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PubMedDate not supplied

Histologic spectrum of struma ovarii.

Six cases of struma ovarii, including two with associated carcinoid, with unusual microscopic features are described. The patients' age ranged from 22 to 50 years. The patients were clinically euthyroid. The largest tumour was 10 cms. in great dimension. All tumours were unilateral. Microscopically various changes observed in a non-neoplastic thyroid gland were observed in the struma including Hashimotos thyroiditis and goitrous change. Adenomatous foci with microfollicles were observed in one case. A trabecular carcinoid admixed with mucinous glands lined bygoblet cells which were argyrophilic was seen in two of the neoplasms. This finding is rare and has been reported only once before. In conclusion it is important for a pathologist to be aware of the changes that may be associated with struma ovarii, so as not to confuse it with other neoplasms. A careful search for typical thyroid follicles, or other components of a dermoid help to arrive at a diagnosis.

Adult↗
PubMed2000

Malignant struma ovarii with Graves' disease.

BACKGROUND: Malignant struma ovarii is a rare tumor, consisting of a struma ovarii with malignant change. Because of the rarity of the tumor, only a few reports with detailed data of thyroid function of the patient have been published. CASE: Medical and surgical treatments were performed in a case of malignant struma ovarii with Graves' disease and data from thyroid function tests were analyzed. After removal of the tumor, rapid improvement of thyroid function was observed and thyroglobulin level decreased. CONCLUSION: This case demonstrates the possible, if not dominant, contribution from the malignant struma ovarii to the hyperthyroidism of the patient.

Female↗
PubMed2005

Malignant struma ovarii: a case report.

Malignant struma ovarii is a rare form of the ovarian germ cell tumors. Hence, diagnosis and management of malignant struma ovarii have not been clearly defined. We present the case of a 34-year-old woman with papillary carcinoma arising in struma ovarii. The malignant component of this tumor was detected after laparoscopic removal, and a re-staging operation was performed afterwards. There was no evidence of clinical malignancy or metastases. In this paper, clinical features, treatment guidelines, diagnostic features, and immunohistochemical characteristics of this tumor are reviewed.

Adult↗
PubMed1983

Malignant struma ovarii. Light and electron microscopic study.

Malignant struma ovarii is a very rare tumor, consisting of a struma ovarii with malignant change. Only 17 examples with metastases have previously been reported. We present a case which involved both ovaries and produced multiple metastases. Microscopy and ultrastructure were identical to a mixed papillary and follicular carcinoma of the thyroid gland. Characteristic ultrastructural features of malignant struma ovarii are: microvilli on the surface and in the cytoplasmatic vacuoles; oncocytic transformation of cytoplasm of some cells; and presence of electron dense, granular and crystalline material (colloid) in the follicles and vacuoles. The patient's thyroid was normal. We conclude that malignant struma ovarii can only be diagnosed wheb a carcinoma arising in the thyroid gland can be excluded. Ultrastructure examination may provide useful diagnostic features separating malignant struma ovarii from strumal carcinoid and serous adenocarcinoma.

Colloids↗
PubMed2001

Malignant struma ovarii with thyrotoxicosis.

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.

Adenocarcinoma, Papillary↗
PubMed1978

[Struma ovarii].

A case of struma ovarii in which the correct diagnosis was only suspected at the time of surgery is reported. A 131I scintiscan offers the only preoperative means of ensuring diagnosis. Indeed the condition itself is rare and its clinical signs resemble those of a small ovarian cyst, so that preoperative diagnosis may well be mistaken. Hyperthyroidism accompanied by a normally functioning cervical thyroid offers the sole reason for suspecting an adnexal mass or a struma ovarii.

Adult↗
PubMed1993

Proliferative and histologically malignant struma ovarii: a clinicopathologic study of 54 cases.

We reviewed 54 cases of struma ovarii with histologic features diverging from the normal pattern of benign thyroid tissue. These 54 lesions were divided into proliferative struma (41 cases) and malignant struma (13 cases). The patients diagnosed with proliferative struma ovarii ranged in age from 18 to 84 years (average, 44 years). The most common clinical findings among the proliferative struma patients were a mass (58%) and acute abdominal pain (12%). Preoperative evidence of hyperthyroidism was noted in three of the patients with proliferative struma, whereas one additional patient presented with ascites and hydrothorax ("pseudo-Meigs' syndrome"). Proliferative struma differed from the usual struma ovarii in that they comprised areas of densely packed follicles or papillary formations that raised the possibility of malignancy. However, none of the lesions that we have designated as proliferative struma ovarii showed histologic evidence of overlapping "ground glass" nuclei, vascular space invasion, or mitotic activity that would have supported an unequivocal diagnosis of malignancy. None developed metastases or recurrent disease. The 14 malignant struma ovarii manifested the classical features of thyroid carcinoma (including the presence of overlapping "ground glass" nuclei lining papillary formations and vascular space invasion). Patients with malignant struma ovarii ranged in age from 30 to 77 years (average, 50 years). Their clinical presentations included a mass (78%) and acute abdominal pain (22%). One patient had clinical and laboratory evidence of hyperthyroidism. On follow-up, one patient had persistent disease with peritoneal involvement, but distant metastases did not develop in any of these patients. A diagnosis of malignant struma ovarii should be reserved for lesions that exhibit the full range of changes seen in thyroid carcinoma arising in the cervical thyroid. By requiring that these rigid criteria be adhered to, the diagnosis of malignant struma ovarii will probably become less frequent as the more commonly encountered proliferative struma ovarii are recognized.

Abdominal Pain↗
PubMed1992

[Struma ovarii maligna].

Benign and malignant struma ovarii are very rare ovarian teratomas. Specific therapy guidelines should be established. A case of a malignant struma ovarii is presented and results of therapy discussed.

Adult↗
PubMedDate not supplied

Struma ovarii showing clinical characteristics of ovarian malignancy.

Struma ovarii is a rare form of ovarian neoplasm, composed entirely or predominantly of thyroid tissue and generally a benign germ cell tumor of the ovary. Ascites have been reported in approximately 15-20% of all cases. However, the combination of struma ovarii and elevated CA125 has rarely been reported. We experienced a rare case of a postmenopausal woman with benign struma ovarii associated with massive ascites, a complex pelvic mass. There was marked elevation of her CA125 level. The clinical impression was ovarian malignancy. Surgical excision of the ovarian mass induced immediate resolution of the ascites and a normalization of the serum CA125 level. No recurrence of the ascites or of the tumor has been observed during the 10-month follow-up. Struma ovarii can mimic ovarian malignancy clinically, particularly if complex and associated with ascites and an elevated CA125 level.

Ascites↗
PubMed2001

Malignant struma ovarii: an unusual presentation.

Malignant struma ovarii is a rare disease; only a few cases are well documented in the literature. Thus, the overall prognosis and modalities of treatment are still somewhat controversial. In this article, the authors report a case of malignant struma ovarii discovered 4 years after ovariectomy after metastasis to the lungs and bones. Review of the pathology of the ovarian struma did not reveal the classic criteria of malignancy, there were, however, many features considered to be atypical and thus suspicious. The patient was treated by total thyroidectomy followed by repetitive doses of 131I. However, because of difficulties in increasing the level of endogenous thyrotropin (TSH) because of functional thyroid metastases in such an advanced disease, recombinant human thyrotropin (rhTSH; Thyrogen, thyrotropin alpha, Genzyme Corporation, Cambridge, MA) was used before administration of radioiodine. With this therapeutic protocol, the patient is still clinically stable 2 years after diagnosis.

Adult↗
PubMed2002

[Hashimoto's thyroiditis in "struma ovarii". Case report and review of the literature].

Struma ovarii, a teratoma in which thyroid tissue is the predominant or sole component account for 2.7% of all ovarian tumors. Pathogenesis is unclear. In addition to symptoms and signs caused by the presence of a mass, struma may be associated with a number of unusual clinical manifestations. Ascitis occurs in approximately one third of the cases, Meigs' syndrome occasionally and hyperthyroidism in only about 5% of cases. Thyroiditis is an occasional finding and Hashimotos' thyroiditis is rare in struma ovarii. The struma may resemble normal thyroid tissue, a thyroid adenoma or thyroid carcinoma. The treatment is surgical and the outcome generally favorable. This paper reports the first clinical case of a patient with Hashimoto's thyroiditis in a pure struma ovarii associated with positive specific antithyroid antibodies in the absence of symptoms and signs due to thyroid disease.

Autoantibodies↗
PubMed1998

I-123 uptake in nonfunctional struma ovarii.

A case of nonfunctional struma ovarii preoperatively diagnosed by scintigraphy of the pelvis using I-123 NaI is reported. US, CT, and MRI revealed a multilobulated mass composed of cystic and solid components. CT showed cystic components with slightly high density and MRI showed various signal intensities on T1- and T2-weighted images. I-123-scintigraphy of the pelvis showed uptake in the pelvic mass. Microscopic examination revealed the histologic appearance of thyroid tissue accompanied by follicular adenoma. I-123 scintigraphy of the pelvis was useful for reaching the correct preoperative diagnosis in this patient with nonfunctional struma ovarii.

Adenoma↗
PubMed1993

Struma ovarii.

OBJECTIVE: To review the clinicopathological experience of patients with benign and malignant struma ovarii. METHOD: A retrospective institutional analysis of 2 patients with malignant and 14 patients with benign struma ovarii, treated during a period of 20 years. RESULT: The patients with struma ovarii constituted 1.0% of all ovarian neoplasms in our institution (16/1501). Four percent of the germ cell tumors were calculated to be of struma ovarii (16/382). The stages of the malignant cases were recorded as 1A and 1C. Besides detection at early stage, a biologically low grade tumor was encountered as well. Although 5 of the patients had goitre, none of them had hyperthyroidism. None of the patients had a bilateral tumor. However, in 2 patients, a serous cystadenoma and dermoid cyst were found in the contralateral ovaries. The preoperative and intraoperative diagnosis of malignant struma ovarii proved to be difficult since 2 patients subjected to radical surgery according to suspicious frozen section reports in this series later were found to be benign struma ovarii. CONCLUSION: The low metastatic potential and slow progression rate of malignant struma ovarii support conservative surgery especially in young patients who have not yet completed their families.

Adolescent↗
PubMed2003

Malignant struma ovarii: a case report of laparoscopic management.

BACKGROUND: Struma ovarii is a rare disease. Malignant transformation is even rarer. Data about its management are lacking. We describe the first reported case of a malignant struma ovarii treated and staged by laparoscopy. CASE: A 49-year-old patient was operated by laparoscopy for a right ovarian teratoma. The patient did not show symptoms of hyperthyroidism. The ovarian teratoma was removed in a plastic bag and definitive histology showed foci of papillary adenocarcinoma in a struma ovarii. The patient was then staged by laparoscopic surgery undergoing left adnexectomy, multiple peritoneal and omental biopsies, and common iliac and paracaval lymph node sampling. Hysterectomy was not performed. The postoperative course was uneventful and the patient was released on the second day. Thyroglobulin level was monitored and the patient is free of disease after more than 1 year. CONCLUSION: The preoperative diagnosis of malignant struma ovarii is difficult. Even with cautious evaluation of the patient, some risk of wrong diagnosis is possible. This is why a meticulous technique of laparoscopic surgery in removing the ovary is important. Laparoscopic staging may also intervene in very limited cases; the expertise to perform open staging of the patient is necessary but the postoperative course is fast.

Adenocarcinoma, Papillary↗
PubMed2000

Sonographic and clinical characteristics of struma ovarii.

Our objective was to evaluate the preoperative clinical, laboratory, and sonographic characteristics of struma ovarii in comparison to ovarian dermoid cysts. A retrospective review of gynecologic patients operated on for mature cystic teratoma over a 10 year period identified 12 cases of struma ovarii. These cases, combined with 4 additional cases from an earlier report, were the subject of this study. Results were compared to 32 cases of ovarian dermoid cysts. Ovarian struma ovarii occurred in 12 (4.8%) of 251 cases of ovarian dermoid cysts. Most patients were premenopausal, and the mean lesion diameter was 57.3 mm (range, 30-95 mm). Struma ovarii occurred more frequently (68.8%) in the right adnexa and was seen with a normal CA-125 level. Blood flow, assessed by Doppler ultrasonography, was located in the center of the lesion in all cases of struma ovarii. Rare cases were seen with elevated tumor markers and low resistance blood flow. With regard to dermoid cysts, blood flow had a higher resistive index. In addition, no blood flow could be detected from the center of the echoic lesion in dermoid cysts (P < 0.0001). In summary, it is difficult to distinguish between struma ovarii and dermoid cysts on the basis of their sonographic appearance. Nevertheless, Doppler flow may aid in the preoperative diagnosis of struma ovarii. Blood flow signals, detected from the center of the echoic lesion, and low resistance to flow may be more common in struma ovarii.

Adult↗
PubMed1987

Struma ovarii: a case report.

A patient with struma ovarii and hyperthyroidism is described. She was treated for Graves' hyperthyroidism at age 22 and received thyroxine for post-operative hypothyroidism. Twenty years later she became thyrotoxic and was treated with antithyroid drugs and radioiodine. Diagnosis of struma ovarii was made by radioiodine profile scanning and an ovarian tumour was removed. This had the pathological features of struma ovarii and autoradiographic evidence of pre-operatively administered 125I was seen in the lesion. The patient had positive results for long acting thyroid stimulator (LATS) and LATS-protector (LATS-P) pre- and post-operatively. Bioassays for thyroid stimulators were positive post-operatively but radioreceptor assays for TsAb were consistently negative. It is suggested that profile scanning is an appropriate investigation for diagnosis. It is not clear whether the lesion was autonomous or being stimulated by circulating thyroid stimulators.

Female↗
PubMed1984

Struma ovarii. Observations on three cases.

The true struma ovarii is a rare teratomatous neoplasia, composed with typical thyroid tissue. Generally it is asymptomatic or only determines a mild hypogastric weighting feeling. In a few subjects this neoplasm is secreting and rise to hyperthyroidism. The Authors describe the clinical and anatomopathological characteristics of 3 cases of true struma ovarii come to their observation. No malignant histologic features in any of them was seen. In the relatively short period of post surgical observations no women showed relapses or metastases. This confirms that true struma ovarii is usually a benign tumor.

Adult↗
PubMed2005

Coexistence of Graves' disease and benign struma ovarii in a patient with marked ascites and elevated CA-125 levels.

BACKGROUND: Struma ovarii is the most common monodermal ovarian teratoma and consists mainly of thyroid tissue. Only 5% of patients with this tumor have features of hyperthyroidism. The pathophysiology of hyperthyroidism in struma ovarii is not clear. CASE: We describe a case of benign struma ovarii, presenting with the clinical features of an ovarian cancer: large complex pelvic mass, large amount of ascites and markedly elevated CA-125 serum levels. The patient was initially treated for Graves' disease, on the basis of ultrasonographic, laboratoristic and scintigraphic evidence. The resistance to the medical treatment led to thyroidectomy. After surgery the hyperthyroidism persisted and, suddenly, the patient presented ascites. A large pelvic mass was then diagnosed which, at the pathologic examination, was diagnosed as a struma ovarii. CONCLUSION: The struma ovarii always has to be considered when a pelvic mass is associated with features of hyperthyroidism.

Adult↗