Infertility: Metastatic ovarian strumosis in an in-vitro fertilization patient

Balasch, Juan; Pahisa, Jaume; Márquez, Manuel; Ordi, Jaume; Fábregues, Francisco; Puerto, B.; Vanrell, Juan A.

doi:10.1093/oxfordjournals.humrep.a137984

Cited by 24 publications

(8 citation statements)

References 10 publications

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“…At least 7 patients in this series had peritoneal tumor implants that were so extremely well differentiated (''strumosis'') that if seen alone might have been called normal thyroid tissue or were so referred to in literature reviews (10,17,22,27,56,65). Two patients with little follow-up were alive with tumors 4 and 6 years later.…”

Section: Other Findingsmentioning

confidence: 98%

Malignant Struma Ovarii: An Analysis of 88 Cases, Including 27 With Extraovarian Spread

Robboy

Shaco‐Levy

Peng

et al. 2009

International Journal of Gynecological Pathology

161

158

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Struma ovarii that display extraovarian spread or later recurrence is exceedingly rare. Among 88 patients with "malignant" struma ovarii followed for prolonged periods, several features helped to predict the adverse clinical course. Adhesions (graded 2 to 4+), peritoneal fluid (> or =1 L) or ovarian serosal rent were worrisome features, occurring in 74% of 27 biologically malignant tumors but only 10% of 61 clinically benign tumors. The size of the strumal component rather than the overall size of the ovarian teratoma also had some predictive value. Tumors with a strumal component < or =6 cm recurred rarely (7%), whereas 33% of the consult and 88% of the literature cases > or =12 cm were clinically malignant. Except for a papillary pattern or poorly differentiated cancer, no microscopic feature reliably predicted the clinical outcome, including those typically associated with malignancy in primary thyroid tumors. Among the consult cases, 7% with histologic follicular adenomas and 29% with papillary carcinomas were clinically malignant. Unequivocal vascular invasion was rare, precluding assessment of its effect. Optically clear nuclei, when extensive, were useful to diagnose papillary carcinoma, but were present nevertheless in smaller numbers in both macrofollicular and microfollicular adenomas. Eight tumors confined initially to the ovary (stage 1) recurred. Papillary carcinomas recurred earlier (average 4 y) than follicular adenomatous neoplasms (average 11 y, range: 1-29 y). Overall, the survival rate for all patients was 89% at 10 years and 84% at 25 years, indicating the need for routine long-term follow-up.

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Section: Other Findingsmentioning

confidence: 98%

Malignant Struma Ovarii: An Analysis of 88 Cases, Including 27 With Extraovarian Spread

Robboy

Shaco‐Levy

Peng

et al. 2009

International Journal of Gynecological Pathology

161

158

View full text Add to dashboard Cite

show abstract

“…Numerous clinical reports have expressed concern about a potential link between the use of fertility drugs and ovarian cancer risk. [34][35][36][37][38][39][40][41][42] The association has biological credibility, given that "incessant ovulation" and associated alterations in endogenous hormones during the reproductive years are plausible explanations for several factors that alter disease risk, including nulliparity and oral contraceptive use. 4,43…”

Section: Clinical Reportsmentioning

confidence: 99%

“…The relationship has been found to predominate among nulligravid women, 23 users of clomiphene, 56 and users of gonadotropins. 23,72,73 These findings, in conjunction with case reports of ovarian cancer developing in women during or shortly after treatment with ovulationinducing agents, [34][35][36][37][38]40,42,74 have led to speculations that ovarian stimulation may induce growth in existing highly differentiated indolent tumors. Alternatively, the findings simply could reflect more intensive medical surveillance among infertile women.…”

Section: Disease Heterogeneitymentioning

confidence: 99%

Fertility Drugs and the Risk of Breast and Gynecologic Cancers

2012

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The evaluation of cancer risk among patients treated for infertility is complex, given the need to consider indications for use, treatment details, and the effects of other factors (including parity status) that independently affect cancer risk. Many studies have had methodologic limitations. Recent studies that have overcome some of these limitations have not confirmed a link between drug use and invasive ovarian cancers, although there is still a lingering question as to whether borderline tumors might be increased. It is unclear whether this merely reflects increased surveillance. Investigations regarding breast cancer risk have produced inconsistent results. In contrast, an increasing number of studies suggest that fertility drugs may have a special predisposition for the development of uterine cancers, of interest given that these tumors are recognized as particularly hormonally responsive. Additional studies are needed to clarify the effects on cancer risk of fertility drugs, especially those used in conjunction with in vitro fertilization. Because many women who have received such treatments are still relatively young, further monitoring should be pursued in large well-designed studies that enable assessment of effects within a variety of subgroups defined by both patient and disease characteristics.

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“…8 On the other hand, McDougall et al 9 proposed strict criteria that included metastasis or vascular invasion. However, the incidence of metastasis is low, being 5-6%, 2,9,10 and there is the possibility of benign disease, such as metastatic ovarian strosis, 11 even when metastatic lesions exist. Pardo-Mindan & Vasquez 12 proposed the following four conditions for the diagnosis of malignant struma ovarii:…”

Section: Discussionmentioning

confidence: 99%

A case of malignant struma ovarii

Yamada

Saeki²,

Okuda

1997

Gynaecol Endoscopy

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We report the case of a 31‐year‐old nulligravida who underwent laparoscopic ovarian cystectomy on account of the tentative diagnosis of mature ovarian cystic teratoma. However, malignant struma ovarii was suggested postoperatively. Additional conservative surgery was performed after 2 weeks, but no residual focus was detected. There has been no sign of recurrence during a 1‐year follow‐up period.

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Infertility: Metastatic ovarian strumosis in an in-vitro fertilization patient

Cited by 24 publications

References 10 publications

Malignant Struma Ovarii: An Analysis of 88 Cases, Including 27 With Extraovarian Spread

Malignant Struma Ovarii: An Analysis of 88 Cases, Including 27 With Extraovarian Spread

Fertility Drugs and the Risk of Breast and Gynecologic Cancers

A case of malignant struma ovarii

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