 , 10 , 11 , 15 , 24 , 48 , 49 ].…”

“…There is no standardized perspective for the diagnosis and management of malignant transformation of struma ovarii, especially in the context of pregnancy [ 48 ]. The surgical approach differs according to the patient’s age, the desire for fertility preservation, and sometimes the gestational context, varying between conservative surgery and total hysterectomy with bilateral adnexectomy, followed by chemotherapy and radiation.…”

“…The surgical approach differs according to the patient’s age, the desire for fertility preservation, and sometimes the gestational context, varying between conservative surgery and total hysterectomy with bilateral adnexectomy, followed by chemotherapy and radiation. When a thyroid carcinoma developed from struma ovarii is diagnosed, thyroidectomy followed by adjuvant therapy with radioactive iodine is proposed [ 10 , 48 , 49 ].…”

“…To ensure comprehensive treatment, the combination of laparoscopic tumor removal with thyroidectomy, followed by radiotherapy with I-131, should be considered. It is crucial to discuss this option thoroughly with the patient until more data about this rare condition become available [ 10 , 48 , 49 ].…”