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Wu Z, Tang L, Lai Y, Liu M, Zhou L. Follicular Thyroid Carcinoma Arising from the Struma Ovarii Coexisting with Papillary Thyroid Carcinoma, Hashimoto's Thyroiditis and Polycystic Ovarian Syndrome-a Case Report and Literature Review. Int J Womens Health 2024; 16:1187-1198. [PMID: 38974515 PMCID: PMC11225954 DOI: 10.2147/ijwh.s454119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 06/21/2024] [Indexed: 07/09/2024] Open
Abstract
Purpose Struma ovarii is a highly specialized teratoma consisting primarily of mature thyroid tissue. However, malignant struma ovarii coexisting with thyroid carcinoma, not to mention autoimmune disease, is uncommon. Malignant struma ovarii complicated with papillary thyroid carcinoma, Hashimoto's thyroiditis and polycystic ovarian syndrome has never been reported in literature. Patients and Methods A 32-year-old female was admitted to our hospital due to a history of abdominal distension and menolipsis over the past half a year. Physical examination touched a 6 × 6 cm mass with a clear boundary, normal movement, and no pressing pain in the right adnexal area, Imaging revealed a cystic solid mass of 6 × 7 cm in the right ovary and the level of tumor markers including CA125, CA199, CA153, CEA, AFP were normal, but with low TSH and increased TPOAb, TGAb, TRAb. Laparoscopic right ovary tumor resection was performed, followed by comprehensive staging surgery, as well as thyroidectomy after pathologic diagnosis. The patient was diagnosed with a combination of follicular thyroid cancer from struma ovarii, papillary thyroid carcinoma and Hashimoto's thyroiditis, along with polycystic ovarian syndrome. Immunohistochemical staining showed positivity for Ag, CK-pan, CK7, PAX8 and TTF-1 in the right ovarian mass, and the left thyroid was positive for the BRAF V600E mutation. Results The patient underwent thyroxine suppression therapy and radioactive iodine 131I therapy after operation. Serum thyroglobulin was undetectable, and no signs of recurrence or metastasis were detected in the imaging examination at the 2-year follow-up. Conclusion Malignant struma ovarii coexisting with thyroid carcinoma is rare. No report has been identified in literature review on the rare malignant struma ovarii coexisting with thyroid carcinoma, Hashimoto's thyroiditis and polycystic ovarian syndrome. Our case can offer experience of diagnosis and treatment to some extent for such rare case. Therefore, it is essential to consider the association between ovarian tumors and the endocrine system. This case is valuable in understanding the diagnosis and management of such an unusual complicated disease.
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Affiliation(s)
- Zhaoting Wu
- Department of Gynecologic Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, People’s Republic of China
- Department of Gynecology, the First People’s Hospital of Chenzhou, Chenzhou, Hunan, People’s Republic of China
| | - Lihua Tang
- Department of Gynecologic Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, People’s Republic of China
| | - Yaozhen Lai
- Department of Gynecologic Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, People’s Republic of China
| | - Muyuan Liu
- Head and Neck Surgery Department, Cancer Hospital of Shantou University, Medical College, Shantou, Guangdong, People’s Republic of China
| | - Li Zhou
- Department of Gynecologic Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, People’s Republic of China
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Shatila M, Ahmad I, Balega J, Kalkat MS, Patel AJ. An unusual case of three concomitant primary solid cancers with unique histopathological characteristics. Int J Surg Case Rep 2023; 113:109080. [PMID: 37995507 DOI: 10.1016/j.ijscr.2023.109080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 11/15/2023] [Accepted: 11/17/2023] [Indexed: 11/25/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Struma Ovarii is a rare type of monodermal teratoma with at least 50 % of its mass being thyroid tissue. They make up <1 % of all ovarian tumours and 3 to 5 % of all ovarian teratomas. These tumours are usually benign but malignant transformation is seen in <5 % of cases. CASE PRESENTATION We present the case of a 45-year-old lady with three synchronous primary cancers on a background of Struma Ovarii; primary lung adenocarcinoma, papillary thyroid carcinoma and ovarian teratoma. Over the course of 18 months, this lady underwent full pelvic clearance of malignant Struma Ovarii and lymph nodes, total thyroidectomy, and an anatomical lung resection. CLINICAL DISCUSSION This case represents an incredibly rare condition of Struma Ovarii for which there is no firm management consensus. Furthermore, the uniqueness of three separate primaries has to the best of our knowledge not previously been reported in the literature. CONCLUSION This reinforces the notion that in select patients, radical management with curative intent is entirely possible but requires complete multi-disciplinary and multi-modal sub-specialty collaboration.
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Affiliation(s)
- Mohamed Shatila
- Department of Thoracic Surgery, University Hospitals Birmingham NHS Trust, UK; Department of Cardiothoracic Surgery, Faculty of Medicine, Alexandria University Hospital, Alexandria, Egypt
| | - Ijaz Ahmad
- Department of Head and Neck Surgery, University Hospitals Birmingham NHS Trust, UK
| | - Janos Balega
- Department of Gynaecological Oncology, City Hospital, Birmingham, UK
| | - Maninder S Kalkat
- Department of Thoracic Surgery, University Hospitals Birmingham NHS Trust, UK
| | - Akshay J Patel
- Department of Thoracic Surgery, University Hospitals Birmingham NHS Trust, UK; Institute of Immunology and Immunotherapy, University of Birmingham, UK.
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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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Seo GT, Minkowitz J, Kapustin DA, Fan J, Minkowitz G, Minkowitz M, Dowling E, Matloob A, Asti D, Dhar M, Shutty C, Brickman A, Urken ML, Brandwein-Weber M, Finkelstein SD. Synchronous thyroid cancer and malignant struma ovarii: concordant mutations and microRNA profile, discordant loss of heterozygosity loci. Diagn Pathol 2023; 18:47. [PMID: 37072862 PMCID: PMC10111709 DOI: 10.1186/s13000-023-01336-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/03/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Struma ovarii is an unusual ovarian teratoma containing predominantly thyroid tissue. Less than 10% of cases undergo malignant transformation in the thyroid tissue and are considered malignant struma ovarii (MSO). MSO have been reported with concurrent thyroid lesions, but molecular data is lacking. CASE PRESENTATION A 42-year-old female developed MSO and synchronous multifocal subcentimeter papillary thyroid carcinoma (PTC). The patient underwent a salpingo-oophrectomy, thyroidectomy, and low-dose radioactive iodine ablation. Both the thyroid subcentimeter PTC and MSO were positive for BRAF V600E mutation, and microRNA expression profiles were similar across all tumor deposits. However, only the malignant component demonstrated extensive loss of heterozygosity (LOH) involving multiple tumor suppressor gene (TSG) chromosomal loci. CONCLUSIONS We present the first reported case of MSO with synchronous multifocal subcentimeter PTC in the thyroid containing concordant BRAF V600E mutations and resulting with discordant LOH findings. This data suggests that loss of expression in tumor suppressor gene(s) may be an important contributor to phenotypic expression of malignancy.
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Affiliation(s)
- Gabriella T Seo
- Thyroid, Head and Neck Cancer (THANC) Foundation, 10 Union Square East, Suite 5B, New York, NY, 10003, USA
| | - Jeremy Minkowitz
- Minkowitz Pathology, 904 49th Street, Brooklyn, NY, 11219, USA
- SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA
| | - Danielle A Kapustin
- Thyroid, Head and Neck Cancer (THANC) Foundation, 10 Union Square East, Suite 5B, New York, NY, 10003, USA.
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 5B, New York, NY, 10003, USA.
| | - Jun Fan
- Department of Pathology, Mount Sinai West Medical Center, 1000 10th Avenue, New York, NY, 10019, USA
| | | | | | - Eric Dowling
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 5B, New York, NY, 10003, USA
| | - Ammar Matloob
- Department of Pathology, Mount Sinai West Medical Center, 1000 10th Avenue, New York, NY, 10019, USA
| | - Divya Asti
- Department of Hematology and Medical Oncology, Northwell Health Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY, 10305, USA
| | - Meekoo Dhar
- Department of Hematology and Medical Oncology, Northwell Health Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY, 10305, USA
| | | | - Alan Brickman
- ParCare Community Health Network, 6010 Bay Parkway, Brooklyn, NY, 11204, USA
| | - Mark L Urken
- Thyroid, Head and Neck Cancer (THANC) Foundation, 10 Union Square East, Suite 5B, New York, NY, 10003, USA
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 5B, New York, NY, 10003, USA
| | - Margaret Brandwein-Weber
- Department of Pathology, Mount Sinai West Medical Center, 1000 10th Avenue, New York, NY, 10019, USA
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Smith LP, Brubaker LW, Wolsky RJ. It Does Exist! Diagnosis and Management of Thyroid Carcinomas Originating in Struma Ovarii. Surg Pathol Clin 2023; 16:75-86. [PMID: 36739168 DOI: 10.1016/j.path.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Thyroid carcinoma originating in struma ovarii comprises a small minority of all cases of struma ovarii. Given the rarity of this diagnosis, literature to guide evaluation and management is limited. The most common carcinoma originating from struma ovarii is papillary thyroid carcinoma. Treatment includes surgery, including a fertility sparing approach if disease is confined to the ovary, with consideration of total thyroidectomy and radioactive iodine ablation for high-risk pathologic features or disease spread beyond the ovary. This review discusses the histopathologic findings, molecular pathology, clinical implications and management, and prognosis of thyroid carcinomas originating in struma ovarii.
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Affiliation(s)
- Lynelle P Smith
- Department of Pathology, University of Colorado School of Medicine, 12605 East 16th Avenue, Mail Stop F768, Aurora, CO 80045, USA
| | - Lindsay W Brubaker
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Colorado School of Medicine, Academic Office 1 12631 East 17th Avenue, B198-6, Aurora, CO 80045, USA
| | - Rebecca J Wolsky
- Department of Pathology, University of Colorado School of Medicine, 12605 East 16th Avenue, Mail Stop F768, Aurora, CO 80045, USA.
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Leuștean L, Ungureanu MC, Preda C, Bilha SC, Obrocea F, Dănilă R, Stătescu L, Apostol Ciobanu DG. Management of malignant struma ovarii: is aggressive therapy justified? Case report and literature review. Thyroid Res 2022; 15:14. [PMID: 35948940 PMCID: PMC9367145 DOI: 10.1186/s13044-022-00132-6] [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: 06/08/2022] [Accepted: 07/22/2022] [Indexed: 12/02/2022] Open
Abstract
Background Struma ovarii (SO) is a rare ovarian teratoma containing predominantly thyroid tissue. In rare situations SO may develop malignancy. Most cases of malignant struma ovarii (MSO) are diagnosed after surgical removal, based on histopathological examination. There are still controversies regarding the extent of surgery and postoperative management in MSO, due to its unpredictable behavior, possible risk of metastasis and relatively high rate of recurrence. Case Presentation We present the case of a patient diagnosed with a right ovarian cyst discovered incidentally during routine ultrasound examination. Its rapid growth and pelvic MRI raised the suspicion of a neoplastic process. She underwent total hysterectomy and bilateral adnexectomy. The anatomopathological diagnosis was MSO with follicular variant of papillary thyroid carcinoma. Prophylactic total thyroidectomy was performed, followed by radioactive iodine ablation (RAI), and suppressive therapy with levothyroxine. At 1 year follow-up, the patient was disease free. Conclusions Even if latest literature reports consider that completion of local surgery with total thyroidectomy and RAI might be too aggressive in cases of MSO without extraovarian extension, in our case it was decided to follow the protocol for primary thyroid carcinoma, in order to reduce the recurrence risk.
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Affiliation(s)
- Letiția Leuștean
- Department of Endocrinology, "Grigore T. Popa" University of Medicine and Pharmacy Iasi, Iasi, Romania
| | - Maria-Christina Ungureanu
- Department of Endocrinology, "Grigore T. Popa" University of Medicine and Pharmacy Iasi, Iasi, Romania
| | - Cristina Preda
- Department of Endocrinology, "Grigore T. Popa" University of Medicine and Pharmacy Iasi, Iasi, Romania
| | - Stefana Catalina Bilha
- Department of Endocrinology, "Grigore T. Popa" University of Medicine and Pharmacy Iasi, Iasi, Romania.
| | | | - Radu Dănilă
- Department of Surgery, "Grigore T. Popa" University of Medicine and Pharmacy Iasi, Iasi, Romania
| | - Laura Stătescu
- Department of Dermatology, "Grigore T. Popa" University of Medicine and Pharmacy Iasi, Iasi, Romania
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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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Li Z, Wang J, Chen Q. Struma ovarii and peritoneal strumosis during pregnancy. BMC Pregnancy Childbirth 2021; 21:347. [PMID: 33934699 PMCID: PMC8091791 DOI: 10.1186/s12884-021-03815-4] [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: 11/20/2020] [Accepted: 04/20/2021] [Indexed: 12/03/2022] Open
Abstract
Background Struma ovarii is a special type of ovarian dermoid cyst and accounts for approximately 2–3 % of all dermoid tumours. Benign struma ovarii may manifest as distant metastasis, called peritoneal strumosis, which makes it biologically similar to malignancy, and has been reported in limited cases but never discovered during pregnancy. Case presentation We report a patient with a history of right struma ovarii cystectomy. During pregnancy, pelvic masses with non-specific clinical presentation were found again. During the caesarean section, contralateral struma ovarii with dissemination of nodules in the peritoneal cavity was found, and pathology revealed that the masses were thyroid follicle ovarian goitres. Discussion and conclusions Recurrent benign struma ovarii with extraovarian dissemination is a rare aggressive clinical manifestation different from malignancy. It is emphasized that adequate assessment and complete resection of suspicious masses are of great importance.
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Affiliation(s)
- Zheng Li
- Department of Obstetrics and Gynecology, Peking University First Hospital, 100034, Beijing, P.R. China
| | - Jingxue Wang
- Department of Obstetrics and Gynecology, Peking University First Hospital, 100034, Beijing, P.R. China
| | - Qian Chen
- Department of Obstetrics and Gynecology, Peking University First Hospital, 100034, Beijing, P.R. China.
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Cui Y, Yao J, Wang S, Zhao J, Dong J, Liao L. The Clinical and Pathological Characteristics of Malignant Struma Ovarii: An Analysis of 144 Published Patients. Front Oncol 2021; 11:645156. [PMID: 33763376 PMCID: PMC7982850 DOI: 10.3389/fonc.2021.645156] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 02/08/2021] [Indexed: 01/20/2023] Open
Abstract
The objective of this study is to summarize the clinical and pathologic characteristics of malignant struma ovarii to facilitate the early diagnosis and treatment of this disease. All 144 patients were females from 27 countries. The mean age of the patients at diagnosis was 42.6 years. Overall, 35.71% of the patients underwent unilateral oophorectomy, 58.57% of the patients underwent bilateral oophorectomy, 5.72% of the patients were not ovariectomized, and 38.57% of the patients received radioactive iodine treatment with an average dose of 158.22 mCI each time. “Impure” types accounted for 70.19% of the cases, while pure types accounted for 29.81% of the cases. Among these cases, papillary thyroid carcinoma accounted for 50.00%, follicular thyroid carcinoma accounted for 26.47%, follicular variant of papillary thyroid carcinoma accounted for 18.63%, papillary and follicular mixed thyroid carcinoma accounted for 2.94%, anaplastic carcinoma accounted for 0.98%, and medullary carcinoma accounted for 0.98%. In total, 21 patients (51.22%) had elevated CA125. More than half of the patients (51.94%) had metastasis outside the ovary. The most common metastatic site was the pelvic cavity. The misdiagnosis rate was 17.27%. Mortality was related to metastasis and the cancer type. Gene mutations were found in the NRAS, KRAS, BRAF, and KIT genes and were similar to those in thyroid carcinoma, but some patients (37.5%) did not exhibit any gene mutations. Regardless of the treatment received, the survival rate is high. Treatment could initially include ovariectomy; however, in cases with metastasis and iodine uptake of the metastatic tumor, thyroidectomy, radioactive iodine therapy, and thyroid hormone inhibiting therapy are indicated.
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Affiliation(s)
- Yuying Cui
- Department of Endocrinology and Metabology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Institute of Nephrology, Jinan, China.,College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Jinming Yao
- Department of Endocrinology and Metabology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Institute of Nephrology, Jinan, China.,Department of Endocrinology and Metabology, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, China
| | - Shengnan Wang
- Department of Endocrinology and Metabology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Institute of Nephrology, Jinan, China
| | - Junyu Zhao
- Department of Endocrinology and Metabology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Institute of Nephrology, Jinan, China
| | - Jianjun Dong
- Department of Endocrinology and Metabology, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Lin Liao
- Department of Endocrinology and Metabology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Institute of Nephrology, Jinan, China.,Department of Endocrinology and Metabology, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, China
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Malignant struma ovarii: surgical, histopathological and survival outcomes for thyroid-type carcinoma of struma ovarii with recommendations for standardising multi-modal management. A retrospective case series sharing the experience of a single institution over 10 years. Arch Gynecol Obstet 2021; 303:863-870. [PMID: 33512594 DOI: 10.1007/s00404-021-05969-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/12/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Struma ovarii is rare, accounting for 0.3-1% of ovarian tumours. Malignant transformation may occur, most often into papillary thyroid carcinoma. There is a paucity of data pertaining to malignant struma ovarii. This paper shares a decade of experience of a single institution in the management of this rare ovarian cancer, exploring the characteristics of this tumour and suggesting a standardised approach to treatment and follow-up. METHODS All patients treated for malignant struma ovarii within a large cancer centre over one decade were identified and data collected retrospectively on presentation, diagnosis, management, follow-up and survival outcomes. A literature review was also undertaken. RESULTS Eleven cases of malignant struma ovarii were managed in the Oxford Cancer Centre between 2010 and 2019, 6 of which were of papillary thyroid carcinoma sub-type. No cases were correctly diagnosed pre-operatively. All patients had stage I disease and were managed surgically-but with variation in radicality. Patients identified as high-risk based on final histopathology underwent additional thyroidectomy and radio-active iodine ablation therapy. One case of synchronous malignancy of the thyroid gland proper was identified. No disease recurrence occurred. CONCLUSION Malignant struma ovarii present a diagnostic challenge. Multi-disciplinary team (MDT) input is essential. Unilateral salpingo-oophrectomy may be adequate if stage I; reserving more radical surgery for advanced disease. Histopathological risk-stratification should be used to identify those most likely to benefit from adjuvant thyroid-targeting therapies. Patients require follow-up, anticipating an overall good prognosis.
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11
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Metastatic Malignant Struma Ovarii and Graves' Disease: A Rare Occurrence. AACE Clin Case Rep 2021; 7:243-246. [PMID: 34307845 PMCID: PMC8282513 DOI: 10.1016/j.aace.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective Malignant struma ovarii (SO) is a rare condition. Although there have been a few reported cases of malignant SO with coexisting Graves’ disease (GD), the exact incidence of metastasis in these cases is not known. We report a rare case of metastatic malignant SO coexisting with GD. Methods Clinical examination, pelvic ultrasound, and histopathology of the resected tumor were performed, followed by iodine-131 (I-131) and whole body scan. Antithyroglobulin titers were postoperatively followed. Results A 43-year-old woman with a history of left ovarian cystic teratoma with SO resected 8 years ago and recently diagnosed GD presented with lower abdominal fullness. Pelvis ultrasound showed a 13.8-cm left adnexal mass, and she underwent left salpingo- oophorectomy. Histology confirmed an intraovarian thyroid tissue housing a highly differentiated follicular thyroid carcinoma, with metastatic peritoneal deposits. She underwent completion surgery and total thyroidectomy. Histology showed no evidence of intrathyroidal malignancy. I-131 therapy was administered, and posttherapeutic I-131 whole body scan revealed a remnant disease. She was started on suppressive levothyroxine therapy and remained clinically well at her 1-year follow-up with downtrending antithyroglobulin titers. Conclusion The coexistence of malignant SO and GD is very rare, and even rarer is the coexistence of metastasis malignant SO and GD. To the best of our knowledge, this is the first reported case of metastatic malignant SO in the setting of GD.
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Poli R, Scatolini M, Grosso E, Maletta F, Gallo M, Liscia D, Nelva A, Cesario F, Forte G, Metovic J, Volante M, Arvat E, Papotti M. Malignant struma ovarii: next-generation sequencing of six cases revealed Nras, Braf, and Jak3 mutations. Endocrine 2021; 71:216-224. [PMID: 32743766 DOI: 10.1007/s12020-020-02438-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/25/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Struma ovarii (SO) is a highly specialized ovarian teratoma, consisting of thyroid tissue. Rarely, carcinomas histologically identical to their thyroid counterparts may occur, and are comprehensively defined as malignant struma ovarii (MSO). Their optimal management is controversial, and the molecular profile of the malignant counterpart in the ovary is incompletely known. In this study, the clinicopathological and molecular features of six MSO from different Italian Institutions were analysed, to explore genetic profiles of potential therapeutic interest. METHODS The histopathological features and immunoprofile (according to the known markers Galectin-3, HBME1, cytokeratin 19 and CD56) were reviewed. In addition, all cases underwent genetic analysis with a next-generation sequencing (NGS) hot spot cancer panel detecting mutations in 50 genes involved in cancerogenesis. RET/PTC rearrangements and TERT promoter alterations were also evaluated. RESULTS Papillary carcinoma in all similar to its thyroid counterpart was found in five of six cases, including classical (two tumors) and follicular variant (three tumors) types. The last case was a poorly differentiated carcinoma. An activating gene mutation, was detected in five of six cases, including two NRAS, two BRAF, and one JAK3 oncogene mutations. No alterations were found in the other panel genes, nor in TERT promoter, or in RET chromosomal regions. CONCLUSIONS MSO is a rare condition. Papillary carcinoma is the predominant malignant type, sharing both histomorphological and molecular features of its thyroid counterpart. Interestingly, the single case of poorly differentiated carcinoma displayed a JAK3 mutation. The presence of such driving mutation could be of potential interest in guiding postoperative treatment.
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Affiliation(s)
- Roberta Poli
- Division of Internal Medicine, Ospedale degli Infermi, via dei Ponderanesi 2 Ponderano, 13875, Biella, Italy.
| | - Maria Scatolini
- Molecular Oncology Laboratory, Fondazione "Edo ed Elvo Tempia Valenta", via dei Ponderanesi 2, Ponderano, 13875, Biella, Italy
| | - Enrico Grosso
- Molecular Oncology Laboratory, Fondazione "Edo ed Elvo Tempia Valenta", via dei Ponderanesi 2, Ponderano, 13875, Biella, Italy
| | - Francesca Maletta
- Pathology Unit, AOU Città della Salute e della Scienza Hospital, via Santena 7, 10126, Turin, Italy
| | - Marco Gallo
- Oncological Endocrinology, AOU Città della Salute e della Scienza di Torino Hospital, via Genova 3, 10126, Turin, Italy
| | - Daniele Liscia
- Pathology Unit, Ospedale degli Infermi, via dei Ponderanesi 2 Ponderano, 13875, Biella, Italy
| | - Anna Nelva
- Endocrinology and Diabetology Unit, Ospedale degli Infermi, via dei Ponderanesi 2 Ponderano, 13875, Biella, Italy
| | - Flora Cesario
- Division of Endocrinology, Diabetes and Metabolism, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Giuseppe Forte
- Pathology Unit, Santa Croce e Carle Hospital, via M Coppino 26, 12100, Cuneo, Italy
| | - Jasna Metovic
- Pathology Unit, Department of Oncology, University of Turin, via Santena 7, 10126, Turin, Italy
| | - Marco Volante
- Pathology Unit, Department of Oncology, University of Turin, via Santena 7, 10126, Turin, Italy
| | - Emanuela Arvat
- Oncological Endocrinology, Department of Medical Sciences, University of Turin, via Genova 3, 10126, Turin, Italy
| | - Mauro Papotti
- Pathology Unit, Department of Oncology, University of Turin, via Santena 7, 10126, Turin, Italy
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Li S, Yang T, Li X, Zhang L, Shi H, Cheng N, Lang J. FIGO Stage IV and Age Over 55 Years as Prognostic Predicators in Patients With Metastatic Malignant Struma Ovarii. Front Oncol 2020; 10:584917. [PMID: 33117719 PMCID: PMC7550973 DOI: 10.3389/fonc.2020.584917] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 08/28/2020] [Indexed: 12/13/2022] Open
Abstract
Introduction: Metastatic malignant struma ovarii (MSO) is an extremely rare disease that lacks treatment consensus and accurate prognosis. The objective of this study was to present the clinical, pathological, and treatment characteristics of metastatic MSO, while also investigate the overall survival (OS) rate and factors affecting prognosis in this population. Materials and Methods: A total of 79 cases of metastatic MSO were reviewed, including four cases of metastatic MSO from our hospital and 75 cases selected from the literature. Logistic regression was used to identify potential factors affecting disease free survival (DFS). The Kaplan-Meier method and log-rank test were used to determine OS; further Cox regression was used to evaluate factors affecting OS. Results: The mean age of all the patients at diagnosis was 43.8 years. The most common metastatic sites were peritoneum, bone, liver, omentum and lung in descending order. Only two patients (2.6%) coexisted with local primary thyroid cancer. Follicular carcinoma (41.8%) as the most prevalent subtype, followed by papillary carcinoma, follicular variant of papillary carcinoma, and mixed follicular-papillary carcinoma. 36.7% of the patients received conservative surgery, 43.0% of them underwent aggressive surgery, and 15.2% of them did not receive any surgery. 74.7% of patients who received adjuvant therapy underwent radioiodine therapy (RAI). Logistics regression revealed that FIGO stage IV was the only prognostic factor in predicting DFS (P = 0.002; Odds Ratio [OR] 5.333; 95% confidence interval [CI]: 1.839–15.471). Only seven deaths occurred. The OS rates at 5, 10, 15 years were 89.3, 82.4, 65.9%, respectively. Multivariate analysis showed age over 55 years (P = 0.006; OR 9.362; 95%CI: 1.895–46.246) was the only risk factor for OS. Conclusion: Patients with metastatic MSO have an excellent disease-specific OS rate, FIGO stage IV and age over 55 years were two factors affecting disease prognosis. Conservative surgery with residual ablation by RAI after total thyroidectomy should be preferred since the benefits of aggressive surgery are uncertain.
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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, Beijing, China
| | - Tengyu Yang
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xiaoyan Li
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Limeng Zhang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Honghui Shi
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Ninghai Cheng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jinghe Lang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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Papillary Thyroid Cancer in a Struma Ovarii in a 17-Year-Old Nulliparous Patient: A case Report. Diagnostics (Basel) 2020; 10:diagnostics10010045. [PMID: 31952290 PMCID: PMC7168171 DOI: 10.3390/diagnostics10010045] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 01/12/2020] [Accepted: 01/13/2020] [Indexed: 02/04/2023] Open
Abstract
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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González-Cejudo C, Calderón AM, García-Arreza A, Vieites B, Martínez MÁ. Conservative surgical approach of a synchronous malignant ovarian struma and papillary thyroid carcinoma in a postmenopausal woman. J OBSTET GYNAECOL 2019; 41:160-161. [DOI: 10.1080/01443615.2019.1677582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Ana María Calderón
- Department of Gynaecology, Hospital Universitario Virgen del Rocio, Seville, Spain
| | - Aída García-Arreza
- Department of Gynaecology, Hospital Universitario Virgen del Rocio, Seville, Spain
| | - Begoña Vieites
- Department of Pathology, Hospital Universitario Virgen del Rocio, Seville, Spain
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Struma ovarii with atypical features and synchronous primary thyroid cancer: a case report and review of the literature. Arch Gynecol Obstet 2019; 300:1693-1707. [DOI: 10.1007/s00404-019-05329-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 10/10/2019] [Indexed: 10/25/2022]
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17
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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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18
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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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Gomes-Lima CJ, Nikiforov YE, Lee W, Burman KD. Synchronous Independent Papillary Thyroid Carcinomas in Struma Ovarii and the Thyroid Gland With Different RAS Mutations. J Endocr Soc 2018; 2:944-948. [PMID: 30087949 PMCID: PMC6065485 DOI: 10.1210/js.2018-00132] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 07/05/2018] [Indexed: 11/29/2022] Open
Abstract
Struma ovarii is a rare ovarian teratoma predominantly composed of thyroid tissue. The simultaneous presence of thyroid carcinoma in the struma ovarii and the thyroid gland is extremely rare. It remains unclear if these carcinomas represent independent primary tumors and whether the molecular mechanisms of the tumors developing in the thyroid and ovarian tissues are similar. We present the case of a patient with two independent papillary thyroid carcinomas (PTCs) in struma ovarii and the thyroid gland that are driven by different RAS mutations. A 62-year-old woman with a history of chronic lymphocytic leukemia/small lymphocytic lymphoma was diagnosed with a pelvic mass during a CT scan. She had surgery that included removal of her ovaries. A 7.2-cm classical variant of PTC arising in a struma ovarii was identified in the right ovary. Two months after the pelvic surgery, total thyroidectomy was performed, and a small nodule (0.8 cm) in the left lobe was diagnosed as a classical variant of PTC. Molecular analysis of tissues obtained from both the malignant struma ovarii and thyroid gland was performed. RAS mutations both in the PTC located in the thyroid and ovarian tissues were identified. However, whereas the thyroid gland tumor showed an HRAS Q61R mutation, the PTC in struma ovarii harbored an NRAS Q61R mutation. In this case, the finding of distinct types of RAS point mutation in thyroid cancers at two different locations provides definitive evidence that these cancers are synchronously developed independent primary tumors.
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Affiliation(s)
- Cristiane J Gomes-Lima
- MedStar Clinical Research Center, MedStar Health Research Institute, Hyattsville, MD.,Department of Medicine, Endocrinology Section, MedStar Washington Hospital Center, Washington, DC
| | - Yuri E Nikiforov
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Wen Lee
- Department of Pathology, MedStar Washington Hospital Center, Washington, DC
| | - Kenneth D Burman
- Department of Medicine, Endocrinology Section, MedStar Washington Hospital Center, Washington, DC
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20
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Lebreton C, Al Ghuzlan A, Floquet A, Kind M, Leboulleux S, Godbert Y. [Thyroid carcinoma on struma ovarii: Diagnosis and treatment]. Bull Cancer 2018; 105:281-289. [PMID: 29459090 DOI: 10.1016/j.bulcan.2017.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 11/14/2017] [Indexed: 10/18/2022]
Abstract
Thyroid carcinoma on struma ovarii (TCSO) is a rare ovarian tumour, derivate from monodermic teratomas. It represents about 0.01% of overall ovarian tumours and 5 to 10% of struma ovarii. The diagnosis is histologic and retrospective after pelvic surgery; radiographic imaging being unspecific. Because of its rarity, the treatment of TCSO is not consensual and should be validated in multidisciplinary team involved in rare ovarian carcinoma. The first treatment is a surgical removal, with a laparoscopic approach. A fertility-conservative surgery is recommended for young women. If the tumour is unresectable and/or with metastatic spread, an adjuvant iodine 131 treatment might be proposed after thyroidectomy. Recurrence of TCSO should be taken care of as a thyroid carcinoma with tyrosine kinase inhibitor in case of progressive distant relapse, refractory to iodine 131 treatment. If the recurrence is localised, a complete surgery is the preferred option. There is no gold standard for the follow up.
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Affiliation(s)
- Coriolan Lebreton
- Institut Bergonié, département d'oncologie médicale, 229, cours de l'Argonne, 33076 Bordeaux, France.
| | - Abir Al Ghuzlan
- Institut Gustave-Roussy, service d'anatomopathologie, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - Anne Floquet
- Institut Bergonié, département d'oncologie médicale, 229, cours de l'Argonne, 33076 Bordeaux, France
| | - Michèle Kind
- Institut Bergonié, département d'imagerie médicale, 229, cours de l'Argonne, 33076 Bordeaux, France
| | - Sophie Leboulleux
- Institut Gustave-Roussy, université Paris-Sud, service de médecine nucléaire et de cancérologie endocrinienne, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - Yann Godbert
- Institut Bergonié, département de médecine nucléaire et de cancérologie thyroidienne, 229, cours de l'Argonne, 33076 Bordeaux, France
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21
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Boyd JC, Williams BA, Rigby MH, Kieser K, Offman S, Shirsat H, Trites JRB, Taylor SM, Hart RD. Malignant Struma ovarii in a 30-year old nulliparous patient. Thyroid Res 2017; 10:3. [PMID: 28572843 PMCID: PMC5450076 DOI: 10.1186/s13044-017-0038-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 05/15/2017] [Indexed: 12/13/2022] Open
Abstract
Background Struma ovarii is a rare monodermal germ cell tumor where the ovary is comprised of at least half thyroid tissue. This phenomenon may indicate an embryological origin. Case presentation A 30-year old nulliparous woman presented with acute right lower quadrant pain and underwent laparoscopic right salpingo-oophorectomy. The excised ovarian mass showed evidence of struma-derived papillary thyroid carcinoma. Ultrasound of the thyroid showed mild enlargement with two solid nodules. A fine needle aspirate of a thyroid nodule was positive for malignancy and a total thyroidectomy was performed. Microscopic features of the thyroid were consistent with papillary thyroid carcinoma. The two tumours were considered as synchronous independent primaries based on their histological presentation. Conclusions We believe that aggressive surgical management followed by radioiodine therapy is best to reduce recurrence risk and optimize survival. The broad scope of interventions needed to treat malignant struma ovarii require a strong interdisciplinary team.
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Affiliation(s)
- J Colin Boyd
- Dalhousie Medical School, Dalhousie University, 5849 University Avenue, Halifax, NS B3H 4H7 Canada
| | - Blair A Williams
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, NS Canada
| | - Matthew H Rigby
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, NS Canada
| | - Katharina Kieser
- Department of Obstetrics and Gynecology, Dalhousie University, Halifax, NS Canada
| | - Saul Offman
- Department of Pathology, Dalhousie University, Halifax, NS Canada
| | - Hemlata Shirsat
- Department of Pathology, Dalhousie University, Halifax, NS Canada
| | - Jonathan R B Trites
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, NS Canada
| | - S Mark Taylor
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, NS Canada
| | - Robert D Hart
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, NS Canada
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Ernaga Lorea A, Hernández Morhain MC, Anda Apiñániz E, Lapeña Calavia S, Eguílaz Esparza N. Metastatic malignant struma ovarii: Two scenarios of the same pathology. ACTA ACUST UNITED AC 2017; 64:121-122. [PMID: 28440778 DOI: 10.1016/j.endinu.2016.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 09/21/2016] [Accepted: 09/23/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Ander Ernaga Lorea
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario de Navarra, Pamplona, Navarra, España.
| | | | - Emma Anda Apiñániz
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | - Sonia Lapeña Calavia
- Servicio de Ginecología y Obstetricia, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | - Nerea Eguílaz Esparza
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
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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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Fernández Catalina P, Rego Iraeta A, Lorenzo Solar M, Sánchez Sobrino P. Estruma ovárico maligno y cáncer papilar de tiroides sincrónicos. ACTA ACUST UNITED AC 2016; 63:366-7. [DOI: 10.1016/j.endonu.2016.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 05/03/2016] [Accepted: 05/04/2016] [Indexed: 10/21/2022]
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Treatment and follow-up of malignant struma ovarii: Regarding two cases. Gynecol Oncol Rep 2016; 17:56-9. [PMID: 27355004 PMCID: PMC4913172 DOI: 10.1016/j.gore.2016.05.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 05/19/2016] [Accepted: 05/31/2016] [Indexed: 02/02/2023] Open
Abstract
Malignant struma ovarii (SO) is a rare tumor, and as a consequence, treatments and follow-up procedures are not clearly established. Presented in this study are two cases of suspicious ovarian masses, resected and corresponding to malignant SO on histopathology. Similar to thyroid cancer, we proposed complementary radioiodine therapy (131I) after total thyroidectomy (no malignancy was observed at this level in our two patients). Patients underwent treatment with 3.7 GBq 131I followed by post-therapy whole-body scintigraphy, which can detect residual disease or occult metastases. Thyroid remnant ablation increases the sensitivity and specificity of follow-up testing using serum thyroglobulin levels as a tumor marker. Our two patients remained disease-free for 3 and 5 years, respectively, after treatment. Malignant struma ovarii is a rare ovarian tumor, corresponding to thyroid carcinoma. It is generally diagnosed after surgical resection of an ovarian mass. Iodine 131 therapy can be proposed for adjuvant therapy, after total thyroidectomy. Follow-up must be extended for 20 years, using thyroglobulin level as a tumor marker.
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Goffredo P, Sawka AM, Pura J, Adam MA, Roman SA, Sosa JA. Malignant struma ovarii: a population-level analysis of a large series of 68 patients. Thyroid 2015; 25:211-5. [PMID: 25375817 DOI: 10.1089/thy.2014.0328] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Malignant struma ovarii (MSO) is a germ cell tumor of the ovary histologically identical to differentiated thyroid cancers. There is a paucity of data on this neoplasm, with fewer than 200 reported cases. The primary objective of this study was to examine the survival rate of women diagnosed with MSO using data from the Surveillance, Epidemiology, and End RESULTS (SEER) database. Secondary objectives were to describe the demographic, clinical, pathologic, and treatment characteristics of this population. METHODS A retrospective analysis was performed of prospectively collected cancer registry data. A total of 68 patients were identified in the SEER database, 1973-2011. The chi-square test, Student's t-test, and Kaplan-Meier curves were employed for data analyses. RESULTS All 68 patients were females with a mean age at diagnosis of 43.0 years. Nearly 33% underwent unilateral oophorectomy, 28.6% bilateral oophorectomy, and 28.6% oophorectomy and omentectomy, and 4.8% were treated with debulking surgery. Pelvic radiation was administered to 12.3% of patients. The mean tumor size was 52.8 mm; 80% of malignant struma ovarii were SEER staged as local. Overall survival rates at 5, 10, and 20 years were 96.7%, 94.3%, and 84.9% respectively. Among the patients, there were six deaths recorded; only one was attributed to MSO. Six individuals (8.8%) had a concomitant or subsequent diagnosis of thyroid cancer. Four patients underwent total thyroidectomy, three patients had radioactive iodine, and one patient underwent external beam radiation. Two thirds of thyroid cancers extended outside the thyroid gland. All six patients with thyroid cancer were alive at the end of follow-up. CONCLUSIONS It was observed that patients with malignant struma ovarii had an excellent disease-specific survival rate, regardless of the management strategy employed. However, MSO patients had a high risk for developing aggressive thyroid cancers. Therefore, MSO patients may benefit from routine thyroid imaging once the diagnosis of MSO is established.
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Affiliation(s)
- Paolo Goffredo
- 1 Duke Clinical Research Institute, Duke University , Durham, North Carolina
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Fatourechi V, Morris JC, Sebo TJ. Coexistence of radioactive iodine-resistant benign struma ovarii with cervical primary papillary cancer of the thyroid: an unusual cause of thyroglobulin-positive radioactive iodine-negative whole-body scans. Thyroid 2014; 24:1432-4. [PMID: 24934079 PMCID: PMC4516955 DOI: 10.1089/thy.2014.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Vahab Fatourechi
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota
| | - John C. Morris
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota
- Department of Molecular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Thomas J. Sebo
- Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota
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