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Donato S, Simões H, Leite V. Malignant Struma Ovarii with Concurrent Thyroid Cancer: Outcomes during and after Pregnancy. Eur Thyroid J 2021; 10:523-527. [PMID: 34956924 PMCID: PMC8647070 DOI: 10.1159/000512735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 10/31/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Struma ovarii (SO) is a rare ovarian teratoma characterized by the presence of thyroid tissue in more than 50% of the tumor. Malignant transformation is rare and the most common associated malignancy is papillary thyroid carcinoma (PTC). Pregnancy may represent a stimulus to differentiated thyroid cancer (DTC) growth in patients with known structural or biochemical evidence of disease, but data about malignant SO evolution during pregnancy are rare. We present the first reported case of a pregnant patient with malignant SO and biochemical evidence of disease. CASE PRESENTATION A previously healthy 35-year-old female diagnosed with a suspicious left pelvic mass on routine ultrasound was submitted to laparoscopic oophorectomy which revealed a malignant SO with areas of PTC. A 15-mm thyroid nodule (Bethesda V in the fine-needle aspiration cytology) was detected by palpation and total thyroidectomy was performed. Histology revealed a 15 mm follicular variant of PTC (T1bNxMx). Subsequently, she received 100 mCi of radioactive iodine therapy (RAIT) with the whole-body scan showing only moderate neck uptake. Her suppressed thyroglobulin (Tg) before RAI was 1.1 ng/mL. She maintained biochemical evidence of disease, with serum Tg levels of 7.6 ng/mL. She got pregnant 14 months after RAIT, and during pregnancy, Tg increased to 21.5 ng/mL. After delivery, Tg decreased to 14 ng/mL but, 6 months later, rose again and reached 31.9 ng/mL on the last follow-up visit. TSH was always suppressed during follow-up. At the time of SO diagnosis, a chest computed tomography scan showed 4 bilateral lung micronodules in the upper lobes which were nonspecific, and 9 months after diagnosis, a pelvic MRI revealed a suspicious cystic nodule located on the oophorectomy bed. These lung and pelvic nodules remained stable during follow-up. Neck ultrasonography, abdominal MRI, and fluorodeoxyglucose-positron emission tomography showed no suspicious lesions. DISCUSSION/CONCLUSION As for DTC, pregnancy seems to represent a stimulus to malignant SO growth. This can be caused by the high levels of estrogen during pregnancy that may bind to receptors in malignant cells and/or by the high levels of hCG which is known to stimulate TSH receptors.
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Affiliation(s)
- Sara Donato
- Endocrinology Department, Instituto Português de Oncologia de Lisboa, Lisbon, Portugal
- *Sara Donato, Endocrinology Department, Instituto Português de Oncologia de Lisboa, Francisco Gentil, Rua Professor Lima Basto, PT–1099-023 Lisbon (Portugal),
| | - Helder Simões
- Endocrinology Department, Instituto Português de Oncologia de Lisboa, Lisbon, Portugal
- NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Valeriano Leite
- Endocrinology Department, Instituto Português de Oncologia de Lisboa, Lisbon, Portugal
- NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
- Unidade de Investigação em Patobiologia Molecular, Instituto Português de Oncologia de Lisboa, Lisbon, Portugal
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Ayhan S, Kilic F, Ersak B, Aytekin O, Akar S, Turkmen O, Akgul G, Toyran A, Turan T, Kimyon Comert G. Malignant struma ovarii: From case to analysis. J Obstet Gynaecol Res 2021; 47:3339-3351. [PMID: 34219334 DOI: 10.1111/jog.14902] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 05/22/2021] [Accepted: 06/06/2021] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the clinico-pathologic features, treatment options, prognostic factors, and survival outcomes of malignant struma ovarii based on a systematic literature review in association with our case study. METHODS A systematic review of the medical literature was performed to identify articles about malignant struma ovarii from January 1983 until July 2020. We evaluated 178 cases. RESULTS The 5-year progression-free survival (PFS) and overall survival (OS) of the entire cohort was 72.5% and 91%, respectively. In univariate analysis, younger age (<43 years), whole strumal cyst diameter >95 mm, presence of a histologic type other than papillary classic-type thyroid carcinoma within the tumor and lymphovascular space invasion were related to poor PFS. Patients who received radioactive iodine ablation (RIA) before the treatment failure had significantly higher PFS than those who did not receive RIA (94.9% vs. 64.8%, p = 0.041, respectively). In univariate analysis, PFS was significantly higher in patients who underwent gynecologic surgery followed by thyroidectomy and RIA compared with those who had surgical treatment only (94.5% vs. 64.3%, p = 0.05, respectively). However, this result could not be identified as an independent prognostic factor in multivariate analysis (p = 0.207). Younger age and absence of capsular involvement were related to significantly increased OS. Histologic type was the only independent prognostic factor for PFS (hazard ratio: 3.30, 95% confidence interval: 1.122-9.748; p = 0.030) CONCLUSION: The most common histologic subtype was the papillary classic type. The presence of a histologic type other than the classic papillary thyroid carcinoma within the tumor was an independent adverse prognostic factor.
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Affiliation(s)
- Sevgi Ayhan
- Department of Gynecologic Oncology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Fatih Kilic
- Department of Gynecologic Oncology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Burak Ersak
- Department of Gynecologic Oncology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Okan Aytekin
- Department of Gynecologic Oncology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Serra Akar
- Department of Gynecologic Oncology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Osman Turkmen
- Department of Gynecologic Oncology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Giray Akgul
- Department of Surgical Oncology, Gulhane Education and Research Hospital, Ankara, Turkey
| | - Atahan Toyran
- Department of Gynecologic Oncology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Taner Turan
- Department of Gynecologic Oncology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Gunsu Kimyon Comert
- Department of Gynecologic Oncology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
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Unusual Case of Malignant Struma Ovarii and Cervical Thyroid Cancer Preceded by Ovarian Teratoma: Case Report and Review of the Literature. Case Rep Endocrinol 2019; 2019:7964126. [PMID: 31007958 PMCID: PMC6441504 DOI: 10.1155/2019/7964126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 02/26/2019] [Indexed: 11/30/2022] Open
Abstract
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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Al Hassan MS, Saafan T, El Ansari W, Al Ansari AA, Zirie MA, Farghaly H, Abdelaal A. The largest reported papillary thyroid carcinoma arising in struma ovarii and metastasis to opposite ovary: case report and review of literature. Thyroid Res 2018; 11:10. [PMID: 30061934 PMCID: PMC6056926 DOI: 10.1186/s13044-018-0054-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 07/05/2018] [Indexed: 11/17/2022] Open
Abstract
Background Malignant struma ovarii (MSO) is a very rare, germ cell tumor of the ovary, histologically identical to differentiated thyroid cancers. Struma ovarii (SO) is difficult to diagnose on clinical basis or imaging and is mostly discovered incidentally, with few published cases in the literature. Case presentation A 42-year old primiparous woman presented with abdominal pain and midline pelvic palpable firm mass arising from the pelvis. Imaging showed pelvic solid cystic mass. Total abdominal hysterectomy, bilateral salpingo-oopherectomy (TAH BSO) and infracolic omentectomy were performed. Histopathology revealed left ovary papillary thyroid carcinoma (PTC) arising in SO (11 cm) and metastatic papillary thyroid carcinoma in the right ovary. Thyroid functions tests were all normal, ultrasound thyroid showed two complex nodules in the left thyroid lobe. Total thyroidectomy was decided, but the patient refused further surgical management and was lost to follow up as she left the country. We undertook a comprehensive literature search, and MSO and thyroid management data from 23 additional publications were analyzed and tabulated. This PTC MSO is probably the largest reported in the literature. Conclusions Among the different surgeries for MSO, TAH + BSO appears to have the best clinical outcome. However, unilateral salpingo-oopherectomy/ unilateral oophorectomy and bilateral salpingo-oopherectomy also seem effective. Ovarian cystectomy alone seems associated with higher recurrence. There remains no consensus on the associations between MSO tumor size and potential extent of metastasis, and about the management of thyroid gland. However, surveillance and thyroid gland work up to detect concurrent thyroid cancer are recommended.
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Affiliation(s)
| | - Tamer Saafan
- 1Department of General Surgery, Hamad General Hospital, Doha, Qatar
| | - Walid El Ansari
- 2Department of Surgery, Hamad General Hospital, Doha, Qatar.,3College of Medicine, Qatar University, Doha, Qatar
| | - Afaf A Al Ansari
- 4Department of Gynecologic Oncology, Hamad General Hospital, Doha, Qatar
| | - Mahmoud A Zirie
- 5Department of Endocrinology, Hamad General Hospital, Doha, Qatar
| | - Hanan Farghaly
- 6Department of Pathology, Hamad General Hospital, Doha, Qatar
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Middelbeek RJW, O'Neill BT, Nishino M, Pallotta JA. Concurrent Intrathyroidal Thyroid Cancer and Thyroid Cancer in Struma Ovarii: A Case Report and Literature Review. J Endocr Soc 2017; 1:396-400. [PMID: 29264493 PMCID: PMC5686688 DOI: 10.1210/js.2017-00052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 03/20/2017] [Indexed: 11/19/2022] Open
Abstract
Context The presence of differentiated thyroid cancer in mature cystic teratomas in the ovaries is rare, and usually incidentally found on surgical pathology specimens. We present a case of simultaneous intrathyroidal thyroid cancer and thyroid cancer within a struma ovarii, presenting specific diagnostic challenges. Case Description A 55-year-old woman had an intrathyroidal, encapsulated 1.2-cm papillary thyroid carcinoma, follicular variant, which was resected. Laboratory studies showed an elevated thyroglobulin level of 35 ng/mL while on suppressive levothyroxine therapy. During preparation for radioactive iodine ablation, thyroglobulin increased dramatically to 3490 ng/mL. A pretreatment whole-body scan showed residual tracer uptake in the thyroid bed and increased radiotracer uptake in the pelvis that raised concern for a pelvic metastasis, given the marked thyroglobulin elevation. After ablation, the posttreatment scan showed intense focal uptake in the pelvis. Single-photon emission computed tomography-computed tomography confirmed that the tracer uptake corresponded to a right adnexal mass. The patient underwent a laparoscopic bilateral salpingo-oophorecotomy with pelvic washings. The final pathology of the right ovary showed papillary thyroid carcinoma arising in a mature cystic teratoma. In addition, there was abundant normal thyroid tissue with colloid surrounding the carcinoma, indicating a source for the dramatic rise in thyroglobulin levels and suggesting that the ovarian papillary thyroid cancer arose within the teratoma and was not metastatic disease. Thyroglobulin measurements have been undetectable for 5 years since surgery and radioiodine treatment. Conclusions Concurrent intrathyroidal thyroid cancer and differentiated thyroid cancer in struma ovarii are very rare, but can often be distinguished on clinical grounds.
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Affiliation(s)
- Roeland J W Middelbeek
- Joslin Diabetes Center, Boston, Massachusetts 02215.,Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215.,Harvard Medical School, Boston, Massachusetts 02215
| | - Brian T O'Neill
- Division of Endocrinology and Metabolism, Fraternal Order of Eagles Diabetes Research Center, University of Iowa Carver College of Medicine, Iowa City, Iowa 52242
| | - Michiya Nishino
- Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215.,Harvard Medical School, Boston, Massachusetts 02215
| | - Johanna A Pallotta
- Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215.,Harvard Medical School, Boston, Massachusetts 02215
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