Extensive peritoneal implant metastases of malignant struma ovarii treated by thyroidectomy and 131I therapy

Abstract

Rationale:Malignant struma ovarii is extremely rare in the clinic. The diagnosis and modalities of treatment are still controversial. Here we describe a case of extensive peritoneal implant metastasis originating from malignant struma ovarii discovered 14 years after ovariectomy and chemotherapy.Patient concerns:A 48-year-old female was admitted to our clinic due to hematochezia with a past history of left malignant struma ovarii. Enhanced computed tomography (CT) examination suggested multiple metastasis nodules in the abdomen and pelvic cavity.Diagnoses:Laparoscopy biopsy results of intraperitoneal nodules showed a metastasis of papillary thyroid carcinoma. While pathological examination after total thyroidectomy showed no definite malignant tumor component in the thyroid tissue. Finally, combined with the patient's past history of malignant struma ovarii, peritoneal implantation metastasis derived from the malignant struma ovarii was diagnosed.Interventions:The patient was treated by total thyroidectomy and iodine 131 (131I) therapy. Post-therapy iodine scan and the single-photon emission computed tomography/computed tomography (SPECT/CT) fusion image showed iodine uptake in the distal descending colon, sigmoid colon, rectal lesions, and a larger lesion in the liver.Outcome:After treatment, although the thyroid globulin remained at a high level 3 months after treatment, the patient's hematochezia was relieved.Lessons:Therefore, thyroidectomy followed by adjuvant 131I treatment should be recommended in patients with malignant struma ovarii as metastatic risk is difficult to predict based on histopathologic examination.

Struma ovarii in bilateral ovarian teratoma—case report and literature review

“…Surgery is the best treatment for benign tumours, and surgery with adjuvant Iodine (I) 133 ablation is used to treat certain malignant tumours, as well as metastatic or recurrent tumours [ 5 ]. Concerning malignant struma ovarii, when the patient does not desire fertility preservation, surgery comprises peritoneal washing, bilateral adnexectomy, total hysterectomy, lymph node sampling and total thyroidectomy [ 6 ]. Instead, following fertility-preserving unilateral adnexectomy, plasma thyroglobulin can be serially monitored as a recurrence marker.…”

Malignant Clinical Course of Histologically Benign Ovarian Struma: case report and literature review

“…The most recent WHO classification of ovarian tumors the term of highly differentiated follicular carcinoma of ovarian origin (HDFCO)/highly differentiated follicular carcinoma arising in struma ovarii was coined as more appropriate for describing extraovarian spreading, so the International Classification of Diseases for Oncology (ICD-O) code is only presented for benign and malignant struma ovarii (16). It may seem feasible to use ICD-O code 1 to reflect the difficulty to accurately predict the biologic behavior of struma ovarii (17).…”

Struma ovarii metast�sico, reporte de un caso

“…Los sitios predominantes de metástasis son: estructuras pélvicas (incluido el ovario contralateral), pulmón, hueso, hígado y cerebro, pero la metástasis es rara en pacientes con struma ovarii maligno. Se han encontrado mutaciones de los genes KRAS y BRAF en pacientes con struma ovarii maligno, así como ausencia de esta mutación en casos benignos 1,4,6,8,[14][15][16][17] .…”

“…Los tumores de células germinales representan el 20% de las neoplasias de ovario y de ellos los teratomas representan el 95%. El struma ovarii comprende del 1.4 al 3% de los teratomas y el 0.3% de todas las neoplasias ováricas, mientras que el struma ovarii maligno con metástasis se ha visto en menos del 5-6% de los casos [1][2][3][4][5][6][7] . Del 15 al 20% de los teratomas ováricos contienen tejido tiroideo, y de estos solo el 5% se consideran struma ovarii, ya que esta definición se utiliza cuando el tejido tiroideo constituye más del 50% del teratoma, o cuando contiene menos del 15% de tejido tiroideo y este es funcional, o cuando presenta algún componente tiroideo maligno 1,[4][5][6] .…”