Treatment and follow-up in an asymptomatic malignant struma ovarii: A case report

Llueca, Antoni; Maazouzi, Yasmine; Herráiz, José Luis; Medina, Mari Carmen; Piquer, Dolors; Segarra, Blanca; Moral, Raquel del; Serra, Anna; Bassols, Guillermo

doi:10.1016/j.ijscr.2017.09.005

Cited by 9 publications

(8 citation statements)

References 14 publications

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“…Most patients with SO present no clinical symptoms and are diagnosed incidentally. In some patients, as it was in the two presented cases, they may cause symptoms similar to those typical of other ovarian tumours, such as low abdominal pain, nausea, vaginal bleeding and abnormal menstrual cycles [5,6]. Sometimes, the first symptom is palpable abdominal mass [5,7,13].…”

Section: Discussionmentioning

confidence: 59%

“…In some patients, as it was in the two presented cases, they may cause symptoms similar to those typical of other ovarian tumours, such as low abdominal pain, nausea, vaginal bleeding and abnormal menstrual cycles [5,6]. Sometimes, the first symptom is palpable abdominal mass [5,7,13]. The late manifestation of malignant SO are signs of metastatic disease such as back pain [14,15].…”

Section: Discussionmentioning

confidence: 60%

“…It is most often diagnosed postoperatively during histopathological examination, while radiological imaging is unspecific [4]. Strumae ovarii are one of the rarest ovarian tumours -they represent 1% of them and comprise 2-5% of teratomas [5]. Less than 200 cases have been so far reported in medical literature [2].…”

Section: Introductionmentioning

confidence: 99%

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The role of immunohistochemical examination in diagnosis of papillary thyroid cancer in struma ovarii

Szczepanek‐Parulska

Pioch

Cyrańska-Chyrek

et al. 2015

Folia Histochem Cytobiol.

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Introduction. Struma ovarii (SO) is a monodermal teratoma in which thyroid tissue comprises more than 50% of the tumour. Papillary thyroid cancer (PTC) in SO is a rare finding, as only 5% of SO cases undergo malignant transformation. Malignant SO is usually asymptomatic and infrequently diagnosed preoperatively. Because of its rarity, there is no consensus about diagnosis and management, while treatment and follow-up procedures are not clearly established. Material and methods. Herewith, we report two cases of PTC in SO. The first patient was a 25-year-old woman diagnosed with bilateral ovarian tumours. The second patient, 19-year-old woman, presented with unilateral ovarian mass. Both patients were qualified for surgical excision of the tumours. Histopathological specimens underwent both conventional histopathological assessment and immunohistochemical staining. Results. In the first patient histopathology revealed SO with two foci of PTC. Immunohistochemically a positive expression of CK7, CK19, p63 and thyroglobulin (Tg) confirmed the diagnosis. She underwent total thyroidectomy in 2016 in order to enable ablative radioiodine therapy and facilitate further thyroglobulin monitoring. Unfortunately, the patient was lost from follow-up. In the second patient, histopathological diagnosis was follicular variant of PTC in SO. Postoperatively, a pelvic CT revealed osteolytic lesion 6 cm in size, being a metastatic change. The patient underwent unilateral ovariectomy, total thyroidectomy and multiple cycles of radioiodine therapy. Currently, 9 years following the diagnosis, the patient achieved disease remission. Conclusions. PTC in SO still remains a diagnostic and therapeutic challenge. Immunostaining for CK7, CK19, p63 and Tg might be helpful in histopathological diagnosis. The decision on the need of total thyroidectomy and radioiodine therapy should be made individually. However, thyroid remnant ablation increases the sensitivity and specificity of follow-up testing using serum Tg level as a tumour marker.

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 60%

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The role of immunohistochemical examination in diagnosis of papillary thyroid cancer in struma ovarii

Szczepanek‐Parulska

Pioch

Cyrańska-Chyrek

et al. 2015

Folia Histochem Cytobiol.

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“…As with most rare diseases, the natural history of MSO is not fully defined and there is a paucity of evidence-based clinical practice guidelines. The extent of ovarian surgery can be a subject of debate [30], especially when preservation of fertility is an issue. Preoperative ultrasonography may help differentiate benign from malignant pathologies and allow for ovarian sparing surgical planning if appropriate [31].…”

Section: Discussionmentioning

confidence: 99%

Unusual Case of Malignant Struma Ovarii and Cervical Thyroid Cancer Preceded by Ovarian Teratoma: Case Report and Review of the Literature

Tzelepis

Barengolts

Garzon

et al. 2019

Case Reports in Endocrinology

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Objective. To present a rare case of malignant struma ovarii (MSO) and synchronous thyroid cancer, review the medical literature, and present the latest trends in management. Methods. The case of a woman with MSO and concomitant thyroid cancer is presented, including clinical presentation, treatment, and follow-up care. A search of the English-language literature was conducted using MEDLINE and Google Scholar data bases. Results. We found 10 publications (one abstract) describing 10 patients with MSO and concomitant thyroid cancer. Six additional patients were reported by a study that analyzed the SEER (cancer registry) database. The median age of women was 42 years, with the majority of them presenting with abdominal symptoms. Histologically, most tumors were papillary carcinomas in both organs. In 5 patients, there was extrathyroidal tumor extension at time of surgery. Conclusion. MSO can occasionally coexist with highly aggressive eutopic thyroid cancer. Although this concurrence is even rarer than MSO, clinicians should routinely investigate for possible synchronous thyroid cancer in all cases of MSO and also consider aggressive postoperative treatment including thyroidectomy and radioiodine ablation therapy in cases of MSO.

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“…Germ cell tumors account for 15-20% of ovarian tumors, and most are mature teratomas [1]. Struma ovarii is characterized by the presence of >50% of thyroid tissue and accounts for 2-5% of cases of mature ovarian teratomas and 1% of all ovarian tumors [2][3][4][5]. Struma ovarii can occur in women of all ages, but it is most common in women in the fourth to sixth decades of life [3,6,7].…”

Section: Introductionmentioning

confidence: 99%

Papillary Thyroid Cancer in a Struma Ovarii in a 17-Year-Old Nulliparous Patient: A Case Report

et al. 2020

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Introduction: Struma ovarii accounts for 2% of mature teratomas. Struma ovarii is diagnosed when thyroid tissue accounts for >50% of the teratoma. Malignant transformation is rare, occurring in <5% of struma ovarii cases. Case presentation: A 17-year-old patient was diagnosed with papillary thyroid cancer in struma ovarii. The patient exhibited menstrual disorders. Abdominal and pelvic CT revealed a 17 cm mass in the left adnexa. Laparoscopic removal of the left adnexa with enucleation of right ovarian cysts was performed. Histopathological diagnosis was a follicular variant papillary carcinoma measuring 23 mm in diameter. Immunohistochemical positive expression of CK19, TTF-1, and thyroglobulin (Tg) confirmed the diagnosis. Molecular analysis detected the BRAF K601E mutation in ovarian tumor tissues. Preoperative serum Tg concentration was >300 ng/mL, which decreased to 38.2 ng/mL after gynecological surgery with undetectable anti-Tg antibodies. The patient underwent total thyroidectomy with no cancer detected on histopathological examination. The patient was treated with I-131 and showed no recurrence 4 years after the diagnosis. Conclusions: Malignant struma ovarii is diagnosed by surgery. Because papillary carcinoma in struma ovarii is rare and there are no guidelines regarding the management of this type of cancer, therapeutic decisions should be made individually based on clinical and pathological data.

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Treatment and follow-up in an asymptomatic malignant struma ovarii: A case report

Abstract: HighlightsStruma ovarii is a rare and asymptomatic ovarian tumor and is usually diagnosed by the pathologist.Struma ovarii malignancy is from thyroid origin and usually associated with thyroid tumors.Management and follow up is not well established.

Cited by 9 publications

References 14 publications

The role of immunohistochemical examination in diagnosis of papillary thyroid cancer in struma ovarii

The role of immunohistochemical examination in diagnosis of papillary thyroid cancer in struma ovarii

Unusual Case of Malignant Struma Ovarii and Cervical Thyroid Cancer Preceded by Ovarian Teratoma: Case Report and Review of the Literature

Papillary Thyroid Cancer in a Struma Ovarii in a 17-Year-Old Nulliparous Patient: A Case Report

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