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PubMed1997

Malignant struma ovarii. A case report and review of the literature.

Malignant struma ovarii is a rare form of ovarian carcinoma; only 3 cases of its pure papillary type have been reported in the literature. A new case of malignant papillary struma ovarii arising in an asymptomatic 32-year-old woman is presented. Due to its rarity, there has been confusion in the diagnosis and management of malignant struma ovarii. Criteria for the diagnosis of malignant papillary struma ovarii are proposed. Conservative treatment after a complete staging procedure is possible due to the usually benign course and low incidence of metastases of this tumor.

Adult↗
PubMed2002

An unusual presentation of struma ovarii mimicking a malignant process.

BACKGROUND: Struma ovarii is a rare form of ovarian neoplasm, composed entirely or predominantly of thyroid tissue. This tumor is generally benign, although malignant transformation has been reported. CASE: We report an unusual presentation of a postmenopausal woman with benign struma ovarii associated with a large amount of ascites, a markedly elevated CA 125 serum level, and a large complex pelvic mass thereby mimicking an ovarian cancer. CONCLUSION: This case serves to remind clinicians that clinical features highly suspicious for ovarian cancer do not necessarily confirm a malignancy.

Aged↗
PubMed2004

Thyrotoxic adenoma followed by atypical hyperthyroidism due to struma ovarii: clinical and genetic studies.

OBJECTIVE: Atypical forms of hyperthyroidism represent a diagnostic challenge for clinicians. Struma ovarii is an ovarian teratoma and constitutes a rare cause of ectopic thyroidal hormonal production. We describe a case of struma ovarii that combined two different sources of hyperthyroidism in the same patient and report genetic studies in order to contribute a better understanding of the autonomy and tumorigenesis of the struma ovarii. CASE REPORT: A 73-year-old nulliparous woman presented a thyroid toxic adenoma that was successfully treated with 10 mCi radioiodine. Unexpectedly, a new onset of hyperthyroidism prompted us to look for a second etiology. A whole-body scan with (123)I detected a pelvic hyperfixation suggesting struma ovarii, and a thyroid differentiated left ovarian teratoma 3 cm in size was surgically removed. We screened for mutations of thyroid-stimulating hormone receptor and Gs-alpha protein genes, as these mutations are common in thyroid adenomas. We did not identify any mutations. Androgen receptor study demonstrated a monoclonal status. Comparative genomic hybridization did not reveal any chromosomal abnormality. However, loss of heterozygosity analysis showed several structural abnormalities, compared with the majority of benign ovarian teratomas, which show a normal karyotype. CONCLUSIONS: This is the first well-documented report of thyrotoxic struma ovarii revealed after treatment of a single thyroid toxic adenoma. We have shown in this case that struma ovarii originates from a single germ cell, and, albeit benign, this tumor presents several chromosomal abnormalities. Struma ovarii-induced hyperthyroidism is likely to be mediated by mechanisms different from those of the classical thyroid toxic adenoma.

Adenoma↗
PubMed1993

Metastasis of malignant struma ovarii to the cranial vault during pregnancy.

Malignant struma ovarii is a rare type of ovarian teratoma; only 16 cases with distant metastases have been reported previously. We report an extremely rare case of malignant struma ovarii metastatic to the cranial vault, which developed during pregnancy. A 28-year-old woman in the 26th week of pregnancy, who had undergone resection of an ovarian tumor 3 years previously, noticed a mass in her left frontal region that had enlarged gradually in 6 months. Magnetic resonance imaging revealed a massive extradural tumor growing through the cranium. Under fetal heart monitoring, the patient underwent total resection of the tumor, including the adjacent cranial bone and dura, and a healthy infant was delivered at full term. Pathological examination showed that the tumor was a follicular adenocarcinoma. Because there was no abnormality in the patient's thyroid gland, this tumor was considered to be a metastasis from the ovarian tumor, a malignant struma ovarii, resected 3 years previously. The management of brain tumor during pregnancy is also discussed.

Adult↗
PubMed2004

Malignant struma ovarii mimic clear cell carcinoma.

INTRODUCTION: Struma ovarii are quite unusual lesions that represent less than 3% of all teratomas and its malignant transformation is very uncommon. The clinical manifestations are characteristic of pelvic tumor and the hormonal metabolism is not usually modified. Radiography, employing ultrasound procedures, is the most commonly used pre-surgical detection method but only histological examination makes the diagnosis. The malignance recognition by pathological study not always is easy; in this sense, it requires an exhaustive sampling of the lesion, being specially carefully in some aspects related with malignant transformation such as extending beyond the capsula and involving peripheral tissues. A thyroidal differentiation must be confirmed by immunohistochemical study and other local processes with similar histology should be ruled out. Given the exceptional character of malignant forms, there does not appear to be unanimous agreement on a standard therapy with a somewhat uncertain prognosis. CASE REPORT: We show a case of a 22-year-old patient with an ovarian tumor that was discovered by ultrasound examination and surgically removed. The histologic study revealed struma ovarii with malignant transformation towards follicular carcinoma and unlike previously published cases, had a prevalence of clear cells. The patient was submitted to a second surgical staging intervention, with conservative surgery and follow-up controls being considered given that was a young woman with a desire to have children. Laparoscopy was employed as the best method capable to facilitate shorter convalescence. OUTCOME: Clinical and analytical controls, measuring thyroglobulin levels, has been satisfactory up to the present.

Adenocarcinoma, Clear Cell↗
PubMed2004

Coexisting Brenner tumor and struma ovarii in the right ovary: case report and review of the literature.

A bilateral ovarian tumor composed of mixed Brenner tumor and struma ovarii in the right ovary and mature cystic teratoma in the left ovary, is described. Mixed Brenner tumor and struma ovarii is rare; eight cases are reviewed. In this case, in addition to the typical Brenner tumor and struma ovarii, some nests composed of both Brenner tumor and struma ovarii in one nest were found in the right ovarian tumor. Immunohistochemically, the struma ovarii is stained for thyroglobulin, and Brenner nests showed various degrees of positive stain for thyroglobulin, which is a specific finding. Brenner tumor, in this case, may produce thyroglobulin or have a receptor to thyroglobulin or analog of thyroglobulin. The origin of mixed Brenner tumor and struma ovarii may be germ cell, as described in some literature, or the Brenner tumor may be of a metaplastic nature, although the Brenner tumor is fourfold the size of struma ovarii in the case presented.

Adult↗
PubMed2002

Struma ovarii associated with pseudo-Meigs' syndrome and elevated serum CA 125.

BACKGROUND: Struma ovarii, presenting as pseudo-Meigs' syndrome with an elevated CA 125 level, is a rare condition. CASE: A 65-year-old patient presented with ascites, hydrothorax, right ovarian mass, and elevated CA 125 level. These findings were suspicious for an ovarian malignancy. The mass was removed and revealed struma ovarii, a specialized ovarian teratoma composed predominantly of mature thyroid tissue. In the setting of ascites and hydrothorax, the condition is known as pseudo-Meigs' syndrome. This is the second reported case in the English language literature of pseudo-Meigs' syndrome with an elevated CA 125 level resulting from struma ovarii. CONCLUSION: Struma ovarii is a rare cause of ascites, hydrothorax, and an elevated CA 125 level.

Aged↗
PubMed2003

Cystic struma ovarii presenting with ascites and an elevated CA-125 level. A case report.

BACKGROUND: Struma ovarii is a monodermal teratoma that usually presents as a solid pelvic mass. Occasionally the lesions are cystic. Rare cases present with ascites or pseudo-Meigs' syndrome. The association of a cystic struma ovarii with ascites and an elevated CA-125 level is exceptionally rare. CASE: A 51-year-old woman presented with ascites and a cystic pelvic mass. There was marked elevation of her CA-125 level. The clinical impression was ovarian carcinoma. Frozen section revealed a multicystic struma ovarii. CONCLUSION: Struma ovarii can mimic ovarian carcinoma clinically, particularly if cystic and associated with ascites and an elevated CA-125 level.

Ascites↗
PubMed1997

[Struma ovarii or malignant ovarian goiter. A case].

BACKGROUND: We report a case of follicular struma ovarii observed in an ovary teratoma without metastatic dissemination. CASE REPORT: A right ovarian tumor was discovered at ultrasound examination in a 31-year-old woman complaining of low abdominal pain. The patient underwent laparoscopic exploration and a 4-cm cystic mass of the right ovary was removed. Microscopic examination showed a malignant struma ovarii of the follicular type with vascular space invasion; other teratomous elements were identified. Immunohistochemical staining for thyroglobulin confirmed the nature of the tumor. The patient was treated by complete right ovariectomy followed by total thyroidectomy and administration of radioactive iodine (99 mCi I-131). Repeat I-131 body scan performed at 6 months was normal. DISCUSSION: Struma ovarii is a rare type of ovarian teratoma, consisting mainly of thyroid tissue. The incidence of malignant struma ovarii is below 1% and fewer than two dozen cases with distant metastases have been reported. The major problem associated with struma ovarii has been the establishment of criteria for malignancy.

Adult↗
PubMed2000

Cystic struma ovarii: a rare presentation of an infrequent tumor.

CONTEXT: Struma ovarii, a rare neoplasm, is a monophyletic teratoma composed of thyroid tissue. It is generally considered to account for less than 5% of mature teratomas. CASE REPORT: A diagnosis of struma ovarii may be the source of many diagnostic problems. It may be cystic and microscopic examination may only reveal a few typical thyroid follicles, resulting in confusion with other cystic ovarian tumors. Extensive sampling should be undertaken and immunohistochemistry may be decisive in establishing the thyroid nature of the epithelial lining. The authors report two cases of cystic struma ovarii, and discuss diagnostic criteria and the limitations of frozen biopsies in these tumors.

Adult↗
PubMed2002

[Struma ovarii. Report of a malignant and a benign case].

Struma ovarii is a rare type of ovarian teratoma, composed entirely or in part of thyroid tissue. Malignant Struma ovarii were exceptional. We report one benign and one malignant cases of Struma ovarii. We insist upon their rarety and the difficulty of preoperatory diagnosis. Prognosis is good after surgery.

Adult↗
PubMed2002

Conservative therapy for malignant struma ovarii. A case report.

BACKGROUND: Thyrocarcinoma in struma ovarii is rare. Treatment options include salpingo-oophorectomy, complete surgical resection and/or adjuvant therapy. CASE: A young woman presented with a pelvic mass. Unilateral salpingo-oophorectomy was performed with findings of malignant thyroid tissue. No adjuvant therapy was administered. CONCLUSION: Conservative surgical approaches should be considered in patients with malignant struma ovarii who wish to maintain fertility.

Adult↗
PubMed2006

[Struma ovarii, a rare form of ovarian tumor].

Struma ovarii, a rare form of ovarian tumor, represents less than 3% of ovarian teratomas. The peak frequency occurs during the fifth decade of life. Diagnosis is usually a surprise of pelvic ultrasound or histological analysis. Surgery is the main mode of treatment and prognosis is excellent. Struma ovarii can be associated with thyroid biology abnormalities, or exceptionally become malignant, and thus managed as a thyroid cancer.

Age Factors↗
PubMed2006

Incidental diagnosis of struma ovarii after thyroidectomy for thyroid cancer: functional imaging studies and follow-up.

BACKGROUND: Struma ovarii is a rare ovarian germ-cell tumor containing thyroid tissue. We report an unusual case of incidental diagnosis of struma ovarii after thyroidectomy for thyroid cancer. CASE: A 24-year-old woman presented with a papillary thyroid carcinoma (pT3N1). After (131)I administration for thyroid remnant ablation, whole-body scan showed a thyroid bed uptake and a right pelvic uptake corresponding to an ovarian cyst on ultrasonography. Preablation thyroglobulin was more elevated than usually found after total thyroidectomy. (18)F-FDG PET was normal. Histopathological analysis revealed a benign struma ovarii. At 6 months, after oophorectomy, serum-stimulated Tg returned to undetectable value and diagnostic WBS was negative. CONCLUSION: Only few cases of incidental scintigraphic diagnosis of struma ovarii have been described. To our knowledge, it is the first case revealed after remnant ablation for thyroid carcinoma. The distinction with ovarian metastasis is discussed.

Adult↗
PubMed2005

[Malignant struma ovarii: a case report].

Malignant transformation of struma ovarii is exceptional (less than 1%). The histolological diagnosis of malignancy is difficult especially in the well differentiated forms. Immunohistochemistry is highly contributive in the anaplastic forms. The prognosis is relatively favorable except for the metastatic and undifferentiated forms. We report a case of malignant struma ovarii with metastasis observed in a 65-year-old woman who died rapidly from her disease. In light of this observation, we discuss the diagnositic, management and outcome features of these particular tumors.

Aged↗
PubMed2000

"Malignant struma ovarii" with peritoneal metastasis: report of two cases.

Malignant struma ovarii with metastasis in an extremely rare form of ovarian carcinoma. We describe two cases of malignant struma ovarii that demonstrated widespread peritoneal metastases. In the second case described here, furthermore, the tumor recurred II years later in the contralateral ovary and omentum, while the primary tumor previously was pure struma ovarii with no evidence of metastasis. Although thyroid tumors themselves are characterized by a long latent interval, patients with benign thyroid tissue arising in nonthyroidal organs with or even without dissemination should be managed with caution and need appropriate long-term follow-up after the initial surgery.

Adult↗
PubMed1999

[Struma ovarii: a variety of monodermic teratoma of the ovary. Report of 8 cases].

Inside the germinal neoplasms of the ovary, the monodermic or specializad teratomas constitute a not very frequent variety. The struma ovarii represents 2.7% as the form more common of this teratomas type, constituted by thyroid tissue. Struma ovarii can associate to other tumors of the ovary of germinal type as dermoid cyst, carcinoid tumor or non germinal tumors as type as dermoid cyst, carcinoid tumor or non germinal tumors as mucinous or serous cyst or Brenner tumor. Most of the struma ovarii are benign and 5-10% only are malignant, of these group 40% has only associated to extraovaric dissemination. The objective of the present work is to analyze the clinical, epidemical and biological characteristics of the struma ovarii. Eight cases of struma ovarii are presented, that occupy 4% inside the ovary tumors diagnosed and treated in our hospital. The clinical charac-teristics of these tumors were: age average 45.5 tears, pelvic mass accompanied by distension and abdominal pain. They were managed as anyone ovary tumor, in not any case the diagnosis it was suspected, 4 were presented of the left side and 4 in the right, the weight average was 726.2 g. Only in 4 cases was carried out the transoperative diagnosis and the eight cases confirmed in the postoperative. In not any case hyperthyroid symptoms, neither morphological criteria of malignancy were presented. Only in two cases the struma ovarii was reported as pure, in the 6 remaining it is accompanied with another type of ovarian neoplasm.

Adult↗
PubMed1995

[Struma ovarii. Three malignant cases and one benign case].

Four cases of struma ovarii were seen among 308 ovarian tumors removed surgically at the Salah Azaiz Institute, Tunis, Tunisia, between 1980 and 1989. This yields an occurrence rate of 1.3%, which is comparable to previously publishes rates (0.3% to 2%). One of the four tumors was malignant. Malignant transformation of struma ovarii is very rare (5% to 10%). The histologic diagnosis of malignancy is difficult, particularly in well-differentiated follicular forms. The prognosis is relatively favorable even in patients with metastases. Based on their personal experience and on a review of the literature, the authors discuss the diagnosis, management, and outcome of struma ovarii, in particular with malignant transformation.

Adult↗