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Malignant Struma Ovarii - A Case Report and Review of the Literature.
Gynecol Obstet Invest.2007 Sep 21;65(2):104-107.
Background:
Struma ovarii is a rare monodermal ovarian teratoma composed
predominantly of mature thyroid tissue. Of these cases, 5-8% are
clinically hyperthyroid and 5-10% of these tumors are malignant. Case
Report: A 53-year-old female presented with a 19 x 5 x 5 cm pelvic
mass that was treated with bilateral salpingo-oophorectomy, pelvic and
para-aortic lymph node sampling, omentectomy and appendectomy and
staging for an ovarian tumor. There was no evidence of distant
metastases or lymph node invasion. Re-evaluation of the patient after
surgery revealed that she was clinically euthyroid and there was no
thyroid malignancy. Histopathology revealed papillary thyroid
carcinoma arising in struma ovarii (malignant struma ovarii).
Conclusion: Malignant struma ovarii is a very rare malignant ovarian
teratoma. In young patients unilateral oophorectomy and complete
surgical staging should be considered when the tumor is confined to
the one ovary (stage Ia). Long-term follow-up for the detection of
metastases or tumor recurrence by serial serum thyroglobulin and
(131)I scan or positron emission tomography/computed tomography may be
required in selected patients with this rare tumor.
Malignant
struma ovarii with a focus of papillary thyroid cancer: a case report.
Arch Gynecol Obstet.2007 Sep 20;
Struma ovarii is a rare form of ovarian neoplasm and its malignant
transformation is even rarer. Because of its rarity, there is no
consensus about its diagnosis and management in the literature. A
53-year-old woman with left adnexial mass underwent total abdominal
hysterectomy with bilateral salpingo-oopherectomy. Postoperatively,
she was diagnosed with a malignant struma ovarii. Postoperative
thyroid ultrasonography revealed a 0.5-cm solid nodule in the thyroid
gland and total thyroidectomy was done. Pathology report was nodular
hyperplasia of benign character. She is currently disease-free for 1
year but long-term follow-up with thyroglobulin levels is necessary
due to reports of increasing recurrence rates.
BRAF in papillary
thyroid carcinoma of ovary (struma ovarii).Am J Surg Pathol. 2007
Sep;31(9):1337-43.
BACKGROUND: Malignant struma ovarii (MSO) are rare tumors that arise
from ectopic thyroid tissue in the ovary, benign struma ovarii (BSO).
Most MSO are histologically classified as papillary thyroid carcinomas
(PTC). Oncogenic activation of BRAF (35% to 69%), RAS (10%), or RET
(5% to 30%) is common in PTC, and the mutations correlate with tumor
subtype, patient age, and clinical behavior. In this study, we
explored the possible role of these genes in the development of BSO
and MSO. DESIGN: Six paraffin-embedded cases of MSO with
histopathologic features of PTC (4 follicular variants, 1 classic, and
1 metastasis of a classic) and 9 BSO were identified. BRAF, NRAS, and
KRAS mutations were evaluated using a combination of polymerase chain
reaction, denaturing high performance liquid chromatography, and
automated sequencing. RET alterations were screened by fluorescence in
situ hybridization with multicolor probes. Corresponding benign
tissues were evaluated when available. RESULTS: BRAF mutations were
present in 4 of 6 MSO and none of 9 BSO. The BRAF mutations included
V600E (2 cases), K601E, and a novel deletion/substitution TV599-600M.
Neither MSO nor BSO contained alterations in NRAS, KRAS, or RET.
CONCLUSIONS: The development of MSOs with PTC features is associated
with BRAF mutations of the type commonly observed in PTC, suggesting a
common pathogenesis for all PTCs regardless of location. In contrast,
mutations in the RET/RAS/RAF pathway are not found in BSO. The
prognostic significance of BRAF mutation status in MSO remains to be
determined.
A case of concomitant
occurrence of struma ovarii and malignant transformation of cystic
teratoma.
Int J Surg Pathol. 2007 Jul;15(3):318-20.
A 77-year-old
woman received a total abdominal hysterectomy and bilateral
salpingo-oophorectomy because of a tumor in the left ovary. The
surgical specimen measured 8.5x4.5x4.0 cm, and the solid lesion
measured 4.0x3.5x3.5 cm. The solid lesion was diagnosed as struma
ovarii. The cyst wall partially comprised squamous epithelium-like and
ciliated columnar epithelium-like cells. The tumorous lesion of the
cyst wall revealed a poorly differentiated adenocarcinoma.
Immunohistochemically, the tumor cells were positive for cytokeratin7,
and were negative for cytokeratin20 and thyroid transcription
factor-1. The authors diagnosed that struma ovarii and other parats
coexisted as a poorly differentiated adenocarcinoma that had arisen
from a mature ovarian cystic teratoma. As for the identification of
the origin of adenocarcinomas arising from mature ovarian cystic
teratomas, more cases need to be identified and investigated.
Malignant struma
ovarii: a case report and review of the literature. J Endocrinol
Invest.2007 Jun;30(6):517-20.
Malignant struma ovarii is a very rare disease. Only few cases are
reported in literature. Because of its rarity, there are various
approaches to its treatment. We describe a case of malignant struma
ovarii, in a 37 year-old female who presented for non cyclic, chronic
pelvic pain and the presence of a right ovarian cyst with mean
diameter of 7 cm. The patient was treated with laparoscopic right
ovariectomy and with multiple biopsies of omental, left ovary and
utero-sacral ligament. The patient underwent subsequently total
thyroidectomy and radioiodine (131I) ablation. A Medline literature
search was performed; we found 48 cases of malignant struma ovarii.
The therapeutic management of the disease is very different in the
described case; particularly after surgical removing of the ovarian
mass, the treatment is still controversial. We think that the
management of malignant struma ovarii could be the same than carcinoma
of the thyroid, so after surgical removing of ovarian neoplasm, we
recommend thyroidectomy, radiotherapy with 131I and levothyroxine
suppressive therapy.
Benign and malignant struma ovarii:
report of three cases and review of the literature.J BUON. 2002
Jan-Mar;7(1):67-70.
Struma
ovarii belongs to the group of monodermal and highly specialized
teratomas and comprises less than 5% of mature teratomas. Thyroid
tissue is present exclusively or predominantly. Malignant
transformation in struma ovarii is uncommon, and when present, it
exhibits a follicular pattern most of the times. Three patients with
the diagnosis of struma ovarii are presented herein. Two of them had a
unilateral adnexal mass with ascites in one case. Total abdominal
hysterectomy with bilateral salpingo-oophorectomy and omentectomy were
carried out in both patients. In both patients thyroid hormonal status
was normal pre and postoperatively. The third patient had a histology
compatible with follicular carcinoma of the thyroid tissue of struma
ovarii; strumal carcinoid was also present. Postoperatively
monochemotherapy with etoposide was administered for 6 cycles every 3
weeks. Thyroid hormones and thyroid ultrasonography (US) were also
normal in this patient. Surgical management is the treatment of choice
for struma ovarii which also represents a preventive measure for
possible future malignant transformation.
The enigma of struma
ovarii.Pathology.2007 Feb;39(1):139-46.
Since its
first description in the early part of the twentieth century, struma
ovarii has elicited considerable interest because of its many unique
features; however, at present a number of aspects remain enigmatic.
Although the typical presentation is that of a pelvic mass, unusual
clinical manifestations such as hyperthyroidism, ascites, and Meigs'
syndrome have been recognised. Uncommon macroscopic and especially
histological patterns in struma can cause difficulties in diagnosis.
Cystic strumas are challenging to diagnose both macroscopically and
histologically. Proliferative changes within struma can be
misdiagnosed as cancer. In regard to the occurrence of thyroid-type
carcinoma in struma ovarii, precise terminology should be utilised,
and the term 'malignant struma ovarii' should be avoided because it
has been used for several different pathological entities. Papillary
carcinoma is the most commonly occurring thyroid-type carcinoma in
ovarian struma; however, cases of follicular carcinoma are not
infrequent. Histological malignancy in struma does not necessarily
equate with biological malignancy, and the majority of thyroid-type
carcinomas do not spread beyond the ovary. Strumal carcinoid, a
neoplasm apparently unique to the ovary containing elements of both
struma and carcinoid, has been misdiagnosed as 'malignant struma
ovarii' in the past. The differential diagnosis of extra-ovarian
spread of struma includes the usual types of thyroid cancer, minimal
deviation follicular carcinoma, and peritoneal strumosis. This review
emphasises articles both recent and past that have significantly
advanced our knowledge of struma ovarii and related neoplasms.
Malignant struma
ovarii with thyrotoxicosis. Gynecol Oncol. 2001Sep;82(3): 575-7.
BACKGROUND:
Malignant struma ovarii is seldom diagnosed preoperatively due to the
rarity of the disease itself and the even rarer complications of
thyrotoxicosis. CASE: A 48-year-old woman presented with symptoms of
hyperthyroidism and a pelvic tumor raising the possibility of ovarian
malignancy. Hormonal findings revealed increased thyroid function, but
the thyroid gland was normal in size and texture. Thus, she was
diagnosed preoperatively as having a hormone-producing malignant
struma ovarii. At surgery, a FIGO stage Ia ovarian papillary
adenocarcinoma of the thyroid was found. An immunohistochemical tumor
stain for thyroglobulin was positive and the ovarian venous
thyroglobulin level was extremely high. Findings of hyperthyroidism
disappeared over several weeks. CONCLUSION: Malignant struma ovarii
can be diagnosed preoperatively. Complications of thyrotoxicosis
should be kept in mind when evaluating an ovarian tumor.
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