scholarly journals Malignant struma ovarii with a robust response to radioactive iodine

2020 ◽  
Vol 2020 ◽  
Author(s):  
M L Gild ◽  
L Heath ◽  
J Y Paik ◽  
R J Clifton-Bligh ◽  
B G Robinson
Keyword(s):  
Case Reports ◽  
Ovarian Tumour ◽  
Ovarian Teratoma ◽  
Skeletal Metastases ◽  
List Type ◽  
Struma Ovarii ◽  
Rare Presentation ◽  
Malignant Struma Ovarii ◽  
Disease Case ◽  
Recombinant Tsh

Summary Struma ovarii is a rare, usually benign ovarian tumour with malignancy occurring in <5% of cases. Metastases, particularly seeding to bone, are extremely rare. Presentation is variable but often features local pain and/or ascites and hyperthyroidism may occur. It is not established how to best treat and follow patients with extensive disease. Case reports of radioiodine (I131) ablative therapy following thyroidectomy have shown reduced recurrence. We describe the case of a 33-year-old woman who presented with bone pain and was diagnosed with skeletal metastases with features of follicular thyroid carcinoma. However, thyroid pathology was benign. She recalled that 5 years prior, an ovarian teratoma was excised, classified at that time as a dermoid cyst. Retrospective review of this pathology confirmed struma ovarii without obvious malignant features. The patient was found to have widespread metastases to bone and viscera and her thyroglobulin was >3000 µg/L following recombinant TSH administration prior to her first dose of I131. At 25 months following radioiodine treatment, she is in remission with an undetectable thyroglobulin and clear I131 surveillance scans. This case demonstrates an unusual presentation of malignant struma ovarii together with challenges of predicting metastatic disease, and demonstrates a successful radioiodine regimen inducing remission. Learning points: Malignant transformation of struma ovarii (MSO) is extremely rare and even rarer are metastatic deposits in bone and viscera. MSO can be difficult to predict by initial ovarian pathology, analogous to the difficulty in some cases of differentiating between follicular thyroid adenoma and carcinoma. No consensus exists on the management for post operative treatment of MSO; however, in this case, three doses of 6Gbq radioiodine therapy over a short time period eliminated metastases to viscera and bone. Patients should continue to have TSH suppression for ~5 years. Monitoring thyroglobulin levels can predict recurrence.

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.

THYROID TYPE CARCINOMA ARISING IN STRUMA OVARII. SIX CLINICAL CASES AND REVIEW

2018 ◽  
Vol 64 (6) ◽  
pp. 708-715
Author(s):  
Natalya Severskaya ◽  
Andrey Rodichev ◽  
Aleksey Ilin ◽  
Dmitriy Semin ◽  
Pavel Isaev ◽  
...  
Keyword(s):  
Radioiodine Therapy ◽  
Clinical Course ◽  
Case Reports ◽  
Thyroid Tissue ◽  
Follicular Carcinoma ◽  
Complete Response ◽  
Pelvic Surgery ◽  
Ovarian Teratoma ◽  
Struma Ovarii

Struma ovarii is a rare variant of the mature ovarian teratoma composed of more than 50% thyroid tissue. Thyroid type carcinoma can occur in 5% of struma ovarii. Given the rarity of this pathology, as well as the different clinical course, approaches to the treatment of this disease are controversial. The proposed approaches to treatment vary from ovarian resection to total hysterectomy with bilateral salpingo-oophorectomy and adjuvant therapy. We present here 6 case reports of thyroid type carcinoma in struma ovarii and outcome of patients treated in our clinic. All patients had pelvic surgery of different extent, followed by thyroidectomy and radioiodine therapy. The incidence of metastasis is 67% (4/6), 2 - intraperitoneal metas-tases, 2 - bone metastases. Among patients with metastases, 2 have reached a complete response, one with a good response continues treatment, one had progression. The follow-up period is 1 to 15 years (median 4 years). One patient with follicular carcinoma died of progression 8 years after diagnosis. The remaining patients are alive.

scholarly journals Struma ovarii: two case reports of a rare teratoma of the ovary

2020 ◽  
Vol 2020 (12) ◽  
Author(s):  
Obed Rockson ◽  
Christine Kora ◽  
Abdelbassir Ramdani ◽  
Aabdi Basma ◽  
Tariq Bouhout ◽  
...  
Keyword(s):  
Histopathological Examination ◽  
Case Reports ◽  
Thyroid Tissue ◽  
Ovarian Teratoma ◽  
Histopathological Study ◽  
Histopathological Diagnosis ◽  
Struma Ovarii ◽  
Rare Type ◽  
Benign Condition ◽  
First Case

Abstract Struma ovarii is an extremely rare type of ovarian teratoma distinguished by the unusual presence of thyroid tissue. It is usually a benign condition; however, malignant transformation is sometimes detected. The diagnosis relies on histopathological examination and is infrequently made on routine investigations. We report two cases of struma ovarii: one benign and the other malignant. The first case involved a 27-year-old woman who underwent a right ovarian cystectomy for an incidental ultrasonographic finding of a solid right adnexal mass. The diagnosis of a benign struma was made after histopathological study. The second case involved a 68-year-old woman who underwent a right salpingo-oophorectomy for a right ovarian bulky mass and the histopathological diagnosis was consistent with that of a malignant struma. We examine the challenges involved in the diagnosis and management of this rare entity.

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.

Malignant Struma Ovarii: Two Case Reports and a Review of the Literature

1999 ◽  
Vol 73 (3) ◽  
pp. 447-451 ◽  
Author(s):  
Raquel B. Dardik ◽  
Michael Dardik ◽  
William Westra ◽  
Fredrick J. Montz
Keyword(s):  
Case Reports ◽  
Struma Ovarii ◽  
Review Of The Literature ◽  
Malignant Struma Ovarii

scholarly journals A Hormonally Active Malignant Struma Ovarii

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Carolina Lara ◽  
Dalia Cuenca ◽  
Latife Salame ◽  
Rafael Padilla-Longoria ◽  
Moisés Mercado
Keyword(s):  
Thyroid Hormone ◽  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Thyroid Tissue ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Ovarian Teratoma ◽  
Struma Ovarii ◽  
Papillary Thyroid ◽  
Malignant Struma Ovarii

Struma ovarii is a rare monodermal variant of ovarian teratoma that contains at least 50% thyroid tissue. Less than 8% of struma ovarii cases present with clinical and biochemical evidence of thyrotoxicosis due to ectopic production of thyroid hormone and only 5% undergo malignant transformation into a papillary thyroid carcinoma. Only isolated cases of hormonally active papillary thyroid carcinoma developing within a struma ovarii have been reported in the literature. We report the case of a 36-year-old woman who presented with clinical signs and symptoms of hyperthyroidism as well as a left adnexal mass, which proved to be a thyroid hormone-producing, malignant struma ovarii.

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 (&lt;=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.

Abstract #603 Malignant Struma Ovarii with a Coexisting Thyroid Nodule: A Case Report

2019 ◽  
Vol 25 ◽  
pp. 310-311
Author(s):  
Safa Ibrahim ◽  
Geeti Sharma ◽  
Biswaraj Tharu ◽  
Manivel Eswaran
Keyword(s):  
Case Report ◽  
Thyroid Nodule ◽  
Struma Ovarii ◽  
Malignant Struma Ovarii

scholarly journals Immune Thrombocytopenic Purpura (ITP) as an Uncommon Extraintestinal Complication of Crohn’s Disease: Case Vignette and Systematic Literature Review

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Raisa Epistola ◽  
Tiffanie Do ◽  
Ritika Vankina ◽  
Daniel Wu ◽  
James Yeh ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Immune Thrombocytopenic Purpura ◽  
Case Reports ◽  
Case Vignette ◽  
Mucosal Permeability ◽  
Extraintestinal Manifestation ◽  
Thrombocytopenic Purpura ◽  
Disease Case ◽  
Inflammatory Bowel

While the association of immune thrombocytopenic purpura (ITP) and inflammatory bowel disease (IBD) has been described in a few case reports, management of ITP as an extraintestinal manifestation of Crohn’s disease (CD) is less studied. There are approximately a dozen cases describing the management of patients dually diagnosed with CD/ITP. Previous reports postulated that the mechanism of ITP in CD was through the presence of circulating immune complexes in the serum and antigenic mimicry due to increased mucosal permeability in active colitis, versus increased mucosal production of TH1-type proinflammatory cytokines during CD flares, which may account for remission of ITP with surgery for CD. We present a case of a 27-year-old man who presented with medically refractory CD and ITP who responded to surgical management with colectomy and splenectomy, along with a systematic review of the literature. These cases suggest that colectomy should be considered in the treatment of medically refractory ITP among patients with concomitant CD.

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