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PubMed2001

Coexistence of Graves' disease and struma ovarii: case report and literature review.

We report a rare case of Graves' disease associated with struma ovarii. A 26-year-old Japanese woman had preexisting Graves' disease and was positive for TSH receptor antibody. She had been on antithyroid medication at presentation. She noted a mass in the lower left abdomen, which was diagnosed as a left struma ovarii by radiological work-up including computed tomography, magnetic resonance imaging and scintigraphy. The surgically excised teratomatous tumor, containing cystic spaces with thyroid tissue, was histologically proved to be struma ovarii. Since thyroid function tests and TSH receptor antibody did not change after surgery, her hyperthyroidism was considered to be due to Graves' disease. Our case was diagnosed as struma ovarii before surgery using various imaging studies.

Adult↗
PubMed2006

Metastatic struma ovarii: late presentation, unusual features and multiple radioactive iodine treatments.

Metastatic malignant struma ovarii is rare and there is a lack of agreement on the criteria of diagnosis and the lines of management. Here we describe a patient with struma ovarii that was initially diagnosed as benign and presented 10 years later with distant metastases. At this time, a pathological review of the initial lesion found that it contained invasive well-differentiated follicular carcinoma. The case was associated with a number of unusual features and challenging management issues, such as a delayed diagnosis of recurrence, functioning metastases with treatment consequences, tumour lysis-induced thyrotoxicosis and cerebrospinal fluid rhinorrhea. The diagnosis and management of struma ovarii should be led by an expert multidisciplinary team. Radioactive iodine should be considered in the management of metastatic disease.

Adult↗
PubMed2004

Struma Ovarii with a focus of papillary thyroid cancer: a case report and review of the literature.

BACKGROUND: Malignant Struma Ovarii is a rare ovarian neoplasm that is usually asymptomatic and infrequently diagnosed preoperatively. A few case studies have described associated thyrotoxicosis. CASE: A 46-year-old female presented for her annual gynecologic exam during which a pelvic mass was appreciated on physical examination. Patient was asymptomatic at presentation. A follow-up ultrasound confirmed the presence of a 16-cm mass in the right adnexa. Patient underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy. Histopathology revealed a mature cystic teratoma with features of Struma Ovarii, containing a single 5-mm focus of papillary cancer within the thyroid tissue. Patient subsequently had a thyroid scan that was normal with normal thyroid function. There was no evidence of metastasis. CONCLUSION: Malignant Struma Ovarii is a very rare disease and there are various approaches to treatment based on staging. In our review, we found a higher rate of metastasis than previously reported. Recurrence was seen after an average period of 4 years. We recommend follow-up with surveillance thyroglobulin levels in cases of malignant Struma Ovarii for at least 10 years.

Carcinoma, Papillary↗
PubMedDate not supplied

Coexistence of malignant struma ovarii and Graves' disease.

OBJECTIVE: To report an unusual case of hyperthyroidism from Graves' disease that was coexistent with malignant struma ovarii. METHODS: We summarize the clinical history, physical findings, laboratory data, imaging studies, pathologic features, and treatment in a patient with recurrent hyperthyroidism and discuss the incidence of ovarian tumors of various histologic origins, including thyroid tissue (that is, struma ovarii). RESULTS: Five years after diagnosis of Graves' disease and resolution of symptoms with 1 year of antithyroid drug therapy, a 53-year-old woman had recurrence of palpitations, tremors, and weight loss. Results of thyroid function tests showed high total and free thyroxine levels and a low thyrotropin level. Thyroid radioiodine uptake was high (69% at 24 hours). Abdominal ultrasound studies disclosed a cystic mass in the right adnexal area. Total abdominal hysterectomy and bilateral oophorectomy revealed a 7.5-cm cystic right ovary that contained a 1.0-cm struma ovarii with a 0.4-cm nodule of follicular variant papillary thyroid carcinoma within it. The patient was treated with methimazole and radioiodine ablation of the thyroid. Three months later, a massive myocardial infarction resulted in her death. CONCLUSION: The concomitant presence of Graves' disease complicates the management of struma ovarii and raises interesting questions about treatment and prognosis.

Antithyroid Agents↗
PubMedDate not supplied

Cystic struma ovarii: imaging findings.

We report three cases of cystic struma ovarii not associated with any solid component. One case was a thin-walled unilocular mass, and the other two cases were multilocular cystic masses. An area of signal void on T2-weighted images and intermediate intensity on T1-weighted images was noted in the two multilocular cases. Preoperative diagnosis was difficult in each case, but struma ovarii should be included in differential diagnoses even in the case of a completely cystic ovarian mass.

Adult↗
PubMedDate not supplied

Struma ovarii: MR findings.

PURPOSE: The purpose of this study was to determine the MR appearance of struma ovarii correlating with the pathological features. METHOD: MR findings of two patients with struma ovarii were retrospectively reviewed and compared with the pathological findings. RESULTS: Both tumors were complex masses composed of multiple cysts and solid components. The size and signal intensity of multiple cysts varied within the tumor. Hyperintense cystic areas on T1-weighted images were thought to correspond pathologically to hemorrhagic cysts and follicles containing viscous proteinaceous colloid. Solid components had as high a signal intensity as did uterine endometrium on T2-weighted images and as intermediate a signal intensity as did uterine muscle layer on T1-weighted images. After intravenous administration of gadolinium-DTPA, the solid components showed marked contrast enhancement. There was also ascitic fluid associated with adhesion and peritoneal thickening. CONCLUSION: The characteristic MR appearance of struma ovarii is thought to be a mixed mass composed of T2-hyperintense solid components with intense contrast enhancement and multiple T1-hyperintense cystic areas suggestive of hemorrhagic degeneration and viscous proteinaceous colloid.

Adult↗
PubMed1976

Malignant struma ovarii.

A rare case of malignant struma ovarii is presented. The tumor was excised together with the ovary and interpreted as a papillary strumal adenocarcinoma arising in a cystic teratoma with predominant thyroid elements. Prior to surgery the patient did not show any symptoms of thyroid hyperfunction. The thyroid function tests performed subsequent to surgery were within normal limits. Periodic examinations of the patient over a period of three years did not reveal any abnormalities. Statistically, this type of malignancy carries a good prognosis with a high "cure" rate.

Adult↗
PubMedDate not supplied

Struma ovarii: MR appearances.

BACKGROUND: Analysis of unenhanced and contrast-enhanced magnetic resonance (MR) images of struma ovarii, a rare benign neoplasm of the ovary, is the aim of this study. METHODS: T2-weighted and Gd-DTPA-enhanced T1-weighted MR images of five histologically proven struma ovarii were evaluated retrospectively. RESULTS: In all patients, unenhanced and contrast-enhanced T1-weighted MR images showed complex cystic masses composed of multiple cysts and a solid component, indicating the presence of large and small thyroid follicles. In four patients, the cyst fluid was hypointense on T1-weighted images and hyperintense on T2-weighted images. In one patient, the fluid was hyperintense on T1-weighted images and hypointense on T2-weighted images due to hemorrhage. CONCLUSION: A complex mass composed of multiple cysts and a solid component, indicating the presence of large and small thyroid follicles, appeared to be a characteristic MR finding of struma ovarii.

Adult↗
PubMed1999

Malignant struma ovarii: two case reports and a review of the literature.

Struma ovarii consists of thyroid tissue derived from germ cells in a mature teratoma. Malignant transformation is very rare, with clinically evident metastatic disease reported in approximately 20 cases. The rarity of this disease renders evaluation of treatment modalities difficult. There is evidence that these tumors behave like their thyroid counterparts, and cytoreductive surgery followed by ablation with radioactive iodine has been advocated. We report the diagnosis and treatment of 2 patients with metastatic malignant struma ovarii treated with a combination of surgery and radiation therapy.

Adult↗
PubMed2002

Malignant Struma Ovarii: an autopsy report of a clinically unsuspected tumor.

BACKGROUND: Struma Ovarii represents less than 3% of ovarian teratomas. The malignant counterpart is very rare. CASE: A 67-year-old female with ascites and progressive weight loss died of respiratory failure secondary to severe chronic obstructive pulmonary disease. Autopsy revealed ascites, hepatic cirrhosis, emphysema, and bronchiectasis. As an incidental finding was seen a huge tumor (10 x 9.5 x 6 cm) in the left ovary. Multiple nodules were detected in the lungs. The thyroid was normal. Microscopy revealed a follicular variant of papillary carcinoma arising in ectopic thyroid tissue in the ovary with metastasis to lungs and pleura. The thyroid gland tissue was normal. CONCLUSION: To our knowledge, this is the first autopsy report of a clinically unsuspected malignant Struma Ovarii.

Aged↗
PubMedDate not supplied

MR findings of struma ovarii.

This study was performed to characterize MR findings of struma ovarii. In 10 patients, T1- and fast spin echo T2-weighted MR images were obtained in the axial, coronal, and sagittal planes using 1.5 T MR units, and they were retrospectively evaluated for the site, size, components, signal intensity, and contrast enhancement.MR images showed a unilateral complex mass with a multilobulated surface and thickened septa, corresponding pathologically to thyroid follicles and the stroma. Cystic portions had variable signal intensities on T1- and T2-weighted images. The contents of cystic components showing low signal intensities both on T1- and T2-weighted images were viscid gelatinous materials (n=4). Solid portions were relatively well-enhanced. In conclusion, struma ovarii has some characteristic MR appearance of a multilobulated complex mass with thickened septa, multiple cysts of variable signal intensities, and enhancing solid components.

Adult↗
PubMed1981

Struma ovarii and Brenner tumor.

One struma ovarii with agregates of epithelial nests indistinguishable from Brenner tumor was studied. The presence of a communication between the nests and the follicles and the association of Brenner, mucinous and respiratory epithelium in the lining of 1 cyst in the same tumor strongly support the germ theory of Brenner tumors associated with teratomatous elements.

Adult↗
PubMedDate not supplied

Struma ovarii: appearance on MR images.

BACKGROUND: The purpose of this multi-institutional study was to examine the appearance of struma ovarii on magnetic resonance (MR) images. METHODS: MR images of 12 patients with histologically proven struma ovarii were retrospectively reviewed. All patients underwent T1-weighted and T2-weighted imaging. Contrast-enhanced T1-weighted images with Gd-DTPA were available in 10 patients. The following determinations were made: tumor morphology, signal intensities, contrast-enhancement effects of solid components with Gd-DTPA, and comparison of MR images with resected specimens. RESULTS: All 12 patients had both cystic and solid components, with a multilobulated surface and thickened septa. Signal intensities on T1-weighted images were mainly low, partly intermediate to high, or high, and those on T2-weighted images were mainly high, with different signal intensities. Contrast-enhancement effects were marked or moderate. The contents that showed low signal intensities on T1-weighted images and signal voids or low signal intensities on T2-weighted images were viscid gelatinous materials. CONCLUSIONS: A multicystic tumor with a solid component, a multilobulated surface, and signal intensities that indicate the presence of viscid gelatinous materials appear to be a characteristic MR finding of struma ovarii.

Adult↗
PubMed2002

Malignant struma ovarii: report of a case and review of the literature.

Malignant struma ovarii is a very rare disease and therefore there is neither common agreement on treatment regimens nor sufficient follow-up experience. The case of a 38-year-old woman with malignant struma ovarii is described. The patient presented with a clinically silent ovarian neoplasm discovered incidentally during investigations for metrorrhagia. The ovarian mass was resected and the tumor was found to be a teratoma. Within the teratoma a papillary thyroid carcinoma of the follicular variant was found. Subsequently, in order to make follow-up of the patient possible by thyroglobulin measurement and radioiodine whole body scintigraphy, near-total thyroidectomy was performed and the thyroid was found to be normal on histology. Whole body radioiodine scintigraphy with (131)I and ablation of the thyroid remnant by the administration of 80 mCi (131)I was performed. The patient recovered uneventfully and is now well.

Adult↗
PubMed2004

Malignant struma ovarii: a case report and review of the literature.

A 45-year-old woman with papillary carcinoma arising in struma ovarii which involved one ovary without dissemination is presented. Total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed. Histopathological examination revealed malignant struma ovarii of the papillary type. The flow cytometric analysis revealed an hypodiploid DNA content (DNA index:0.67). Since these are rare tumors, there is no universal exact protocol for the treatment and follow-up of patients with malignant struma ovarii. More data are needed to determine the prognosis and management in preferring mode of therapy.

Carcinoma, Papillary↗
PubMed2000

Struma ovarii mimicking a benign multicystic ovarian tumor: MR imaging in one case.

Struma ovarii is a rare form of mature teratoma of the ovary. A case of struma ovarii is presented with magnetic resonance (MR) imaging and pathologic findings. MR imaging showed a multiloculated cystic adnexal mass with well-defined margin and septum. Internal cystic spaces presented homogeneous signal intensity of fluid content in both T1-weighted and T2-weighted images. Subtle contrast enhancement was depicted in internal septi. Imaging features were indistinguishable from benign multicystic ovarian tumor, and different from the reported cases in the literature.

Adolescent↗
PubMed1990

Hyperthyroidism during pregnancy due to coexistence of struma ovarii and Graves' disease.

A patient with hyperthyroid Graves' disease and struma ovarii is described. She had pre-existing Graves' disease and positive thyrotrophin receptor antibody. She was treated with radioactive iodine 5 months before she became pregnant. Paripartum she had torsion of an ovarian cyst with histological evidence of a functional struma ovarii. Immediate exacerbation of her thyrotoxic state was observed after operation as a result of release of thyroid hormone from the tumour. It is postulated that the tumour was stimulated by circulating thyrotrophin receptor antibody.

Adult↗