Goitre ovarien malin

[Pseudosyndrome of Meigs revealer of an ovarian goiter]

The pseudosyndrome of Meigs is caracterised by a triad, which associates a solid benign tumor of the ovary, an ascitis and a pleural effusion. Surgical extraction of the tumor entails disappearance of the symptomatology. The authors report in this study a case of an ovarian goitre revealed by this syndrom.

Disseminated struma ovarii containing focal anaplastic carcinoma in peritoneal implants: a case report

Malignant changes in struma ovarii have been defined using histopathologic criteria for carcinomas of the cervical thyroid gland. We report a case of struma ovarii with extensive extraovarian spread containing a small focus of anaplastic carcinoma (AC) in peritoneal implants. AC arising in benign-looking struma ovarii with peritoneal implants has not been reported. Multiple pelvic masses were identified on abdominopelvic computed tomography in a 38-yr-old woman. An exploratory laparotomy revealed multiple, variable-sized masses on the omentum, and colonic and uterine serosa. A microscopic but grossly unidentifiable lesion in the right ovary had a histologic appearance that mimicked hyperplastic follicular epithelium of nodular thyroid goiter. Multiple peritoneal implants showed histology similar to the ovarian lesions except a focal area of AC in the omental mass. Anaplastic cells demonstrated characteristic immunoreactivity for p53, cyclin D1, and a high Ki-67 index of about 30%, with loss of expression of thyroid transcription factor-1 and thyroglobulin, whereas the remaining goitrous background showed opposite expression patterns in all aspects. Furthermore, the areas of AC showed p53 mutation by molecular analysis. The AC harboring p53 mutation within extraovarian spread suggests that disseminated struma ovarii mimicking nodular goiter has potential for histologic progression through similar pathogenetic mechanism with cervical thyroid carcinoma despite the innocuous appearance.

Metastatic follicular struma ovarii complicating pregnancy: a case report and review of the literature

A 35-year-old woman was determined to have an ovarian cyst and underwent a right ovarian cystectomy at 10 weeks of gestation. A histopathological examination revealed follicular carcinoma arising in a teratoma. No evidence of metastasis was found after delivery. She underwent a total thyroidectomy, followed by radioactive iodine (RAI) therapy. However, her serum thyroglobulin level increased to 1,437 ng/ml (normal range: 0-52 ng/ml) after 10 months. Radioiodine scintigraphy and abdominal computed tomography revealed liver metastasis and peritoneal seeding. She underwent debulking surgery of the liver, right salpinx, and peritoneal seeding nodules. A pathological examination showed metastatic follicular carcinoma with focal poorly differentiated features. Adjuvant RAI therapy was restarted, and her serum thyroglobulin levels returned to normal. In conclusion, metastatic lesions were successfully treated with a combination of debulking surgery and RAI therapy. Close medical follow-up monitoring serum thyroglobulin levels is mandatory in such patients.

Optimal surgical management of well-differentiated thyroid cancer arising in struma ovarii: a series of 4 patients and a review of 53 reported cases

BACKGROUND

Well-differentiated thyroid cancer arising in struma ovarii is rare. The optimal management of this entity remains undefined. Unilateral cystectomy, unilateral salpingo-oophorectomy (USO), or total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH/BSO), in addition to total thyroidectomy and radioactive iodine (RAI) ablation, have been employed by various groups. We hypothesized that in patients with thyroid cancer arising within struma ovarii, pelvic surgery alone would be sufficient, provided there is no evidence of gross extra-ovarian extension.

METHODS

We review a series of four patients from a single institution and 53 cases from the literature, comparing the extent of treatment and outcomes. Our literature review focused on low-risk patients with struma ovarii confined to the ovary, without evidence of gross extra-ovarian spread or distant metastases. Cumulative recurrence rate was determined by using the Kaplan-Meier method.

RESULTS

We report the treatment of four patients with well-differentiated thyroid cancer arising within struma ovarii. Patients underwent USO, BSO, or TAH/BSO. One patient underwent prophylactic total thyroidectomy in anticipation of RAI treatment, and was found to have a synchronous papillary thyroid carcinoma. All patients clinically remain without evidence of disease at a median follow-up of 9 (range 0.8-13) years. Treatment strategies in 53 cases from a review of the literature varied. The pooled cumulative recurrence rate of 57 cases with struma ovarii confined to the ovary was 7.5% at 25 years.

CONCLUSIONS

Thyroid cancer arising in struma ovarii is rare. Controversy exists regarding the extent of pelvic resection and management of the thyroid gland. In our series of four patients, all patients are alive without evidence of disease, and the 25-year recurrence rate of 57 cases was low (7.5%), despite a variety of approaches to surgical resection and adjuvant treatment. Extensive pelvic surgery and prophylactic total thyroidectomy to facilitate RAI therapy may be reserved for patients with gross extra-ovarian extension or distant metastases.

Lethal, malignant, metastatic struma ovarii

BACKGROUND

Struma ovarii (SO) is extremely rare, with less than 200 reported cases in the medical literature. SO is defined by the presence of an ovarian tumor containing thyroid tissue as the predominant cell type. Malignant transformation is rare and lethal cases of SO are even rarer. We report on a patient presenting with left ovarian cystic SO and lethal outcome.

SUMMARY

A 45-year-old woman was diagnosed with a follicular variant of papillary carcinoma on laparotomy and left salpingo-oophorectomy. She had persistently elevated serum thyroglobulin following total thyroidectomy + radioiodine and second-look surgery. Imaging scan analysis showed pelvic tumor recurrence and hypervascular liver metastases during follow-up as well as peritoneal carcinomatosis in the pelvis, right abdominal wall, and malignant ascites. The patient died from cachexia at 37 months after diagnosis.

CONCLUSIONS

Such an aggressive malignant disease and lethal course of SO is rare. Total thyroidectomy is mandatory to exclude a primary thyroid neoplasm and for radioiodine therapy and follow-up. SO may spread to contralateral ovary, pelvic nodes, peritoneum, liver, lungs, and bones through hematogeneous spread, which is different from the dissemination pattern of papillary thyroid carcinomas. Imaging highlights the mixed behavior of this ovarian tumor.

Typical thyroid-type carcinoma arising in struma ovarii: a report of 4 cases and review of the literature

Struma ovarii has elicited considerable interest because of its many unique features since Ludwig Pick first elucidated its relationship to teratoma in the early part of the 20th century. In this article, we report 3 cases of papillary and 1 of follicular thyroid carcinoma; 2 of these cases were associated with mature cystic teratoma. Metastases occurred in 2 patients, and 1 died of neoplasm. In regard to the occurrence of thyroid-type carcinoma in struma ovarii, precise terminology should be used, and the expression malignant struma ovarii was avoided as a diagnostic term. Upon review of the literature, papillary carcinoma and follicular carcinoma are the most frequent types of malignancy to occur in ovarian struma; other forms of thyroid carcinoma occur only rarely. The diagnostic criteria for cases of papillary carcinoma are similar to those described in the cervical thyroid gland and are based primarily on nuclear and architectural features. In reference to follicular carcinoma, invasion into the surrounding ovarian tissue, vascular invasion, or metastasis is evidence of malignancy. Histological malignancy in a struma does not necessarily equate with biological malignancy, and the majority of thyroid-type carcinomas do not spread beyond the ovary. Occasionally, metastases of ovarian struma have an innocuous histological appearance, and such cases are referred to as highly differentiated follicular carcinoma of ovarian origin (HDFCO). Because its histological appearance resembles that of nonneoplastic thyroid, HDFCO characteristically cannot be diagnosed until the neoplasm spreads beyond the ovary. In this article, we apply the term typical thyroid carcinoma to those forms of thyroid malignancy arising in ovarian struma that closely resemble the types described in the cervical thyroid gland to distinguish them from HDFCO. Typical follicular carcinoma is more aggressive than the somewhat more common papillary carcinoma, and HDFCO is the least aggressive of these tumor types. Cases of thyroid-type carcinoma arising in the ovary sometimes lack evidence of preexisting struma. The more aggressive thyroid-type neoplasms can arise in thyroid tissue within a mature cystic teratoma, or they may overgrow and replace the struma. Primary thyroid-type carcinoma must be distinguished from rare instances of ovarian metastases that originate in the cervical thyroid gland and the less differentiated forms from other ovarian neoplasms such as clear cell adenocarcinoma and tumors with an oxyphilic appearance. In the differential diagnosis with other ovarian neoplasms, cases of thyroid-type carcinoma associated with strumal carcinoid should not be diagnosed as malignant strumal carcinoid because the latter diagnosis might lead to suboptimal therapy.

A case of metastatic struma ovarii treated with 131I therapy: focus on preservation of fertility and selected review of the literature

Struma ovarii is a rare monodermal ovarian teratoma composed predominantly of mature thyroid tissue. We describe herein the case of a 22-year-old woman who underwent a right salpingo-oophorectomy for struma ovarii at the age of 12 years, who was admitted 8 years later with signs and symptoms of a left pelvic tumor. Laparoscopy detected a left ovarian endometriotic cyst and multiple nodules on the pelvic peritoneum, right lateral abdominal wall, diaphragm, vesical plica and liver. The diagnosis was abdominal and pelvic widespread dissemination of recurrent struma ovarii, with features consistent with the follicular variant of papillary thyroid carcinoma. The patient was treated with a combination of conservative surgery and two 131I administrations (cumulative activity of 350 mCi after dosimetric evaluation). Because of the high degree of hormonogenesis shown by the metastases, the first administration was performed following use of recombinant human (rh) thyroid-stimulating hormone (TSH) to reach adequate TSH levels. To avoid the 'stunning effect' and to obtain high-quality scintigraphy, a whole-body scan was performed with 123I after rh-TSH and before the 131I therapy. We also discuss the potential role and the possible benefit of using gonadotropin-releasing hormone analogs and ovarian tissue cryopreservation to preserve fertility in women treated with 131I for pelvic metastases from malignant struma ovarii.