scholarly journals Postmenopausal Bleeding with an Accidental Discovery of an Ovarian Strumal Carcinoid Tumor: A Case Report

2021 ◽  
pp. 20-24
Author(s):  
Eman M. Ibrahim ◽  
Salma S. El Ashwah ◽  
Fatma I. El-Saeed ◽  
Hosam A. F. Halim ◽  
Amal A. F. Halim
Keyword(s):  
Carcinoid Tumor ◽  
Adnexal Mass ◽  
Early Stage ◽  
Thyroid Tissue ◽  
Diagnostic Tools ◽  
Pelvic Mri ◽  
Cystic Changes ◽  
The Right ◽  
Strumal Carcinoid

Aim: Ovarian strumal carcinoid is a tumor formed of thyroid tissue and carcinoid elements. It represents less than 2% of all ovarian tumors and less than 5% of mature teratomas. Physicians in many lacations may not be aware about this pathology. Presentation of Case: A multiparous 78-year-old woman presented    by postmenopausal vaginal bleeding. The abdomen& pelvic sonar detected   atrophied endometrium and a right adnexal mass      with mixed echogenicity and increased blood flow, a finding that was confirmed later with a pelvic MRI which revealed a well-defined mass of abnormal signal at the right adnexa showing cystic changes contacting anteriorly the related intestinal loops and the urinary bladder, while contacting posteriorly the recto-sigmoid.  It measured8x6x6cm. Biopsy revealed atypical epithelial proliferation.  CA125 was 90KU/L (normal range,0-35KU/L) while the levels of CEA, CA19-9 and alpha feto protein were normal. After discussion with the family, exploratory hysterectomy and bilateral salpingioophorectomy, along with omentectomy, peritoneal washing and peritoneal sampling were performed. Grossly, the right ovary was    largely occupied by an ovoid mass (9cmx6cmx2 cm). The tumor was staged as IA according to AJCC 2010. Histological examination of the adnexal mass revealed admixture of benign thyroid tissue and tumor tissue formed of trabeculae & nests of monotonous round cells. Such cells showed positivity for thyroglobulin, synaptophysin, chromogranin and low positivity for ki67 and so a diagnosis of   strumal carcinoid tumor was documented. The patient was set to a close follow up. The last follow up was at August 2020 and was satisfactory. Discussion and conclusion: Strumal carcinoids are rare. Pelvic sonar and CA125 are not specific diagnostic tools. They should be considered in the differential diagnosis of any ovarian mass. The disease usually presents at an   early stage.

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.

Proctor-guided virtual reality–enhanced three-dimensional video-assisted thoracic surgery: an excellent tutoring model for lung segmentectomy

2020 ◽  
pp. 030089162097217
Author(s):  
Francesco Guerrera ◽  
Samanta Nicosia ◽  
Lorena Costardi ◽  
Paraskevas Lyberis ◽  
Federico Femia ◽  
...  
Keyword(s):  
Early Stage ◽  
Thoracoscopic Surgery ◽  
Three Dimensional ◽  
Resection Margins ◽  
Early Stage Lung Cancer ◽  
Video Assisted ◽  
Tissue Sparing ◽  
The Right ◽  
Colon Rectal Cancer

Objective: Lung segmentectomy using video-assisted thoracoscopic surgery (VATS) is an effective strategy to treat early-stage lung cancer. The objective of this case report is to show the efficacy of Hyper Accuracy 3D™ (HA3D) reconstruction as a tool for trainee surgeons and expert surgeons to perform complex procedures. Methods: An 84-year-old man was treated for colon-rectal cancer. During follow-up, a pulmonary nodule on the right anterior upper lobe suspected for intestinal metastasis was revealed by a computed tomography scan. According to functional tests and radiology, a right anterior upper lobe segmentectomy was planned. HA3D lung reconstruction was used during surgery. Results: Using the HA3D virtual model, the procedure was performed with healthy tissue sparing, ensuring safe resection margins. No postoperative morbidities were noted. The patient referred good pain control. The hospital stay was 6 days. Conclusions: VATS segmentectomy is a technically demanding procedure. HA3D lung reconstruction can help surgeons effectively perform the resection, aiding at individuating intersegmental planes, bronchi, and vessels, guaranteeing oncologic radicality and safe surgical margins, and preserving respiratory function.

scholarly journals A case benign struma ovarii

2021 ◽  
Vol 10 (3) ◽  
pp. 1224
Author(s):  
P. G. Paul ◽  
Anjana Annal ◽  
K. Anusha Chowdary ◽  
George Paul ◽  
Manali Shilotri
Keyword(s):  
Adnexal Mass ◽  
Thyroid Tissue ◽  
Clinical Manifestations ◽  
Benign Disease ◽  
Definitive Diagnosis ◽  
Ovarian Tumors ◽  
Struma Ovarii ◽  
Standard Line ◽  
Imaging Characteristics ◽  
The Right

Struma ovarii is a rare ovarian tumor and a monodermal variant of dermoid tumors of the ovary in which thyroid tissue components constitute more than 50% of the mass. Struma ovarii accounts for 0.5–1.0% of all ovarian tumors and 2-5% of ovarian teratomas. Most cases are benign, but malignant transformation is found in a small percentage. It usually presents as a unilateral adnexal mass at fifth and sixth decades of life, with symptoms like other ovarian tumors. The definitive diagnosis is made by histological examination. Adnexectomy remains the standard line of treatment for benign disease. A 41-year-old lady presented with pain in abdomen for 3 months. On ultrasonography and MRI, a multiloculated solid cystic lesion of 7×6 cm with internal echoes was found in the right adnexa. Laparoscopic right adnexectomy was performed. Histopathology was consistent with struma ovarii. Due to its vague clinical manifestations and diverse imaging characteristics, pre-operative diagnosis is challenging. 

scholarly journals A Case of Early Stage Bladder Carcinosarcoma in Late Recurrence of Urothelial Carcinoma after Transurethral Resection

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Daisaku Hirano ◽  
Toshiyuki Yoshida ◽  
Daigo Funakoshi ◽  
Fuminori Sakurai ◽  
Shou Ohno ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Transurethral Resection ◽  
Early Stage ◽  
Bladder Wall ◽  
Late Recurrence ◽  
Gross Hematuria ◽  
Pelvic Mri ◽  
History Of ◽  
The Right ◽  
Immunohistochemical Studies

Carcinosarcomas of the urinary bladder are rare biphasic neoplasms, consisting of both malignant epithelial and malignant mesenchymal components, and the prognosis of this tumor is unfavorable in most patients with even possibility of resection of disease. A 77-year-old male with a history of transurethral resection (TUR) of urothelial carcinoma (UC) of the bladder and adjuvant intravesical chemotherapy with pirarubicin 10 years ago revisited our department with a gross hematuria. Cystoscopy demonstrated an approximately 2.5 cm nonpapillary tumor on the right wall of the bladder. Pelvic MRI showed the tumor without extending the base of the bladder wall. The tumor could be completely removed with TUR. The malignant epithelial elements consisted of high-grade UC and the majority of mesenchymal components were fibrosarcomatous differentiation based on immunohistochemical studies. The tumor could be pathologically also suspected to be an early stage on TUR specimens. Although he has received no additional intervention due to the occurrence of myocardial infarction at three weeks after the TUR, he has been alive with no evidence of recurrence of the disease 27 months after the TUR. Some early stages of bladder carcinosarcoma might have a favorable prognosis without aggressive treatments.

Intracranial Aneurysm Associated with Perianeurysmal Fat Tissue Lesion and Parenchymal Cystic Changes

2005 ◽  
Vol 18 (5-6) ◽  
pp. 575-580
Author(s):  
A. Cerase ◽  
I.M. Vallone ◽  
A. Atesalp ◽  
A. Demirci ◽  
C. Venturi ◽  
...  
Keyword(s):  
Vessel Wall ◽  
Arterial Wall ◽  
Fat Tissue ◽  
Cerebral Vessel ◽  
Cystic Changes ◽  
Mechanisms Of Development ◽  
The Right ◽  
Wide Neck ◽  
Rule Out

The purpose of this report is to describe the seven-year clinical and neuroradiological follow-up of a perianeurysmal fatty lesion and perianeurysmal parenchymal cystic changes accompanying an asymptomatic unruptured wide-neck saccular aneurysm of the right middle cerebral artery trifurcation incidentally discovered in a 27-year-old male. The possible mechanisms of development are discussed. Notably, the close anatomical association between the two malformative lesions should rule out an incidental coexistence. Possible explanations include i) congenital structural deficiency of the cerebral vessel wall occurring at the same time of the formation of the fatty lesion, ii) fatty lesion inducing degeneration of the cerebral vessel wall possibly by limiting the nutrition of the smooth muscle cells, and iii) fatty lesion secreting some factors inducing weakness of the arterial wall to hemodynamic stress. Finally, both these lesion should lead to further impairment of perforating arteries resulting in areas of perianeurysmal encephalomalacia.

scholarly journals Endometrial stromal sarcoma in a 20-year-old woman

2019 ◽  
Vol 12 (12) ◽  
pp. e228874
Author(s):  
Rubina Sohail ◽  
Shahlla Kanwal ◽  
Adnan Murtaza ◽  
Bushra Haq
Keyword(s):  
Adnexal Mass ◽  
Stage Iv ◽  
Endometrial Stromal Sarcoma ◽  
Final Diagnosis ◽  
Sexually Active ◽  
Uterine Sarcomas ◽  
Stromal Sarcoma ◽  
Pelvic Wall ◽  
The Right

Endometrial stromal sarcoma (ESS) is an uncommon and challenging condition comprising 10% of all uterine sarcomas and found in women 42–58 years of age. ESS is difficult to diagnose in young women as it masquerades as a leiomyoma. We report this tumour in a 20-year-old woman presenting with heavy and prolonged menses and urinary retention. She was not sexually active and did not give consent for pelvic examination. A preoperative diagnosis of a submucous leiomyoma with an adnexal mass was made. At laparotomy, the leiomyoma was found to be wedged between the cervix and the vagina, and was removed vaginally. A 5–6 cm retroperitoneal mass was adherent to the right pelvic wall, which was also removed. Histopathology of both specimens revealed ESS. The final diagnosis according to the International Federation of Gynaecology and Obstetrics classification was stage IV ESS. After oncology consult, she was referred for chemotherapy. She is now on follow-up.

scholarly journals Primary strumal carcinoid tumor of the ovary arising from a heterochronous struma ovarii in young female patient

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Kuang-Ting Liu ◽  
◽  
Yueh-Ching Chang ◽  
Yu-Chieh Lin ◽  
Junn-Liang Chang ◽  
...  
Keyword(s):  
Carcinoid Tumor ◽  
Thyroid Tissue ◽  
Cystic Teratoma ◽  
Young Female ◽  
Cystic Mass ◽  
Mature Cystic Teratoma ◽  
Struma Ovarii ◽  
Metastatic Carcinoid ◽  
Ovarian Cystectomy ◽  
Strumal Carcinoid

Primary ovarian carcinoid tumors are extremely rare. Ovarian strumal carcinoid is usually derived from mature cystic teratoma, an ovarian germ cell tumor composed of two distinctive components characteristic thyroid tissue intermixed with a carcinoid tumor. The incidence of stromal carcinoid tumor is accounting for 0.3-1% of all ovarian tumors and 3% of all mature teratomas. Herein, we report a 25-year-old female presented with severe abdominal pain. She had right struma ovarii after Laparoscopic-Assisted Ovarian Cystectomy (LAOC) procedure one year ago. The sonography of abdomen images study demonstrated a well capsulated cystic mass measured up to 11 cm in dimension. The mature cystic teratoma was the first diagnostic possibility. She underwent the laparoscopy-assisted left ovarian cystectomy. Histopathological and immunohistochemical examinations confirmed strumal Carcinoid Tumor of the Ovary (SCTO) arising from strum ovarii in the left ovary. She was recovered well and was still asymptomatic after two years follow-up. In conclusion, we first describe the primary SCTO arising from a heterochronous struma ovarii. The symptoms of SCTO are usually non-specific and misleading. Therefore, it is important to fully understand the characteristics, diagnosis and management of SCTO. Diagnosis should be confirmed by pathology and immunohistochemistry, and clinically metastatic carcinoid should be excluded.

scholarly journals Morphology and immunohistochemical studies of ovarian strumal carcinoid

2012 ◽  
Vol 65 (3-4) ◽  
pp. 102-105
Author(s):  
Mihaela Mocko-Kacanski ◽  
Aleksandra Levakov ◽  
Matilda Djolai ◽  
Snezana Bozanic ◽  
Jelena Amidzic
Keyword(s):  
Histopathological Examination ◽  
Thyroid Tissue ◽  
Brown Tumor ◽  
Thyroid Transcription Factor 1 ◽  
Gynecology And Obstetrics ◽  
Eosinophilic Cytoplasm ◽  
The Right ◽  
Immunohistochemical Studies ◽  
Novi Sad ◽  
Strumal Carcinoid

Introduction. Teratomas are tumors derived from pluripotent germ cells, and they appear most frequently in ovaries. Strumal carcinoid belongs to the group of monodermal teratomas. Strumal carcinoid is characterized by the presence of carcinoid tumor, intermingled with thyroid tissue. Case report. A 52-year-old postmenopausal woman was referred to the Department of Gynecology and Obstetrics, Clinical Center of Vojvodina, Novi Sad with complex right adnexal mass for surgery. Laparotomy revealed tumor arising from the right ovary, of firm consistency and intact capsule. On gross examination, yellowish brown tumor was 26 x 17 x 10 cm, with vague nodularity. The cut sections revealed predominantly solid mass with two cystic areas, and one of the cysts showed a tuft of hair. On histopathological examination, the cystic spaces were lined with skin and mucinous epithelium. The solid areas showed a population of monomorphic cells with eosinophilic cytoplasm and nuclei with ?salt and pepper? chromatin, arranged in acinar and trabecular patterns, respectively. In addition, focally follicular structures with central eosinophilic colloid-like material were seen. Based on the presence of these two components, a diagnosis of Strumal Carcinoid was made and confirmed on immunohistochemistry. The tumor cells were diffusely immunopositive for synaptophysin, chromogranin, and the follicles including the central colloid were immunopositive for thyroglobulin and Thyroid transcription factor-1. Neither proliferative or mitotic activity nor capsular or angiolymphatic invasion were noticed. At 3 year follow up the patient was disease free. Conclusion. In order to diagnose this rare tumor a team, consisting of a pathologist, surgeon and radiologist, is needed. Diagnosis of strumal carcinoid has to be confirmed on immunohistochemistry.

scholarly journals Regrowth of Thyroid Gland: Is This Possible????

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A951-A952
Author(s):  
Pawarid Techathaveewat ◽  
Manal Alhakim ◽  
Ricardo Rafael Correa ◽  
Karyne Lima Vinales
Keyword(s):  
Thyroid Gland ◽  
Multinodular Goiter ◽  
Thyroid Tissue ◽  
Curative Treatment ◽  
Prior History ◽  
Normal Thyroid Tissue ◽  
Normal Thyroid ◽  
Benign Goiter ◽  
The Right

Abstract Introduction: Adult Thyroid gland which derived from primitive pharynx and neural crest is considered a non-regenerative organ. In this nature, partial or total thyroidectomy is considered a curative treatment for compressive non-malignant goiter. While there is a potential regrowth from stimulating by pituitary thyroid stimulating hormone (TSH), such growth is rarely significant and suppressive TSH therapy is currently indicated only for thyroid malignancy. We present an unusual case of rapid regrowth of normal thyroid tissue that expanded both of the lobes from a single unilateral remnant. Case: 58-year-old male with prior history of multinodular goiter status post subtotal thyroidectomy due to compressive symptoms in 2006 present to our clinic for follow up. Post-operatively, case was complicated with Iatrogenic Hypoparathyroidism thus on replacement of calcium and calcitriol. Follow up neck ultrasound (US), showed no thyroid gland with minimal residual tissue in the right fossa and pathology was benign. In 2011, patient complained of new onset globus sensation, and voice changes which initially concern for gastroenterology issue as the etiology. A neck US unexpectedly revealed normal right thyroid lobe of 5.7 cm without any tissue on the left and no nodule. FNA subsequently performed which was benign tissue. Due to high risk of complication for repeat surgery, annual US was planned for monitoring. In 2013 there was a significant new growth of left thyroid of 1.7 cm in size, no nodules. A repeat US six months later revealed an increase in size in the right from 5.7 to 6.1 cm as well as 1.7 to 2.1cm on the left. Patient denied any compressive symptoms, so we continue with neck US surveillance. By 2020, the right lobe was 6.4 cm and left lobe at 2.4 cm. Within both lobes, now multiple nodules start appearing. FNA were performed on several of those nodules with a benign cytopathology in all of them. Of note, other than regrowth of his thyroid, it is also physiologically functional as patient is euthyroid without levothyroxine replacement since 2013. Discussion: When patient underwent thyroidectomy for benign multinodular goiter, thyroid function test is the only routine test for follow up without additional further images. While it is considered a curative treatment, some regeneration or recurrence is still a possibility which is shown in our case. This is one of the few cases in the literature that we could found about normal thyroid tissue regrowth. It is still unclear how the mechanism for this phenomenon occurs. Further studies may need to be pursued with regards to suppressive TSH therapy or even radioactive iodine ablation for benign goiter that have regrowth potential. It is crucial that physicians become aware of such occurrence may happen since new thyroid nodules can also develop in the new thyroid tissue and fine needle aspiration should be performed accordingly.

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