Papillary thyroid carcinoma of struma ovarii.
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A case of ovaric strauma diagnosed with combine use of I123 and tecnesium 99m pertecnetate is presented. We believe that I123 is more useful than I131 for the detection of ectopic thyroid tissue.
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Adenocarcinomas represent a relatively rare complication of a cystic teratoma of the ovary. Those of thyroid origin have been reported in only a few cases. In this paper we report a case of papillary carcinoma of the thyroid arising from a cystic teratoma. The patient had no thyroid symptoms, but because of the presence of antimicrosomal and antithyroglobulin antibodies the diagnosis of Hashimoto's disease was made.
Strumal carcinoid is an ovarian teratoma composed of thyroid tissue and carcinoid, intimately admixed in variable proportions. To further elucidate the histogenesis of strumal carcinoid, the expression pattern of thyroid transcription factor-1 (TTF-1) was evaluated in two cases of strumal carcinoid using immunohistochemical techniques. TTF-1 is a nuclear transcription protein that is selectively expressed in the thyroid and respiratory epithelium, and is thought to be expressed specifically in pulmonary and thyroid neoplasms. While the follicular lining cells of the strumal carcinoid showed positive staining for TTF-1, the carcinoid element was, for the most part, negative. These results confirm that TTF-1 is expressed in the thyroidal element of ovarian teratomas and also provide further evidence that the carcinoid component of the strumal carcinoid bears no relation to thyroidal differentiation.
We have studied the thyroid tissue present in a cystic ovarian teratoma with the purpose of characterizing its structural and histochemical components. The methods of hematoxilyn and eosin, PAS, PAS/sialidase, Alcian blue at pH 2.5 and 1.0, were used, as well as, blocking reactions, Cason's thrichromic, and toluidine blue at pH 3.8. In the tissue we observed zones with follicles of normal appearance that varied considerably in size. The epithelium was constituted by cuboid cells surrounding a colloid substance of uniform aspect, that was strongly acidophilic, PAS positive and with variable reactivity with toluidine blue and weakly alcianophilic. With the thrichrome method, the different follicles stained in different tones. Parafollicular clear cells, bigger and less basophilic than follicular ones, with a nucleus having a lax chromatin, were identified. Cystic follicles were observed in whose cavities were conspicuous histyocytes surrounding rests of colloid substance, with metachromatic and PAS positive granules in their cytoplasm. Some groups of follicles were rudimentary, scarcely differentiated, and mostly without colloid. Others, with a greater degree of differentiation, showed diminutes follicles with intensely basophilic and PAS positive colloid. Beasides, follicular groups with excessive content of colloid appeared very distended and lined by a flat epithelium. According to the characteristics analyzed it may be concluded that: 1) it is a highly differentiated monoblastic teratoma, in which it appears non-encapsulated thyroid tissue; 2) the tumor resembles in different areas, either normal thyroid tissue, thyroid adenoma of the macrofollicular type, fetal or microfollicular and solid or embryonary adenoma, and follicles with the pattern of "thyroiditis".