DOCSLIB.ORG

Struma Ovarii Maligno, Estadio IIIC: Reporte De Un Caso Y Revisión De La Literatura

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Struma Ovarii Maligno, Estadio IIIC: Reporte De Un Caso Y Revisión De La Literatura ARTÍCULOCASO CLÍNICO ORIGINAL STRUMA OVARII MALIGNO,MANUSCRITO ESTADIO ACEPTADO IIIC: REPORTE DE UN CASO Y REVISIÓN DE LA LITERATURA Roberto Altamirano A.1, 2, Francisca Solar A.1, Alfredo Núñez S.1, Guillermo Narbona Y.3, Isidora Burgos O.3 1. Departamento de Ginecología Oncológica del hospital San Borja Arriaran, Facultad de Medicina. Universidad de Chile, Santiago, Chile. 2. Departamento de Ginecología y obstetricia, Clínica Dávila, Facultad de Medicina. Universidad de Los Andes, Santiago, Chile. 3.Interno de 6to año de Medicina. Escuela de Medicina. Universidad de Los Andes, Santiago, Chile. CIMEL 2018; 23(2): xx-xx RESUMEN Caso Clínico: Se presenta el caso de una paciente que debutó con un diagnóstico incidental de tumor ovárico compatible con Struma ovarii, en el que la cirugía de estadificación evidenció siembras peritoneales. Se decidió realizar tiroidectomía profiláctica, terapia con radio yodo y quimioterapia adyuvante.Motivo de Reporte: El struma ovarii constituye una variable infrecuente dentro de los teratomas maduros del ovario. Menos del 5% tendrán una transformación maligna. En general los pacientes son asintomáticos, aunque un pequeño porcentaje de ellos manifiestan un hipertiroidismo sincrónico. Si bien no existe un diagnóstico y tratamiento estandarizados, el pronóstico y la sobrevida suelen ser buenos. Conclusiones: Este tipo de aproximación – manejo quirúrgico agresivo sumado a terapia adyuvante con radio yodo – se perfila como lo más aceptado actualmente. Ante la necesidad de sumar reportes del manejo de casos similares en la literatura, se plantea este caso clínico como un modelo de diagnóstico y tratamiento. Palabras clave: Struma ovarii maligno, germinoma, teratoma, hipertiroidismo. MALIGNANT STRUMA OVARII STAGE IIIC: CASE REPORT AND REVIEW OF LITERATURE ABSTRACT Clinical case: We present the case of a patient who debuted with an incidental diagnosis of an ovarian tumor compatible with Struma ovarii, in which the staging sur- gery evidenced peritoneal seeding. It was decided to perform prophylactic thyroidectomy, radioiodine therapy and adjuvant chemotherapy. Reason for Report: The struma ovarii constitutes an infrequent variable within the mature teratomas of the ovary. Less than 5% will have a malignant transformation. In general, patients are asymptomatic, although a small percentage of them manifest synchronous hyperthyroidism. Although there is no standardized diagnosis and treatment, the prognosis and survival are usually good. Conclusions: This type of approach - aggressive surgical management in addition to adjuvant therapy with radio iodine - is emerging as the most accepted currently. Given the need to add reports on the handling of similar cases in the literature, this clinical case is presented as a diagnostic and treatment model. Keywords: Malignant Struma ovarii; germinoma; teratoma; hyperthyroidism. Citar como: Altamirano R et.al. PStruma ovarii maligno, estadio IIIC: Reporte de un caso y revisión de la literatura. CIMEL 2018; 23(2): xx-xx. DOI: https://doi.org/10.23961/cimel.v23i2.977 INTRODUCCIÓN que entre un 20 a 44% se comportan como tumores asinto- máticos, unilaterales y con predominancia izquierda, mien- Los tumores germinales del ovario constituyen hasta un 30% tras que su frecuencia asociada con hipertiroidismo previo a de los tumores ováricos, de estos un 95% son teratomas ma- la cirugía es baja(4). duros(1), alrededor de un 2% corresponden a una variante monodérmica llamada struma ovarii, el cual se caracteriza Se presenta un caso de struma ovarii maligno como hallazgo por poseer más de un 50% de tejido tiroideo, cuya trasfor- incidental, con siembra peritoneal y múltiples implantes, se mación maligna es aún más rara, alrededor del 5%(2). En el realizó cirugía con citoreducción y tiroidectomía con radio mundo se han descrito menos de 200 casos, por lo que su yodo, con una buena respuesta. diagnóstico y tratamiento es controversial y estará estricta- mente ligado al diagnóstico histopatológico intraoperatorio; PRESENTACIÓN DEL CASO sin embargo, en análisis de series de casos: el pronóstico y la sobrevida es bueno(3). Mujer de 35 años, caucásica, previamente sana, multípara de 2 partos vaginales eutócicos sin complicaciones, con último emba- Generalmente, se presenta alrededor de los 30 hasta 50 años razo cursado el año 2011. Mantiene relaciones sexuales activas. como una masa pélvica asintomática, cuyo reporte refiere No utiliza fármacos. Sin otros antecedentes mórbidos conocidos. CIMEL 2018, Volumen 23, Número 2 xx CASO CLÍNICO Sin alergias conocidas a la fecha. Sin antecedentes familiares de Se observaron múltiples implantes entre 0.5 y 3cm, de aspecto importancia. Tabaquismo activo con un IPA (índice de paquetes tumoral en peritoneo parietal, para-rectal, mesenterio, omento y año) de 3. Realiza actividad física 3 veces a la semana. Vive en San- espacio peritoneo-suprarrenal. También se evidenciaron ganglios tiago donde trabajaba como secretaria. sospechosos en arteria iliaca derecha. Se observaron, además, nó- dulos retroperitoneales sobre ambos uréteres. Por el contrario, el Dentro de sus antecedentes quirúrgicos, se realizó una esteriliza- hígado, bazo y ambas superficies diafragmáticas no presentaron ción quirúrgica en enero de 2014. Como hallazgo durante la ci- patología. No se observaron ganglios sospechosos en la región rugía se evidenció un nódulo ovárico izquierdo al que se le realizó para-aórtica. Se realizó disección tumoral dificultosa debida a ex- una biopsia diferida que resultó compatible con Struma ovarii. En tenso proceso adherencial. Finalmente se logró una citoreducción ese momento se decidió realizar manejo expectante. óptima. En Julio de 2014 se realizó una histerectomía electiva vía abdomi- Posteriormente, se recibió el resultado de la biopsia de la pieza ope- nal abierta debido a una hiperplasia endometrial en la que se des- ratoria que informa struma ovarii maligno con carcinoma papilar cribieron ovarios con características normales. La pieza operatoria en anexo izquierdo, implantes tanto en espacio de Morrison como no fue enviada a biopsia diferida. El PAP (prueba de Papanico- en espacios peritoneales, para-rectales, mesenterio e intestino del- laou) del mismo año no encontró hallazgos patológicos. gado. Sin tumor en ganglios ilíacos derechos, retroperitoneo bila- teral ni omento. Consulta en urgencia el día 6 de febrero del 2015 por cuadro de dolor abdominal difuso, mayor en fosa iliaca derecha, de aparición Se evaluó función tiroidea, la cual es normal (TSH: 1.09 mUI/L, súbita, tipo cólico, de intensidad progresiva hasta alcanzar 10/10 T4L: 1.15 ng/dL, T3: 0.96 ng/dL) y Anticuerpo Anti-Tiroglobulina en la escala visual análoga (EVA), sin irradiación. Asociado a náu- (menor a 15 UI/ml en un inicio). Durante el seguimiento se soli- seas, sin otros síntomas acompañantes. Al examen físico se encon- citó Tiroglobulina que se encontraba en 84.21 ng/ml y Ac Anti- traba afebril, con abdomen sensible a la palpación, mayor en fosa Tiroglobulina en 41.9 UI/ml. El comité oncológico decidió reali- iliaca derecha, pero sin signos de irritación peritoneal. zar tiroidectomía profiláctica, la cual se llevó a cabo el 6 de agosto de 2015, más 200mCi de radio Yodo y quimioterapia (cisplatino) Se le realizó una TAC de abdomen y pelvis (Figura 1.) donde se adyuvante. Mantiene controles en el Centro de Cáncer UC Chris- diagnosticó una lesión anexial derecha compatible con torsión tus, recibiendo supresión hormonal hasta la fecha (Levotiroxina ovárica. El ginecólogo tratante decidió realizar ooforectomía lapa- 100mcg) con valores de TSH menores a 1. roscópica, halló un tumor de 15 cm aproximadamente con aper- tura intraoperatoria de la cápsula, que se envió a biopsia diferida. Se rehospitalizó para instalación de catéter doble jota, en contexto de una infiltración ureteral. Se controla con ecografía tiroidea sin La paciente se recuperó satisfactoriamente, pero el resultado de la hallazgos patológicos. En los controles evolucionó asintomática, biopsia informó teratoma monodérmico compatible con struma con herida a nivel cervical anterior sin signos de infección o he- ovarii maligno de tipo papilar. matomas. Los hallazgos de anatomía patológica e inmunohisto- química son compatibles con un Cáncer de Ovario, tipo Struma Evaluada por el comité oncológico se decidió completar con una Ovarii Maligno, estadio IIIC según los estadios de cáncer de ova- cirugía de estadificación, la cual se realizó el 2 de julio 2015. rio de la FIGO. En el Rastreo Corporal Total con I131 surgió evidencia de tejido tiroideo funcionante en abdomen, sugerente de compromiso se- cundario. Estos implantes habrían estado bajo efecto terapéutico del radio yodo por lo que sólo se decidió realizar control con imá- genes en 3 meses. El 16 de noviembre de 2015 se tomó un scan- ner de tórax, abdomen y pelvis que mostró nódulos pulmonares indeterminados (Figura 2.), implantes peritoneales subhepáticos y nódulo gastro-hepático inespecífico (Figura 3). Se decidió realizar nuevo control imagenológico en 3 meses. El 17 de febrero de 2016 se realizó nuevo escáner de tórax, abdomen y pelvis que no mos- tró cambios respecto al estudio previo. La paciente se mantiene en seguimiento sin evidencia de enfermedad en la pelvis, cúpula sana hasta la fecha. Último control en enero 2018 donde se encontraba asintomática. Respecto a los hallazgos imagenológicos, se mantie- ne conducta expectante, sin necesidad de nuevos estudios de imá- Figura 1. TAC de Pelvis compatible con lesión anexial genes por el momento. CIMEL 2018,
Load more

Recommended publications
  • Germ Cell Tumors )
    Systemicist Pathology.. Lecture # 13 Title : FGT 5 ( Germ Cell Tumors ) Done by: Dema Mhmd Khdier A man may die, nations may rise and fall…….But an idea lives on Teratoma :tumor contain fully developed tissues and organs, including hair, teeth, muscle, and bone. Germ Cell Tumors 1)Teratoma _ Immature teratoma _ Mature teratoma : ** Cystic (dermoid cyst) ** Solid ** Monodermal teratoma 2) Dysgerminoma 3) Yolk sac tumor 4) Choriocarcinoma 5) Embryonal carcinoma 6) Mixed germ cell tumors ~Teratoma _15% to 20% of ovarian tumors _ in the first two decades of life _ Young age ↑ incidence of malignancy _ > 90% are benign mature cystic teratomas. Benign Mature Cystic Teratomas (Dermoid Cysts ) _Most common ovarian tumors in childhood _90% are unilateral, more on the right. Complications: 1) In 1%, malignant transformation of one of the tissue elements, usually SCC. 2)10-15% undergo torsion due to long pedicle. Torsion: twisting around,,, may cause obstruction and abdominal pain Gross: _Multiloculated cyst filled with sebum & matted hair. _Teeth protruding from a nodular projection. _ Occasionally foci of bone and cartilage. Microscopic : _Mature tissues representing all three germ cell layers. _A cyst lined by epidermal type epithelium with adnexal appendages. Monodermal _Specialized _ teratoma _Usually solid and unilateral (one type of tissues ) *Struma ovarii _Composed of mature thyroid tissue. _ May produce hyperthyroidism. _Thyroid tumors may arise . *Ovarian carcinoid : Rarely produce carcinoid syndrome. ***Combined struma ovarii and carcinoid ~ Metastasis to Ovary Formation of fibrosis , 1)older ages 2) bilateral and multinodular 3) solid gray-white masses collagen around tumor 4)Malignant tumor cells arranged into cords and glands in a desmoplastic stroma cells 5) Cells may be "signet-ring" mucin-secreting 6) Primaries: GI (Krukenberg tumors), breast, lung.
    [Show full text]
  • Metastatic Malignant Struma Ovarii Presenting As Paraparesisfrom a Spinal Metastasis
    Case Reports Metastatic Malignant Struma Ovarii Presenting as Paraparesisfrom a Spinal Metastasis I. RossMcDougall,DavidKrasne,John W. Hanbery,and John A.Collins Division ofNuclear Medicine, Department ofDiagnostic Radiology & Nuclear Medicine, Department ofPathology, Division ofNeurosurgery, Department ofSurgery, Stanford University School ofMedicine, Stanford, California A 42-yr-oldwomanhada solItarymetastasesto herspine(T2)froma malignantstrumaovaril. Thethyroidwasexcludedas the siteof the primarycancer.Thelesioncausedparaparesis. Thespinalmetastasiswas treatedby surgeryandtwo dosesof 1311(200mCIeachtime).The patientrespondedverywellandis entirelyfreeof symptomsandsigns.Repeatwhole-body @ 1!, shows flQ @bflQrm8IIt@ J Nucl M@d3Oi4O7=@11,1OMQ truma ovarii is a very rare ovarian tumor which can For several years she had upper backache which had been present in various ways. It can be discovered on path attributed to stress; however, a radiograph from a chiroprac obogic examination of an asymptomatic ovarian mass, tor's office on 2/22/84 showed complete loss of the body of it can present as a cause of ascites and or hydrothorax, the second thoracic vertebra. it can cause hyperthyroidism (1-3) and very infre When she had an episode of acute abdominal pain in February, 1985 a left irregular, firm, tender ovarian mass (10 quently malignant transformation of the tumor can x 8 cm) was found on gynecologicexamination. A mature occur and be a source of metastases. This tumor is cystic teratoma containing benign thyroid tissue was diag extremely uncommon (4,5). It is defined as, “ateratoma nosed pathologically. In the months after the surgery she noted in which thyroid tissue is present exclusively or forms altered sensation from the breasts downwards. The sensory a grossly recognizable component of a more complex changes progressed until her transfer and first admission to teratoma―(6).
    [Show full text]
  • Cystic Struma Ovarii – a Pathological Rarity and Diagnostic Enigma
    Case Report Cystic Struma Ovarii – A pathological rarity and diagnostic enigma Hemalatha AL1,*, Abilash SC2, Girish M3 1Professor, 2Associate Professor, DM Wayanad Institute of Medical Sciences. KUHS, 3Associate Professor, Dept. of Pathology, Chamarajanagar Institute of Medical Sciences, RGUHS *Corresponding Author: Email: [email protected] Abstract Struma ovarii, a rare ovarian neoplasm, is a monophyletic teratoma composed predominantly of thyroid tissue. It accounts for less than 5% of mature teratomas. Cystic struma ovarii is a rare variant wherein the thyroid component could be minimal in contrast to struma ovarii which has more than 50% 0f thyroid tissue. Diagnostic difficulties may arise if the Struma ovarii is either cystic or co-exists with any other cystic ovarian tumor. The dilemma gets worse when the tumor reveals only a few typical thyroid follicles and the gross examination shows a multi-loculated cyst with mucoid content. Extensive tissue sampling becomes mandatory in such cases to confirm cystic Struma ovarii and its co-existence with another cystic ovarian neoplasm. We report one such rare occurrence of an ovarian tumor with co-existent cystic Struma ovarii and Mucinous cystadenoma. The case is reported for its rarity and for the diagnostic challenge encountered. Keywords: Cystic Struma ovarii, Mucinous cystadenoma, Germ cell tumor, Thyroid tissue Introduction Struma ovarii or specialized monodermal teratoma is an ovarian neoplasm of germ cell origin composed predominantly of mature thyroid tissue. It is a rare tumor which comprises 1% of all ovarian tumors and 2.9% of mature teratomas.(1) Cystic type of Struma ovarii is a distinctive variant and may create diagnostic dilemmas because of its rarity and also because of presence of minimal quantity of thyroid tissue, thus resulting in confusion with other cystic ovarian tumors.
    [Show full text]
  • Case Report Struma Ovarii Simulating Ovarian Sertoli Cell Tumor: a Case Report with Literature Review
    Int J Clin Exp Pathol 2013;6(3):516-520 www.ijcep.com /ISSN:1936-2625/IJCEP1212027 Case Report Struma ovarii simulating ovarian sertoli cell tumor: a case report with literature review Yan Ning1,2, Fanbin Kong1, Janiel M Cragun3,4, Wenxin Zheng2,3,4 1Obstetrics & Gynecology Hospital, Fudan University, Shanghai, China; 2Department of Pathology, University of Arizona College of Medicine, Tucson, AZ, USA; 3Department of Obstetrics and Gynecology, University of Arizona, Tucson, AZ, USA; 4Arizona Cancer Center, University of Arizona, Tucson, AZ, USA Received December 18, 2012; Accepted January 18, 2013; Epub February 15, 2013; Published March 1, 2013 Abstract: Struma ovarii, as a monodermal variant of ovarian teratoma, constitutes about less than 3% of ovarian teratomas. It is difficult to be macroscopically recognized. Multiple appearances under microscope serve as another reason to mislead the accurate pathologic evaluation. Here, we report an unusual case of struma ovarii occurred in a 77 years old woman, which is currently known as the oldest age for this disease. The frozen section morphologi- cally showed sex cord like elements and was suspicious for a sex-cord stromal tumor, probably a Sertoli cell tumor. Final pathological diagnosis was confirmed as struma ovarii based on the typical morphologic thyroid follicles and immunohistochemical staining results. Keywords: Struma ovarii, sertoli cell tumor, ovary Introduction Medical Network. She initially complained of urinary incontinence and un-resolving hematu- Struma ovarii is the most common type of ovar- ria and was referred to an urologist. CT scan ian monodermal germ cell teratoma, account- revealed intracystic bladder masses and an ing for nearly 3% of all ovarian teratoma [1].
    [Show full text]
  • Concomitant Struma Ovarii with Serous Cystadenoma in a Background of Tuberculosis
    Clinical Case Reports and Reviews Case Report ISSN: 2059-0393 Concomitant struma ovarii with serous cystadenoma in a background of tuberculosis: A rare and interesting presentation Swati Bhardwaj1, Surbhi Goyal1, Amit Kumar Yadav1*, Achala Batra2 and Ankur Goyal3 1Department of Pathology, VMMC and Safdarjung Hospital, New Delhi, India 2Department of Obstetrics and Gynaecology, VMMC and Safdarjung Hospital, New Delhi, India 3Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India Abstract Struma ovarii is a rare ovarian tumour accounting for less than 5% of all ovarian neoplasms. It may occur with nongerminal epithelial ovarian neoplasms, but the coexistence of struma ovarii with serous cystadenoma is extremely uncommon with only 6 cases reported so far. Occurrence of these two in a setting of tubercular oophoritis is even rarer, and to the best of our knowledge, this is the first such case. We present a case of a 63-year-old multiparous postmenopausal woman who presented with an ovarian mass. Clinicoradiologically possibility of a neoplastic ovarian cyst was considered. Histopathological examination revealed coexisting triple pathologies; of which struma ovarii in a setting of tuberculosis was an incidental finding. This case is important, not only being rare, but it also highlights the importance of careful and extensive histopathological examination even in a seemingly simple cystic lesion of the ovary to avoid missing concomitant focal pathologies. Introduction the lower abdomen and pelvis, separate from the uterus. The mass was extending on both sides of midline and ovaries were not visualized Struma ovarii is a rare ovarian tumour accounting for less than 5% separately.
    [Show full text]
  • Uncommon Causes of Thyrotoxicosis*
    CONTINUING EDUCATION Uncommon Causes of Thyrotoxicosis* Erik S. Mittra1, Ryan D. Niederkohr1, Cesar Rodriguez1, Tarek El-Maghraby2,3, and I. Ross McDougall1 1Division of Nuclear Medicine and Molecular Imaging Program at Stanford, Department of Radiology, Stanford University Hospital and Clinics, Stanford, California; 2Nuclear Medicine, Cairo University, Cairo, Egypt; and 3Nuclear Medicine, Saad Specialist Hospital, Al Khobar, Saudi Arabia Several of the conditions are self-limiting and do not need Apart from the common causes of thyrotoxicosis, such as prolonged treatment. Graves’ disease and functioning nodular goiters, there are When a patient is thought to be thyrotoxic, a convenient more than 20 less common causes of elevated free thyroid hor- algorithm is to measure free thyroxine (free T ) and mones that produce the symptoms and signs of thyrotoxicosis. 4 thyrotropin (TSH). When the former is higher than normal This review describes these rarer conditions and includes 14 il- lustrative patients. Thyrotropin and free thyroxine should be but the latter is suppressed, thyrotoxicosis is diagnosed. measured and, when the latter is normal, the free triiodothyronine When the former is normal but TSH is low, it is valuable to 123 level should be obtained. Measurement of the uptake of Iis measure free triiodothyronine (free T3); when the latter is recommended for most patients. abnormally high, the diagnosis is T3 toxicosis (2–4). When Key Words: thyrotoxicosis; Graves’ disease; thyroiditis; thyroid both free hormones are normal but TSH is low, the term hormones ‘‘subclinical thyrotoxicosis’’ can be applied (5). Once it has J Nucl Med 2008; 49:265–278 been determined that thyrotoxicosis is present, measure- DOI: 10.2967/jnumed.107.041202 ment of 123I uptake can differentiate among several disor- ders (Table 1).
    [Show full text]
  • Struma Ovarii: Mimicking As Malignant Ovarian Tumour
    MOJ Clinical & Medical Case Reports Case Report Open Access Struma ovarii: mimicking as malignant ovarian tumour Abstract Volume 8 Issue 5 - 2018 Struma ovarii is a variant of mature cystic teratoma, with predominant thyroid Pratibha Singh, Nitisha Lath, Meenakshi element. Diagnosis is by histopathology. It may mimic as ovarian malignancy. It may be associated with ascites in minority; even CA- 125 has been found to be raised in Gothwal, Garima Yadav, P Khera Department of Obstetrics & Gynecology, All India Institute of some cases. We here report a case of struma Ovarii, which mimicked as malignant Medical Sciences, India ovarian tumour. It is difficult to diagnose these cases preoperatively as there are no specific clinical, radiological or serum markers for these tumours in the absence of Correspondence: Pratibha Singh, Department of Obstetrics & thyroid abnormality. Gynecology, All India Institute of Medical Sciences, India, Email [email protected] Keywords: struma ovarii, monodermal ovarian teratoma Received: December 29, 2017 | Published: October 10, 2018 Introduction Decision for surgery was taken for confirmation of diagnosis and debulking of the tumour. Exploratory Laprotomy was done- Intra- Struma ovarii is a rare histological diagnosis, a variant of dermoid operative findings were in which thyroid tissue constitute >50% of the component, also called as monodermal ovarian teratoma where thyroid tissue predominates.1 1. Mild ascites (serous) 30-40ml. This tumour was first described in 1889 by Boettlin. It comprise 1% 2. Left ovarian multilobulated mass 12x10cm with solid areas. Right 2 of all ovarian tumour and 2.7% of all dermoid tumour. It is mostly ovary was healthy looking benign, with malignant transformation in just 5%.3 It rarely produces sufficient thyroid hormone to cause hyperthyroidism, or exceptionally 3.
    [Show full text]
  • Clinical Characteristics of Struma Ovarii
    J Gynecol Oncol Vol. 19, No. 2:135-138, June 2008 DOI:10.3802/jgo.2008.19.2.135 Original Article Clinical characteristics of struma ovarii Seung-Chul Yoo, Ki-Hong Chang, Mi-Ok Lyu, Suk-Joon Chang, Hee-Sug Ryu, Haeng-Soo Kim Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea Objective: To evaluate the clinical characteristics of struma ovarii. Methods: Twenty-five cases of struma ovarii were reviewed retrospectively from June 1994 to April 2007. The presenting clinical, radiologic, and pathologic features of the patients were reviewed. Results: The mean age of the patients in this study was 45.3 years. The majority was of premenopausal status. Sixteen patients had clinical symptoms such as low abdominal pain, palpable abdominal mass and vaginal bleeding. Although one patient had an abnormal thyroid function test, the laboratory findings normalized after operative treatment. CA-125 levels were elevated in 6 cases. Diagnosis by preoperative imaging studies were 8 dermoid cysts, while only 3 cases were diagnosed as struma ovarii. There were 4 cases of malignant struma ovarii, and no patients with recurrent disease. Conclusion: Struma ovarii is a rare tumor. The presented clinical, laboratory and radiological findings of patients are very diverse. The diagnosis was confirmed by pathologic findings. The treatment of benign struma ovarii is surgical resection only. The cases of malignant struma ovarii may need adjuvant treatment, but recurrence is uncommon. Key Words: Struma ovarii, Dermoid tumor, Malignancy
    [Show full text]
  • Could Micrornas Be Useful Tools to Improve the Diagnosis and Treatment of Rare Gynecological Cancers? a Brief Overview
    International Journal of Molecular Sciences Review Could MicroRNAs Be Useful Tools to Improve the Diagnosis and Treatment of Rare Gynecological Cancers? A Brief Overview Riccardo Di Fiore 1,2,* , Sherif Suleiman 1, Francesca Pentimalli 3 , Sharon A. O’Toole 4 , John J. O’Leary 5, Mark P. Ward 5, Neil T. Conlon 6 , Maja Sabol 7 , Petar Ozreti´c 7 , Ayse Elif Erson-Bensan 8 , Nicholas Reed 9, Antonio Giordano 2,10, C. Simon Herrington 11 and Jean Calleja-Agius 1,* 1 Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, MSD 2080 Msida, Malta; [email protected] 2 Center for Biotechnology, Sbarro Institute for Cancer Research and Molecular Medicine, College of Science and Technology, Temple University, Philadelphia, PA 19122, USA; [email protected] 3 Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, I-80131 Napoli, Italy; [email protected] 4 Departments of Obstetrics and Gynaecology and Histopathology, Trinity St James’s Cancer Institute, Trinity College Dublin, 8 Dublin, Ireland; [email protected] 5 Department of Histopathology, Trinity St James’s Cancer Institute, Trinity College Dublin, 8 Dublin, Ireland; [email protected] (J.J.O.); [email protected] (M.P.W.) 6 National Institute for Cellular Biotechnology, Dublin City University, Glasnevin, 9 Dublin, Ireland; [email protected] 7 Laboratory for Hereditary Cancer, Division of Molecular Medicine, Ruder¯ Boškovi´cInstitute, 10000 Zagreb, Croatia; [email protected] (M.S.); [email protected] (P.O.) Citation: Di Fiore, R.; Suleiman, S.; 8 Department of Biological Sciences, Middle East Technical University, Ankara 06810, Turkey; Pentimalli, F.; O’Toole, S.A.; O’Leary, [email protected] J.J.; Ward, M.P.; Conlon, N.T.; Sabol, 9 Beatson Oncology Centre, Gartnavel General Hospital, 1053 Great Western Road, Glasgow G12 0YN, UK; M.; Ozreti´c,P.; Erson-Bensan, A.E.; [email protected] 10 et al.
    [Show full text]
  • Struma Ovarii with Atypical Features and Synchronous Primary Thyroid Cancer: a Case Report and Review of the Literature
    Archives of Gynecology and Obstetrics (2019) 300:1693–1707 https://doi.org/10.1007/s00404-019-05329-z GYNECOLOGIC ONCOLOGY Struma ovarii with atypical features and synchronous primary thyroid cancer: a case report and review of the literature Molly R. Siegel1 · Rebecca J. Wolsky2,3 · Edwin A. Alvarez1 · Biftu M. Mengesha1 Received: 3 April 2019 / Accepted: 10 October 2019 / Published online: 3 November 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019 Abstract Purpose To present a case of struma ovarii with a typical features and synchronous primary thyroid carcinoma and review the available literature to guide diagnosis and management of these tumors. Methods We present a case from our hospital of a 55-year-old woman who had an adnexal mass with features concern- ing for papillary thyroid carcinoma and was ultimately determined to be struma ovarii with atypical features. Subsequent thyroid imaging and biopsy revealed a primary cervical thyroid carcinoma. We performed a PubMed search of published English language articles using the search terms “malignant struma ovarii,” “metastatic struma ovarii,” “struma ovarii with malignant transformation,” “struma ovarii papillary thyroid carcinoma,” “struma ovarii follicular thyroid carcinoma,” and “struma ovarii with concurrent primary thyroid carcinoma.” Results Literature review included 104 studies with a total of 195 patient cases. The average age at presentation was 44.9 years. 25.1% of patients had metastatic disease at presentation, and 6.2% had synchronous primary carcinomas; all of which were located in the thyroid. Conclusions Thyroid carcinoma arising in struma ovarii or mature cystic teratoma should prompt clinical evaluation and imaging of the thyroid given the possibility of synchronous primaries, metastases, and recurrence.
    [Show full text]
  • The Largest Reported Papillary Thyroid Carcinoma Arising in Struma Ovarii and Metastasis to Opposite Ovary: Case Report and Review of Literature Mohamed S
    Al Hassan et al. Thyroid Research (2018) 11:10 https://doi.org/10.1186/s13044-018-0054-9 CASEREPORT Open Access The largest reported papillary thyroid carcinoma arising in struma ovarii and metastasis to opposite ovary: case report and review of literature Mohamed S. Al Hassan1, Tamer Saafan1* , Walid El Ansari2,3, Afaf A. Al Ansari4, Mahmoud A. Zirie5, Hanan Farghaly6 and Abdelrahman Abdelaal1 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.
    [Show full text]
  • Review Article. Struma Ovarii: a Mini
    Int J Clin Exp Med 2018;11(10):10364-10371 www.ijcem.com /ISSN:1940-5901/IJCEM0070646 Review Article Struma ovarii: a mini review Ting Zhang, Pingping Chen, Yuping Gao Department of Assisted Reproduction, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shang- hai, China Received December 9, 2017; Accepted July 2, 2018; Epub October 15, 2018; Published October 30, 2018 Abstract: SO is a rare ovarian tumour with little clinical and imaging features. Most of the cases are benign and often associated with mature cystic teratoma. Increase of CA125 levels in the serum can potentially lead to a mis- diagnosis of a malignant ovarian carcinoma preoperation. The diagnosis of a cystic struma ovarii is usually made on histopathology. Up to 5-10% of all cases of struma ovarii are reported to be malignant. Best treatment for benign struma is laparoscopic operation. Prognosis of benign strumosis and malignant struma ovarii without metastases is good. Malignant struma ovarii generally has a favorable prognosis while the prognosis of MSO with metastases is less favorable. Keywords: Struma ovarii, papillary thyroid carcinoma, malignant struma ovarii Introduction age incidence with mature cystic teratoma. Onset age of the disease is extensive, mostly in The monodermal teratoma struma ovarii (SO) women of fertile age with the peak age inci- was originally described by Bottlin in 1888 as dence in the fifth decade. It was found that 6% a rare form of ovarian tumor. Struma ovarii of the cases occur bilaterally [6] while most means ovarian goiter which originates from a cases occur in one side as more often affect single germ cell after the first meiotic division the left ovary [7, 8].
    [Show full text]