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PubMed1983

Malignant struma ovarii. A case report and literature review.

A woman developed papillary adenocarcinoma in a struma ovarii. The focus of malignancy was within a benign struma found at laparotomy for a pelvic mass. The patient had a previous history of bilateral cystic teratomas. The tumor was composed of papillae of crowded, pleomorphic cells with minimal cytoplasm but a wide range of chromatin patterns. Immunoperoxidase staining for thyroglobulin revealed positive regions in both the benign and malignant areas of tumor. A 15-year review of cystic teratomas in the state of Colorado revealed a frequency of 0.3% for malignant struma ovarii.

Adult↗
PubMed1993

Struma salpingis associated with struma ovarii.

We report a case of a struma salpingis, a benign teratoma consisting entirely of thyroid tissue in the fallopian tube. This 0.2-cm tumor was an incidental finding in a 44-year-old, clinically euthyroid, woman. The ipsilateral ovary showed a 0.1-cm struma ovarii, and there was a 7.0-cm mucinous cystadenoma of the contralateral ovary. To our knowledge, this is the second report of struma salpingis and the first account of concurrent thyroid tissue in both the tube and ovary. Struma salpingis probably arises from germ cells arrested in their migratory path towards the genital crest.

Adult↗
PubMed2003

Malignant struma ovarii: a case report and analysis of cases reported in the literature with focus on survival and I131 therapy.

BACKGROUND: Malignant struma ovarii is a rare type of germ cell tumor that is most often diagnosed postoperatively. The natural history and optimal treatment regimen for the disease are essentially unknown due to the small numbers of published cases. CASE: A 32-year-old woman presented with pelvic pain and an ovarian mass that was ultimately treated by total abdominal hysterectomy/bilateral salpingo-oophorectomy. Postoperatively, she was diagnosed with a malignant struma ovarii. The patient was subsequently treated with thyroidectomy and I(131) ablation and is currently disease free. A Medline literature search was performed and clinical data from 23 additional cases were compiled. CONCLUSION: In this review of 24 cases, 16 patients were followed conservatively postoperatively while 8 received varied additional therapy (4 with I(131)). There were 8 recurrences and all occurred in the conservatively managed patients. I(131) for recurrent disease provided an initial complete response in 7 women. Treatment with thyroidectomy and I(131) should be considered in the first line of management for malignant struma ovarii.

Adult↗
PubMed1991

Struma ovarii simulating a teratodermoid cyst. Computed tomographic findings in one case.

A case report is presented in which there were computed tomographic (CT) findings of struma ovarii (SO) simulating a teratodermoid cyst. The patient was a 73-year-old woman with a painful mass in the lower abdomen. CT revealed a large complex mass with multiple cystic and solid components. One of the cysts had fat-fluid level and minor calcification in the wall. The histological findings were struma ovarii. To our knowledge, these CT findings have not been described previously. Our case demonstrates the importance of including struma ovarii in the CT differential diagnosis of teratodermoid cysts.

Aged↗
PubMed2003

[Struma ovarii. Analysis of a series of 7 cases and review of the literature].

The authors report the result of a retrospective study of 7 cases of struma ovarii, four malignant and three benign cases, removed surgically at the Salah Azaiez Institute, Tunis, Tunisia, over a period of 20 years (1980-2000). 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. Echography objectives pelvic tumor in all cases. The diagnosis is usually histological. Treatment is exclusively surgically, all patients with malignant struma ovarii were staged la (FIGO). Mean follow up was 4 years and 4 months (range: 1-7 years). No recurrences were reported and no distant metastases. Supervision was based on serum level thyroglobuline and scintigraphy with iodine 131. Histologic diagnosis of malignancy is difficult. Treatment is based on surgery and prognosis is relatively favorable even in malignant cases.

Adult↗
PubMed1990

[Struma ovarii, a rare ovarian tumor].

Teratomas, which consist only or predominantly of thyroid tissue, are termed struma ovarii. Two cases are reported, where after previous strumectomy the histologic diagnosis was struma ovarii. Because of postoperative TSH-rise hormonal activity can be assumed. The proper diagnosis is seldomly made preoperatively, this could be done by abdominal scintigraphic imaging of radioiodine uptake in the tumour.

Female↗
PubMed2003

[Struma ovarii: a rare tumor that deserves special management. Case report and review of the literature].

Struma ovarii is a rare benign tumor which represents less than 3% of ovarian teratomas. We report a case of struma ovarii occurring in a 64-year-old woman. This tumor was thought to be a malignant ovarian tumor until surgical exploration. Based on this observation and the review of the literature we describe the main characteristics and propose a diagnostic and therapeutic management scheme for such tumors.

Adnexa Uteri↗
PubMed1994

Cystic struma ovarii: a frequently unrecognized tumor. A report of 20 cases.

Twenty cases of cystic struma ovarii in women aged 23 to 83 (average, 46) years are described. The patients had the usual signs and symptoms of an adnexal mass. The tumors, all of which were unilateral and confined to the ovary, ranged from 2 to 19 (average, 13.5) cm in greatest dimension. Eighteen were multilocular, two unilocular. They were typically filled with clear to green-brown fluid. Microscopic examination showed cysts of various sizes separated by fibrous septa, which in many areas appeared nonspecific, but in all the cases contained at least small numbers of thyroid follicles. The cysts were typically lined by nonspecific-appearing, flat to cuboidal epithelial cells. The paucity of thyroid follicles in many areas and the nonspecific appearance of the epithelial cells lining the cysts often caused the diagnosis of struma ovarii to be overlooked. Clues to the correct diagnosis, in addition to the thyroid follicles in the septa, included the presence of larger areas of typical struma in a few cases and the association with a dermoid cyst in three cases. Immunohistochemical staining for thyroglobulin confirmed the nature of the tumor in all three cases in which it was performed. The diagnosis of cystic struma should be entertained when examining a multilocular or unilocular cystic ovarian neoplasm whose features are not obviously those of another tumor type, and a careful search for thyroid follicles should be undertaken to establish the diagnosis. In problematic cases, immunohistochemical staining for thyroglobulin may be required to establish the diagnosis.

Adult↗
PubMed2003

Struma ovarii coexisting with mucinous cystadenoma detected by radioactive iodine.

The authors describe a case of struma ovarii coexisting with mucinous cystadenoma. Ultrasonography and magnetic resonance imaging showed a multilocular cystic mass with a solid component. The ovarian tumor demonstrated uptake of I-123 sodium iodide, allowing a preoperative diagnosis of struma ovarii. In women with an unexplained increase in thyroid function and low I-123 uptake in the cervical thyroid gland, scintigraphy of the pelvis should be considered.

Adult↗
PubMed1995

Struma ovarii simulating ovarian tumors of other types. A report of 30 cases.

Thirty cases of struma ovarii with unusual microscopic features are described. They occurred in women 23 to 71 (average 49) years of age. Most of the patients had the usual symptoms and signs of an adnexal mass. Three patients had ascites and two had Meigs' syndrome. The tumors, all unilateral and confined to the ovary, ranged from 4 to 25 (average 12) cm in greatest dimension. They were typically predominantly solid and red-brown but cysts were present within foci of struma in several cases; an associated dermoid cyst was noted grossly in nine cases. Microscopic examination showed a prominent diffuse pattern in 21 cases, prominent microfollicles imparting in many cases a pseudotubular appearance in 20 cases, abundant eosinophilic cytoplasm in nine cases, and abundant clear cytoplasm in four cases. A contiguous dermoid cyst which had not been recognized on gross examination was documented in five cases. The typical paucity of thyroid follicles in cellular areas of these tumors often caused either a failure to consider a diagnosis of struma ovarii or led to serious consideration of other diagnoses. Clues to the correct diagnosis were the presence of rare typical thyroid follicles in foci that were predominantly diffuse or pseudotubular, the presence of larger areas of typical struma in 22 cases, and the association with a dermoid cyst in 14 cases. Immunohistochemical staining for thyroglobulin confirmed the nature of the tumor in all five cases in which it was performed. The diagnosis of struma should be entertained when one is examining an ovarian neoplasm with solid or pseudotubular patterns or a content of oxyphilic or clear cells. A careful search for thyroid follicles should be undertaken to establish the diagnosis and immunohistochemical staining for thyroglobulin performed to confirm it in problematic cases.

Adult↗
PubMedDate not supplied

Struma ovarii: US and CT findings.

We describe the ultrasound and CT findings in a case of struma ovarii. Ultrasound showed a multicystic mass with a well-vascularized solid part. CT demonstrated a multilocular cystic mass with calcifications and solid, enhancing components. To prevent radical surgery, struma ovarii should be included in the differential diagnosis when a mixed, multilocular, teratoma-like tumour of the ovary shows a well-vascularized, enhancing, central solid component.

Adult↗
PubMed2000

A struma ovarii with increased serum basement membrane components: a case report.

We report a case of struma ovarii with hyperthyroidism and elevated serum concentrations of type IV collagen and laminin. Circulating levels of type IV collagen and laminin were measured using specific radioimmunoassays (RIAs) for 7S collagen and the P-1 fragment of laminin, and the basement membrane components in the tumor were investigated by immunohistochemical analysis. Strong immunohistochemical staining specific for type IV collagen and for laminin was observed to be localized in the follicular walls. The serum levels of these antigens, as determined by RIA, were very high before removal of the tumor but decreased rapidly postoperatively. The present findings suggest that struma ovarii produces large amounts of type IV collagen and laminin. In addition, elevated levels of thyroid hormones might enhance the turnover of the basement membrane in various tissues.

Aged↗
PubMed2007

Silent corticotroph cell pituitary adenoma in a struma ovarii.

This is the first report of a silent corticotroph cell pituitary adenoma arising in a struma ovarii. The patient, a 79-year-old woman, was found to have an asymptomatic left-sided adnexal mass confirmed by vaginal sonography to be a complex cystic and solid tumor. Pathological analysis demonstrated an 8-cm partially cystic struma ovarii in which there was a focus of predominantly basophilic adenohypophyseal cells arranged in a diffuse pattern, adjacent to mature neural tissue containing numerous Herring bodies. The epithelial lining cells of the colloid-filled small and cystic follicles were immunoreactive for thyroglobulin. The pituitary cells were predominantly immunoreactive for adrenocorticotropic hormone, in addition to synaptophysin.

ACTH-Secreting Pituitary Adenoma↗
PubMed1990

[Struma ovarii. Short report of 2 cases].

A 75-year old and a 48-year old woman were treated by hysterectomy and unilateral adenectomy. The extirpated ovarian tumors both have shown histologically the structures of Struma ovarii with monodermal differentiation. The Struma ovarii represents a rare special manifestation of mature teratoma with typical histological appearance. At similarities to original thyroid tissue are given directions.

Aged↗
PubMed2000

Struma ovarii in a 50 year old Ethiopian woman.

Struma ovarii represents the dominant growth of thyroid tissue in a teratoma. This exceedingly rare neoplasm is described in a 50 year-old Ethiopian woman who presented with right lower quadrant pain and mass of 10 years duration. The patient had nonspecific symptoms in addition to the above complaints. The diagnosis was disclosed by pathologic examination. This exceedingly rare neoplasm is discussed with clinicopathologic correlation and literature review.

Abdominal Pain↗
PubMed2005

RET/PTC3 rearrangement and thyroid differentiation gene analysis in a struma ovarii fortuitously revealed by elevated serum thyroglobulin concentration.

Struma ovarii (SO) is usually asymptomatic and only in a few cases it is associated with thyrotoxicosis. The presurgical diagnosis is very uncommon. In the majority of cases a pelvic mass is discovered at physical examination or by abdominal ultrasound. Only the hystopathologic examination is able to reveal the characteristic features of SO, with thyroid cells organized in follicles as the main tumoral tissue constituent. The histologic recognition of malignancy is not easy and usually requires an exhaustive sampling of the lesion to evaluate the extracapsular invasion. We report the case of a 59-year-old woman who came to our observation for the fortuitous finding of elevated serum thyroglobulin (Tg) levels (600-800 ng/mL). Because the thyroid function was normal and the ultrasound showed only a subcentrimetric nodule, the clinical suspicious of a SO was considered. Ultrasound examination of the abdomen showed a solid mass of 2 cm in the left ovary. A (131)I uptake was observed at scintiscan in the site of the solid mass. Three months after the resection of the left ovary serum Tg levels were markedly reduced (106 ng/mL), and its values continued to decrease down to 34 ng/mL at last control. The histology showed that the ovarian mass was mainly constituted of thyroid tissue (98%), with no malignant features. The molecular analysis of several thyroid differentiation gene mRNAs in the SO tissue showed an abundant expression of all genes but pendrin (PDS). A reduced PDS mRNA expression might explain the defective thyroxine (T(4)) production. Despite the absence of malignant features, the expression of RET/PTC3 rearrangement was found, raising the possibility of a potential malignant nature of the tumor. A cancer-free period of 3-4 years, as in our patient, is not long enough to definitively exclude a late onset metastatic disease but, unfortunately, the patient died of nonmedical reasons. In conclusion, we report a case of SO that, to our knowledge, is the first in which the clinical suspicion arose from the inappropriately elevated presurgical serum levels of Tg. A quite exhaustive molecular analysis of thyroid specific genes and oncogenes provided two interesting findings: the low PDS mRNA expression, which may explain the low hormonal production and the absence of thyrotoxicosis and the presence of a RET/PTC3 rearrangement, which prompts the possibility of a late malignant evolution.

Female↗