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

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.

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

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.

Strumal Carcinoid Focus in Mature Cystic Teratoma in a Patient with Breast Cancer and Desire for Fertility Preservation

Ovarian primary carcinoid tumors are very rare, accounting for 0.5-1.7% of all carcinoid tumors and 3% of ovarian teratomas. This type of tumor frequently arises from a mature cystic teratoma. The primary ovarian carcinoid tumors are divided into 4 major types, based on their histological characteristics: insular, trabecular or mucinous pattern. Strumal carcinoid refers to insular or trabecular pattern associated with struma ovarii. The strumal type is the most common histologic form, accounting for 40% of primary ovarian carcinoid tumors. Approximately 5% of carcinoid tumors of the non-mucinous type can be malignant. However, in the case of ovarian strumal carcinoid, the occurrence of metastasis is unusual. This article is based on a case of a 30-year-old nulliparous woman diagnosed with strumal carcinoid, who presented a right ovarian tumor suggestive of teratoma synchronous to a breast cancer. She was referred to our center for fertility preservation.