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Brown M, Haight P, Ringel M, Phay J, Esnakula A, Vazzano J, Cosgrove C. Recurrent malignant struma ovarii presenting as peritoneal carcinomatosis in the setting of an intact thyroid: A case report and review of the literature. Gynecol Oncol Rep 2024; 54:101456. [PMID: 39076679 PMCID: PMC11284547 DOI: 10.1016/j.gore.2024.101456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 07/03/2024] [Accepted: 07/07/2024] [Indexed: 07/31/2024] Open
Abstract
Malignant struma ovarii is an exceedingly rare pathology with a paucity of established criteria regarding management and surveillance with recommendations largely based on case reports and retrospective data. Many authors have supported stratification of malignant struma ovarii into low vs high-risk disease with more conservative management reserved for those deemed low-risk. Here we present a unique case of recurrent metastatic malignant struma ovarii after surveillance was undertaken in the setting of initially low-risk disease.
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Affiliation(s)
- Morgan Brown
- The Ohio State University Wexner Medical Center, Department of Obstetrics and Gynecology, United States
| | - Paulina Haight
- The James Comprehensive Cancer Center at The Ohio State University, Department of Gynecologic Oncology, United States
| | - Matthew Ringel
- The James Comprehensive Cancer Center at The Ohio State University, Department of Molecular Medicine and Therapeutics, United States
| | - John Phay
- The James Comprehensive Cancer Center at The Ohio State University, Department of Surgical Oncology, United States
| | - Ashwini Esnakula
- The Ohio State University Wexner Medical Center, Department of Pathology, United States
| | - Jennifer Vazzano
- The Ohio State University Wexner Medical Center, Department of Pathology, United States
| | - Casey Cosgrove
- The James Comprehensive Cancer Center at The Ohio State University, Department of Gynecologic Oncology, United States
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Poljo A, Klasen JM, von Strauss Und Torney M, Posabella A, Taha-Mehlitz S, Hummer B, Kern B. A rare case of retroperitoneal teratoma with evidence of papillary thyroid carcinoma: a case report. BMC Endocr Disord 2024; 24:85. [PMID: 38858658 PMCID: PMC11165822 DOI: 10.1186/s12902-024-01606-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/23/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Teratomas are germ cell tumors composed of somatic tissues from up to three germ layers. Primary retroperitoneal teratomas usually develop during childhood and are uncommon in adults and in the retroperitoneal space. While there are only a few cases of retroperitoneal thyroid tissue, we report a unique case of a retroperitoneal papillary thyroid carcinoma. CASE PRESENTATION A 41-year-old woman presented in our institution due to intermitted unspecific abdominal pain. Magnetic resonance imaging detected a multi-cystic solid retroperitoneal mass ventral to the psoas muscle and the left iliac artery. After surgical removal of the retroperitoneal mass, histology sections of the specimen indicated evidence of papillary thyroid carcinoma cells. A staging computed tomography scan of the body showed no further manifestations. To reduce the risk of recurrence, total thyroidectomy was performed followed by radioiodine therapy with lifelong hormone substitution. CONCLUSIONS Primary retroperitoneal teratoma with evidence of papillary thyroid carcinoma is a rare condition. Preoperative diagnosis is difficult due to its non-specific clinical manifestation and lack of specific radiologic findings. Histopathology analysis is necessary for diagnosis. Although surgery is considered the first line treatment, there is still discussion about the extent of resection and the need for total thyroidectomy with adjuvant radioiodine therapy.
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Affiliation(s)
- Adisa Poljo
- University Digestive Health Care Center Basel - Clarunis, Department of Visceral Surgery, St. Claraspital and University Hospital Basel, Basel, 4002, Switzerland
| | - Jennifer M Klasen
- University Digestive Health Care Center Basel - Clarunis, Department of Visceral Surgery, St. Claraspital and University Hospital Basel, Basel, 4002, Switzerland.
| | - Marco von Strauss Und Torney
- University Digestive Health Care Center Basel - Clarunis, Department of Visceral Surgery, St. Claraspital and University Hospital Basel, Basel, 4002, Switzerland
- St. Clara Research Ltd, Basel, 4058, Switzerland
| | - Alberto Posabella
- University Digestive Health Care Center Basel - Clarunis, Department of Visceral Surgery, St. Claraspital and University Hospital Basel, Basel, 4002, Switzerland
| | - Stephanie Taha-Mehlitz
- University Digestive Health Care Center Basel - Clarunis, Department of Visceral Surgery, St. Claraspital and University Hospital Basel, Basel, 4002, Switzerland
| | - Barbara Hummer
- Department of Clinical Pathology and Cytopathology, Viollier AG, Allschwill, 4123, Switzerland
| | - Beatrice Kern
- University Digestive Health Care Center Basel - Clarunis, Department of Visceral Surgery, St. Claraspital and University Hospital Basel, Basel, 4002, Switzerland
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Kabootari M, Habibi Tirtashi R, Zadeh-Vakili A, Zarkesh M, Samadanifard H, Haghighi S, Azizi F, Amouzegar A. RET/PTC rearrangement in papillary thyroid carcinoma arising in malignant struma ovarii with abdominal wall metastasis and cervical thyroid gland: a case report and review of the literature. Thyroid Res 2023; 16:39. [PMID: 37759238 PMCID: PMC10537935 DOI: 10.1186/s13044-023-00181-5] [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: 12/24/2022] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Struma ovarii refers to rare mature cystic teratomas containing at least 50% of thyroid tissue, and malignant transformation is known to be even rarer. The synchronous development of malignant struma ovarii and cervical thyroid carcinoma are also scarce and poorly understood due to limited data about molecular features. Here, we present the first report of RET/PTC 1 rearrangement in synchronous metastatic malignant struma ovarii to the abdominal wall and cervical thyroid cancer. CASE PRESENTATION We described a 47-year-old multigravida woman with bilateral adnexal and lower abdominal wall masses detected during the evaluation of abnormal uterine bleeding. The patient underwent a hysterectomy, bilateral salpingo-oophorectomy, and surgical removal of abdominal wall mass. Then, the pathological evaluation revealed papillary thyroid carcinoma (PTC) within struma ovarii and metastatic PTC in the abdominal wall fibro adipose tissue. Further, cervical thyroid gland physical examination and ultrasound illustrated a nodule within the left lobe. Subsequently, a total thyroidectomy was performed, and a histological examination revealed PTC. Furthermore, all affected tissue, i.e., struma ovarii, abdominal wall metastasis, and cervical thyroid gland tested for BRAF and RAS mutations and RET/PTC 1 rearrangement. RET/PTC 1 rearrangement was identified among all three different sites. Finally, after six years of follow-up, the patient had no evidence of recurrence or distant metastasis. CONCLUSIONS In light of these findings, malignant struma ovarii might yield a clue to cervical thyroid carcinoma, and the molecular analysis could provide valuable information for understanding the underlying mechanism, tumor clinicopathological behaviors, and prognosis.
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Affiliation(s)
- Maryam Kabootari
- Metabolic Disorders Research Center, Golestan University of Medical Sciences, Gorgan, Iran
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Habibi Tirtashi
- Metabolic Disorders Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Azita Zadeh-Vakili
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Aerabi St, Daneshjoo Blv, Velenjak, P.O. Box 19395-4763, Tehran, Tehran, Iran
| | - Maryam Zarkesh
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Samadanifard
- Department of Endocrinology, School of Medicine, Hazrat-e Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Shirin Haghighi
- Department of Hematology and Medical Oncology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Aerabi St, Daneshjoo Blv, Velenjak, P.O. Box 19395-4763, Tehran, Tehran, Iran
| | - Atieh Amouzegar
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Aerabi St, Daneshjoo Blv, Velenjak, P.O. Box 19395-4763, Tehran, Tehran, Iran.
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Identifying the Carcinogenic Mechanism of Malignant Struma Ovarii Using Whole-Exome Sequencing and DNA Methylation Analysis. Curr Issues Mol Biol 2023; 45:1843-1851. [PMID: 36975488 PMCID: PMC10047136 DOI: 10.3390/cimb45030118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
Background: Since malignant struma ovarii is a very rare disease, its carcinogenic mechanism has not been elucidated. Here, we sought to identify the genetic lesions that may have led to the carcinogenesis of a rare case of malignant struma ovarii (follicular carcinoma) with peritoneal dissemination. Methods: DNA was extracted from the paraffin-embedded sections of normal uterine tissues and malignant struma ovarii for genetic analysis. Whole-exome sequencing and DNA methylation analysis were then performed. Results: Germline variants of RECQL4, CNTNAP2, and PRDM2, which are tumor-suppressor genes, were detected by whole-exome sequencing. Somatic uniparental disomy (UPD) was also observed in these three genes. Additionally, the methylation of FRMD6-AS2, SESN3, CYTL1, MIR4429, HIF3A, and ATP1B2, which are associated with tumor growth suppression, was detected by DNA methylation analysis. Conclusions: Somatic UPD and DNA methylation in tumor suppressor genes may be associated with the pathogenesis of malignant struma ovarii. To our knowledge, this is the first report of whole-exome sequencing and DNA methylation analysis in malignant struma ovarii. Genetic and DNA methylation analysis may help elucidate the mechanism of carcinogenesis in rare diseases and guide treatment decisions.
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Egan C, Stefanova D, Thiesmeyer JW, Lee YJ, Greenberg J, Beninato T, Zarnegar R, Christos PJ, Klein IL, Fahey TJ, Finnerty BM. Proposed Risk Stratification and Patterns of Radioactive Iodine Therapy in Malignant Struma Ovarii. Thyroid 2022; 32:1101-1108. [PMID: 35765923 DOI: 10.1089/thy.2022.0145] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Introduction: Malignant struma ovarii (MSO) is a rare thyroid cancer arising within an ovarian teratoma. While surgical excision of the primary tumor is widely accepted as standard of care, recommendations for adjuvant treatment of MSO-whether or not to administer radioactive iodine (RAI)-are based largely on case reports and remain debated. In this study, we aimed to propose a risk stratification and analyze RAI utilization patterns in MSO cases. Methods: The National Cancer Database (NCDB) was queried for patients with MSO between 2004 and 2016. Demographic, oncological, and clinicopathologic data were compared between groups using Fisher's exact test. Kaplan-Meier curves were used to estimate overall survival (OS), and variables associated with OS were assessed via univariate Cox regression. We adapted the 2015 American Thyroid Association risk guidelines for MSO patients. We stratified patients into low-, intermediate-, and high-risk groups using metastasis, extraovarian extension, lymphovascular invasion, lymph node status, surgical margins, tumor size, and grade. Risk stratification, demographic, oncological, and clinicopathologic data were compared between the groups receiving and not receiving RAI therapy. We then queried the Surveillance, Epidemiology, and End Results (SEER) 18 registry for patients with MSO between 2000 and 2018 to confirm our risk stratification analysis. Results: In the NCDB analysis, a total of 158 patients were identified, and 19 received RAI. RAI therapy was associated with distant metastasis (p = 0.005) and lymph node status (p = 0.012). Twenty-one NCDB patients were stratified as high risk, and 30% of high-risk patients received RAI. High-risk stratification was associated with decreased OS via univariate Cox regression (hazard ratio = 4.0 [95% confidence interval 1.11-14.26], p = 0.034). In our subsequent analysis using the SEER registry, there were 95 MSO patients, and 18 received RAI. Again, the majority of high-risk patients did not receive RAI, with only 41% of high-risk patients receiving RAI. Conclusions: MSO is a rare malignancy with apparently variable and inconsistent patterns of postoperative RAI administration. The risk stratification described here provides a framework to identify patients potentially at risk for mortality, and utilization of RAI in this group should be studied further.
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Affiliation(s)
- Caitlin Egan
- Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Dessislava Stefanova
- Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Jessica W Thiesmeyer
- Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Yeon Joo Lee
- Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Jacques Greenberg
- Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Toni Beninato
- Department of Surgery, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Rasa Zarnegar
- Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Paul J Christos
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Irwin L Klein
- Department of Medicine, NYU School of Medicine, Melville, New York, USA
| | - Thomas J Fahey
- Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Brendan M Finnerty
- Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
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Xiao W, Zhou JR, Chen D. Malignant struma ovarii with papillary carcinoma combined with retroperitoneal lymph node metastasis: A case report. World J Clin Cases 2022; 10:2961-2968. [PMID: 35434086 PMCID: PMC8968795 DOI: 10.12998/wjcc.v10.i9.2961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/22/2021] [Accepted: 01/29/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Struma ovarii is a rare specific ovarian tumor. It is a highly differentiated monodermal teratoma with a malignant transformation rate as low as 5%. Thus, malignant transformation and metastasis are extremely rare. The clinical manifestations of this disease are not typical and are easily misdiagnosed.
CASE SUMMARY A 55-year-old female patient had a history of pain in the right hepatic region for approximately 1 year. Computed tomography and magnetic resonance imaging showed a solid cystic mass in the right adnexal region and a solid mass in the right retroperitoneum. The patient underwent surgical resection, and the combined morphological and immunohistochemical results led to the final diagnosis of right struma ovarii with papillary carcinoma and right retroperitoneal lymph node metastasis.
CONCLUSION Malignant struma ovarii with distant metastasis is extremely rare, and the clinical manifestations of this disease are nonspecific. Accurate preoperative diagnoses are difficult to obtain, and pathological examination is the gold standard for diagnosing this disease.
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Affiliation(s)
- Wen Xiao
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Jin-Rong Zhou
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Dong Chen
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
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Li S, Kong S, Wang X, Zhang X, Yin M, Yang J. Survival Outcomes and Prognostic Predictors in Patients With Malignant Struma Ovarii. Front Med (Lausanne) 2021; 8:774691. [PMID: 35004743 PMCID: PMC8733601 DOI: 10.3389/fmed.2021.774691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 11/19/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Malignant struma ovarii (MSO) is an extremely rare ovarian malignant tumor and there is limited data on the survival outcomes and prognostic predictors of MSO. The objectives of this study were to investigate the disease-free survival (DFS), overall survival (OS), and disease-specific survival (DSS) rates of patients with MSO, and also evaluate the prognostic factors in this population. Methods: A retrospective study was conducted and 194 cases of MSO were selected. DFS was assessed by the logistic regression, OS by the Kaplan–Meier method, and DSS was evaluated by the Cox regression. Results: The median age of these patients was 46.0 years; 142 cases (73.2%) were confined to the ovary and 52 cases (26.8%) had extraovarian metastasis at the initial diagnosis of MSO. During the follow-up, 75.3% of these patients showed no evidence of disease and 18.0% were alive with disease. Only 13 deaths occurred, with 10 attributed to MSO. The 5, 10, and 15-year OS rates were 91.4, 87.7, and 83.5%, respectively. The 5, 10, and 15-year DSS rates were 93.8, 90.0, and 85.7%, respectively. Logistic regression revealed that International Federation of Gynecology and Obstetrics (FIGO) stage IV was the only risk factor for DFS [p < 0.001; odds ratio (OR) 7.328; 95% CI 3.103–16.885, FIGO stage IV vs. stage I; p = 0.021; OR 4.750, 95% CI 1.264–17.856, FIGO stage IV vs. stage II-III]. The multivariate Cox regression analysis showed that poor differentiation was the only risk factor for both OS (p = 0.005, OR 6.406; 95% CI 1.730–23.717) and DSS (p = 0.001, OR 9.664; 95% CI 2.409–38.760), while age ≥45 years was the prognostic predictor for OS (p = 0.038, OR 4.959; 95% CI 1.093–22.508). Conclusion: Survival outcomes were excellent in patients with MSO, irrespective of the treatment strategy, FIGO stage IV, age ≥45 years, and poor differentiation of tumors were the independent risk factors.
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Affiliation(s)
- Sijian Li
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Shujun Kong
- Department of Obstetrics and Gynecology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Xiaoxue Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Xinyue Zhang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Min Yin
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Jiaxin Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
- *Correspondence: Jiaxin Yang
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