scholarly journals Unusual Case of Malignant Struma Ovarii and Cervical Thyroid Cancer Preceded by Ovarian Teratoma: Case Report and Review of the Literature

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Elias G. Tzelepis ◽  
Elena Barengolts ◽  
Steven Garzon ◽  
Joseph Shulan ◽  
Yuval Eisenberg
Keyword(s):  
Thyroid Cancer ◽  
English Language ◽  
Postoperative Treatment ◽  
Ovarian Teratoma ◽  
Struma Ovarii ◽  
Ablation Therapy ◽  
Malignant Struma Ovarii ◽  
Abdominal Symptoms ◽  
Cancer Review ◽  
Radioiodine Ablation

Objective. To present a rare case of malignant struma ovarii (MSO) and synchronous thyroid cancer, review the medical literature, and present the latest trends in management. Methods. The case of a woman with MSO and concomitant thyroid cancer is presented, including clinical presentation, treatment, and follow-up care. A search of the English-language literature was conducted using MEDLINE and Google Scholar data bases. Results. We found 10 publications (one abstract) describing 10 patients with MSO and concomitant thyroid cancer. Six additional patients were reported by a study that analyzed the SEER (cancer registry) database. The median age of women was 42 years, with the majority of them presenting with abdominal symptoms. Histologically, most tumors were papillary carcinomas in both organs. In 5 patients, there was extrathyroidal tumor extension at time of surgery. Conclusion. MSO can occasionally coexist with highly aggressive eutopic thyroid cancer. Although this concurrence is even rarer than MSO, clinicians should routinely investigate for possible synchronous thyroid cancer in all cases of MSO and also consider aggressive postoperative treatment including thyroidectomy and radioiodine ablation therapy in cases of MSO.

scholarly journals Metastatic malignant struma ovarii with coexistence of Hashimoto’s thyroiditis

2016 ◽  
Vol 2016 ◽  
Author(s):  
Marco Russo ◽  
Ilenia Marturano ◽  
Romilda Masucci ◽  
Melania Caruso ◽  
Maria Concetta Fornito ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Risk Stratification ◽  
Thyroid Tissue ◽  
Surgical Excision ◽  
Disease Diagnosis ◽  
Ovarian Teratoma ◽  
List Type ◽  
Struma Ovarii ◽  
Malignant Struma Ovarii

Summary Struma ovarii is a rare ovarian teratoma characterized by the presence of thyroid tissue as the major component. Malignant transformation of the thyroidal component (malignant struma ovarii) has been reported in approximately 5% of struma ovarii. The management and follow-up of this unusual disease remain controversial. We report the case of a woman with a history of autoimmune thyroiditis and a previous resection of a benign struma ovarii that underwent hystero-annexiectomy for malignant struma ovarii with multiple papillary thyroid cancer foci and peritoneal involvement. Total thyroidectomy and subsequent radioiodine treatment lead to complete disease remission after 104 months of follow-up. The diagnosis and natural progression of malignant struma ovarii are difficult to discern, and relapses can occur several years after diagnosis. A multidisciplinary approach is mandatory; after surgical excision of malignant struma, thyroidectomy in combination with 131I therapy should be considered after risk stratification in accordance with a standard approach in differentiated thyroid cancer patients. Learning points Malignant struma ovarii is a rare disease; diagnosis is difficult and management is not well defined. Predominant sites of metastasis are adjacent pelvic structures. Thyroidectomy and 131I therapy should be considered after risk stratification in accordance with standard approaches in DTC patients.

scholarly journals MON-440 Unusual Case of Metastatic Struma Ovarii Diagnosed at the Time of Hysterectomy

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Jennifer Merrill ◽  
Sara Ahmadi ◽  
Jennifer Perkins
Keyword(s):  
Thyroid Cancer ◽  
Total Thyroidectomy ◽  
Mature Teratoma ◽  
Thyroid Tissue ◽  
Whole Body ◽  
Ovarian Teratoma ◽  
Thyroid Ultrasound ◽  
Struma Ovarii ◽  
Follicular Variant ◽  
Malignant Struma Ovarii

Abstract Introduction: Struma ovarii is rare ovarian teratoma composed of more than 50% mature thyroid tissue, which can rarely transform to malignancy. There are fewer than 200 cases reported and no established treatment approach. We present a case of metastatic malignant struma ovarii. Case Presentation: A 41 year old female was diagnosed with metastatic papillary thyroid carcinoma (PTC) after it was found on uterine histopathology. History was notable for remote left ovarian cystectomy of a mature teratoma with prominent thyroid component. She had no personal or family history of craniocervical radiation or thyroid cancer. Eight years later, she had a total hysterectomy for menorrhagia. Pathology showed subcentimeter serosal deposits of follicular variant PTC, staining positive for thyroglobulin, CK19, and HBME1. Endometrial and cervical pathology were normal; the myometrium had many leiomyomata. Post-hysterectomy TSH was 2.3 (0.34 - 5.66 µIU/mL), and thyroglobulin 44.3 (<=33.0 ng/mL). Thyroid ultrasound showed a 7 mm isoechoic nodule without lymphadenopathy. Whole body PET/CT showed multiple hypermetabolic masses in the pelvic peritoneum and liver. The right ovary had many cystic lesions and was enlarged to 5.3 x 4.5 cm. She underwent partial hepatectomy, oophorectomy, salpingectomy, and omental resection with no residual disease. Pathology showed follicular variant PTC in both ovaries, peritoneum, colonic mesentery, and omentum. Thyroglobulin fell to 6.9 ng/mL 3 weeks later. A 0.2 cm focus of follicular variant PTC with capsular invasion was found on pathology after total thyroidectomy. She underwent radioiodine ablation with 150 mCi. Postablative scan showed residual activity in the thyroid bed and right hemipelvis, but no new foci of activity. CT abdomen showed resolution of perihepatic lesions and thyroglobulin declined further to 0.5 ng/mL. Discussion: A low risk of recurrence (7.5%) has been reported in patients with malignant struma ovarii, with survival rates of 96.7% at 5 years and 84.9% at 20 years, despite a variety of surgical and adjuvant management strategies. Unilateral cystectomy, unilateral salpingo-oophorectomy, or total abdominal hysterectomy and bilateral salpingo-oophorectomy may be sufficient for patients with well differentiated thyroid cancer arising in struma ovarii without metastases. Thyroid ultrasound should be performed to exclude primary thyroid malignancy. Patients with distant metastases may benefit from aggressive treatment including resection of gross abdominal and pelvic disease and total thyroidectomy to facilitate radioactive iodine ablation and surveillance for recurrence. Conclusion: Due to its rarity, there is no consensus on optimal treatment of malignant struma ovarii. More research in this field is warranted.

scholarly journals Malignant Struma Ovarii with Concurrent Thyroid Cancer: Outcomes during and after Pregnancy

2021 ◽  
pp. 1-5
Author(s):  
Sara Donato ◽  
Helder Simões ◽  
Valeriano Leite
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Tissue ◽  
Pelvic Mass ◽  
Pregnant Patient ◽  
Whole Body ◽  
Ovarian Teratoma ◽  
Struma Ovarii ◽  
Pelvic Mri ◽  
Biochemical Evidence

<b><i>Introduction:</i></b> Struma ovarii (SO) is a rare ovarian teratoma characterized by the presence of thyroid tissue in more than 50% of the tumor. Malignant transformation is rare and the most common associated malignancy is papillary thyroid carcinoma (PTC). Pregnancy may represent a stimulus to differentiated thyroid cancer (DTC) growth in patients with known structural or biochemical evidence of disease, but data about malignant SO evolution during pregnancy are rare. We present the first reported case of a pregnant patient with malignant SO and biochemical evidence of disease. <b><i>Case Presentation:</i></b> A previously healthy 35-year-old female diagnosed with a suspicious left pelvic mass on routine ultrasound was submitted to laparoscopic oophorectomy which revealed a malignant SO with areas of PTC. A 15-mm thyroid nodule (Bethesda V in the fine-needle aspiration cytology) was detected by palpation and total thyroidectomy was performed. Histology revealed a 15 mm follicular variant of PTC (T1bNxMx). Subsequently, she received 100 mCi of radioactive iodine therapy (RAIT) with the whole-body scan showing only moderate neck uptake. Her suppressed thyroglobulin (Tg) before RAI was 1.1 ng/mL. She maintained biochemical evidence of disease, with serum Tg levels of 7.6 ng/mL. She got pregnant 14 months after RAIT, and during pregnancy, Tg increased to 21.5 ng/mL. After delivery, Tg decreased to 14 ng/mL but, 6 months later, rose again and reached 31.9 ng/mL on the last follow-up visit. TSH was always suppressed during follow-up. At the time of SO diagnosis, a chest computed tomography scan showed 4 bilateral lung micronodules in the upper lobes which were nonspecific, and 9 months after diagnosis, a pelvic MRI revealed a suspicious cystic nodule located on the oophorectomy bed. These lung and pelvic nodules remained stable during follow-up. Neck ultrasonography, abdominal MRI, and fluorodeoxyglucose-positron emission tomography showed no suspicious lesions. <b><i>Discussion/Conclusion:</i></b> As for DTC, pregnancy seems to represent a stimulus to malignant SO growth. This can be caused by the high levels of estrogen during pregnancy that may bind to receptors in malignant cells and/or by the high levels of hCG which is known to stimulate TSH receptors.

scholarly journals A Survey of UK Centres on Low Iodine Diet Recommendations prior to Radioiodine Ablation Therapy for Differentiated Thyroid Cancer

2019 ◽  
Vol 9 (3) ◽  
pp. 132-138 ◽  
Author(s):  
Clare Yvonne England ◽  
Laura Moss ◽  
Matthew Beasley ◽  
Ingrid Haupt-Schott ◽  
Georgia Herbert ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Working Group ◽  
Online Survey ◽  
Normal Diet ◽  
Ablation Therapy ◽  
Radioiodine Ablation ◽  
Simple Question ◽  
The Uk ◽  
Practice Methods ◽  
Current Guidelines

Background: Guidelines suggest that a low iodine diet (LID) is advised prior to radioiodine ablation (RIA) for thyroid cancer. We aim to describe current practice regarding LID advice in the UK, determine uptake of the 2016 UK LID Working Group diet sheet and discover whether there are differences in practice. Methods: We used an online survey distributed between November 2018 and April 2019 to centres in the UK that administer 131I. We asked questions on whether a LID is advised, for how long, how advice is presented, whether and how compliance is measured and whether treatment is delayed if LID advice is not followed. Results: Fifty-six clinicians from 47 centres that carry out RIA for thyroid cancer responded. Forty-four centres (94%) advise a LID prior to RIA, the majority for 14 days (82%). Two-thirds of the centres use the UK LID Working Group diet sheet. Patients are told to resume normal eating when 131I is administered at 17 centres (39%), with 18 (41%) advising waiting for 24–48 h after administration. Most centres (95%) use only a simple question or do not assess compliance. Only 2 (5%) indicate that RIA would be delayed if someone said they had not followed LID advice. Conclusions: UK practice regarding LID prior to RIA for thyroid cancer is consistent with current guidelines, but non-adherence does not usually delay RIA. The UK Low Iodine Diet Working Group diet sheet is widely recognised and used. Practice could be improved by centres working to harmonise advice on when to restart a normal diet.

Malignant struma ovarii with a focus of papillary thyroid cancer: a case report

2007 ◽  
Vol 277 (4) ◽  
pp. 371-373 ◽  
Author(s):  
Melike Doganay ◽  
Tayfun Gungor ◽  
Sabri Cavkaytar ◽  
Levent Sirvan ◽  
Leyla Mollamahmutoglu
Keyword(s):  
Thyroid Cancer ◽  
Case Report ◽  
Papillary Thyroid Cancer ◽  
Struma Ovarii ◽  
Papillary Thyroid ◽  
Malignant Struma Ovarii

Thyroid-Type Carcinoma of Struma Ovarii

2010 ◽  
Vol 134 (5) ◽  
pp. 786-791 ◽  
Author(s):  
Xuchen Zhang ◽  
Constantine Axiotis
Keyword(s):  
Radioactive Iodine ◽  
Follicular Carcinoma ◽  
Total Abdominal Hysterectomy ◽  
Conservative Surgery ◽  
Abdominal Hysterectomy ◽  
Postoperative Treatment ◽  
Ovarian Teratoma ◽  
Struma Ovarii ◽  
Favorable Prognosis ◽  
Radioactive Iodine Ablation

Abstract Struma ovarii is a monodermal variant of ovarian teratoma. Thyroid-type carcinoma arising in struma ovarii is rare. The most common type is papillary carcinoma, followed by typical follicular carcinoma, and the new entity of follicular carcinoma—highly differentiated follicular carcinoma of ovarian origin; other forms occur rarely. Consensus on the surgical and postoperative treatment of patients with thyroid-type carcinoma arising in struma ovarii has not been reached. Surgical treatment ranges from total abdominal hysterectomy, plus bilateral salpingo-oophorectomy with omentectomy, to conservative surgery, involving unilateral oophorectomy or strumectomy (cystectomy) for fertility preservation. Adjuvant therapy includes external radiotherapy, chemotherapy, thyroidectomy, and radioactive iodine ablation. Thyroid-type carcinomas arising in struma ovarii, especially the newly recognized entity—highly differentiated follicular carcinoma of ovarian origin—have a favorable prognosis.

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