Papillary carcinoma of the thyroid arising in struma ovarii – report of a case and review of management guidelines

Abstract

This study was designed to determine serum human leukocyte antigen-G (HLA-G) levels and establish whether serum HLA-G level is related with insulin resistance, oxidative stress, dyslipidemia and ovarian hyperandrogenism in women with polycystic ovary syndrome (PCOS). Twenty-five patients with PCOS and 23 healthy control women were evaluated in this study. Serum HLA-G, lipid fractions, glucose, insulin, malondialdehyde (MDA), glutathione (GSH), white blood cell (WBC), sex hormone-binding globulin (SHBG) and other hormone (gonadotropins and androgens) levels were measured. The estimate of insulin resistance was calculated by homeostasis model assessment (HOMA-IR). Serum luteinizing hormone (LH), total testosterone, fasting insulin, WBC levels and LH/follicle-stimulating hormone (FSH) ratio, free androgen index (FAI) and HOMA-IR values were significantly higher in patients with PCOS compared with healthy women. However, the women with PCOS had considerably lower serum FSH, SHBG, MDA, GSH and HLA-G levels than healthy subjects. HLA-G was inversely related with HOMA-IR, FAI, LH/FSH ratio and WBC, but positively with high-density lipoprotein cholesterol. Decreased serum HLA-G level may be related with insulin resistance, ovarian hyperandrogenism and oxidative stress in women with PCOS. Nevertheless, the exact role of HLA-G in the pathogenesis of the disease remains to be elucidated.     

Immature ovarian teratoma in an adolescent: a case report and review of the literature

BACKGROUND: Benign cystic teratomas are relatively common tumors in reproductive age women, but can occur at any age. While the incidence of malignant elements in a teratoma is low (approximately 1-2%), the survival of patients with immature teratoma is poor. Definitive diagnosis is mandatory. CASE: We describe a case of a 13-year-old African American female, gravida 0, presenting with a large pelvic mass, determined to be a benign cystic teratoma by intra-operative frozen section. However, due to the size of the tumor and the preponderance of neural elements we performed a full surgical staging procedure (excluding hysterectomy and complete removal of adnexa). The final pathology report revealed foci of immature neural tissue, with a final diagnosis of an immature cystic teratoma Stage Ia. CONCLUSION: Foci of immature neural elements can be readily missed on frozen section, especially with a large tumor. Full surgical staging at the time of initial laparotomy is justified when encountering an apparently mature cystic teratoma with a preponderance of neural elements on frozen section.     

Cystic teratoma of the caecum, demonstrating as an ovarian tumor: case report and literature review

Benign cystic teratoma of the caecum of 24 year woman interpreted as an ovarian tumor. Rare case that can contribute to the gynecology theory, practice and diagnostic.     

Metastatic malignant melanoma arising in a mature ovarian cystic teratoma: a case report and literature review

Primary malignant melanoma arising inform the ovary is rare, with only 30 cases described in the literature to date. The case reported here occurred in a 19-year-old woman and was rapidly progressive, resulting in death only 37 days following initial presentation. Management of this case is discussed in the context of the other reported cases. Surgery, ranging from an ovarian cystectomy to a radical debulking procedure, has been the main treatment with adjuvant chemotherapy utilized in only 4 of the previous cases. Key problems in management relate to the ability to make the diagnosis at the time of surgery and the overall poor response rates of melanoma to adjuvant chemotherapy.     

Immature teratoma in pregnancy: a case report and literature review

BACKGROUND: The management of a Stage I immature teratoma during pregnancy with a review of the literature is reported. CASE REPORT: A growing adnexal mass was removed at 12 weeks of gestation. Although the frozen section was negative, because of intraoperative clinical suspicion, a right salpingo-oophorectomy and surgical staging were performed. Histological examination revealed a Stage Ia, grade 1 immature ovarian teratoma. Appropriate surgical staging enabled avoidance of chemotherapy despite the unexpected histological diagnosis. The pregnancy was terminated because of fetal distress, with cesarean section at 34 weeks of gestation. At that time the peritoneal cavity was inspected and biopsies were taken as in second-look laparotomy. Two years after the first operation the patient remains disease free. CONCLUSION: For adnexal masses removed during pregnancy frozen section is useful but when there is clinical suspicion surgical staging must be performed.     

Repeated pregnancy with concomitant presence of ovarian teratoma: A case report and literature review

Objective

Benign mature teratoma during pregnancy is common, mostly discovered incidentally by antenatal sonography. However, repeated pregnancy coincident with ovarian mature teratoma is rarely reported. The cases of teratoma with rapid growing characteristics are even more unique.

The growing teratoma syndrome: a case report and a review of the literature

Abstract.   Tangjitgamol S, Manusirivithaya S, Leelahakorn S, Thawaramara T, Suekwatana P, Sheanakul C. The growing teratoma syndrome: a case report and a review of the literature. Int J Gynecol Cancer 2006; 16(Suppl. 1): 384–390.
We present the case of a 5-year-old girl with ovarian immature teratoma, which recurred a few months after an incomplete surgical staging. The recurrent masses, located in the upper abdomen and lower pelvis, were accompanied by rise in levels of serum alpha-fetoprotein. The patient and her parents refused surgical resection of these recurrent masses; therefore, chemotherapy was promptly given. After multiple cycles of chemotherapy, all the masses remained stable in size despite normalization of the tumor marker. Subsequent complete resection of the masses showed only mature teratoma (MT) component without any residual malignant germ cell tumor. The patient was disease free for 2 years, when another episode of recurrence developed as a 5-cm mass in the perihepatic area. The third laparotomy revealed a tumor mass, histologically composed of only MT tissue. She is now doing well without any evidence of the disease, 24 months after the last surgery.     

Prolonged survival following salvage surgery for chemorefractory ovarian immature teratoma: a case report and review of the literature

BACKGROUND: Data regarding salvage surgery for ovarian immature teratoma (IT) are lacking despite its established role in the management of chemorefractory testicular germ cell tumors. In this report, a case of advanced IT that was salvaged by secondary cytoreduction following failure of both primary therapy and salvage chemotherapy is described, and the available literature is reviewed. CASE: A 28-year-old patient underwent primary cytoreductive surgery followed by platinum-based chemotherapy for stage IIIC, grade 3, ovarian IT. Second-line chemotherapy was administered after residual disease was identified at second-look surgery. Following failure of salvage chemotherapy, aggressive secondary debulking resulted in long-term disease-free survival of over 48 months. CONCLUSION: There appears to be a distinct role for salvage surgery in selected cases of chemorefractory IT. More studies are needed to further define the subset of patients who benefit most from this management approach.     

HPV induced ovarian squamous cell carcinoma: case report and review of the literature

Background Ovarian squamous cell carcinoma is usually derived from a teratoma, a Brenner tumour or endometriosis. Association with an HPV infection is rare. Case A fourth case of ovarian squamous cell cancer associated with HR-HPV is presented. Debulking for stage IIIc ovarian squamous cell cancer was performed and she received adjuvant combination chemotherapy. She developed bone metastases and received radiotherapy. The Progression of these metastases and the newly developed metastases did not respond to an oral tyrosine kinase inhibitor (gefitinib). Conclusion The development of bone metastases in association with an ovarian squamous cell carcinoma is a rare finding, and it did not respond to treatment with a tyrosine kinase. A review of literature is presented.     

Primary ovarian fibrosarcoma: a case report and review of the literature

Primary ovarian fibrosarcomas are very rare tumors with great heterogeneity among reported cases. There are only a few reports of the subject in the literature, and along with the nature of the disease, diagnosis and treatment still remain to be established. In this report, we reviewed the cases published in the English literature within the past 30 years and tried to highlight certain aspects of the disease. A 52-year-old parous woman was admitted to our hospital with the complaints of abdominopelvic pain. Initial diagnostic work-up revealed a solid mass on the right ovary. After explorative laparotomy, the pathologic examination reported a primary ovarian fibrosarcoma. The patient has been free of disease for 1 year without any adjuvant therapy. Although ovarian fibrosarcomas are unusual causes of solid masses in postmenopausal women, it should be kept in mind when evaluating adnexal masses in this age group.     

Successful infertility treatment following fertility-sparing surgery and chemotherapy for ovarian immature teratoma: a case report and a literature review

Introduction  

Malignant ovarian germ cell tumors (MOGCTs) are highly chemosensitive tumors most commonly found in adolescent girls and young women. However, patients with advanced disease can now be successfully cured with fertility-sparing surgery and adjuvant chemotherapy, resulting in childbearing.     

Primary ovarian carcinosarcoma: a case report and review of the literature

Primary ovarian carcinosarcoma is characterized by an admixture of malignant epithelial and stromal elements. This neoplasm is extremely rare with fewer than 400 cases reported in the English literature. Its histogenesis, clinical features and optimal treatment remain unclear because of the rarity of primary ovarian carcinosarcoma. This study focuses on the clinical, pathological, immunohistochemical features and survival of a 73-year-old patient with primary ovarian carcinocarcoma. The patient was treated with surgery followed by combined chemotherapy with carboplatin and taxol and assigned to FIGO Stage IIIc. She died from the disease 17 months after surgery. In conclusion, ovarian carcinosarcoma is a very aggressive tumor, especially when it is diagnosed at advanced stage.     

Squamous cell carcinoma arising in an ovarian mature cystic teratoma complicating pregnancy: a case report

Background   The question of whether patients with pure stage I squamous cell carcinoma in a mature cystic teratoma (MCT) should undergo conservative surgery, or postoperative adjuvant treatment remains unresolved. Case  A 33-year-old woman with a left ovarian cyst underwent laparoscopic cystectomy at 16 weeks of gestation. Histological examination confirmed squamous cell carcinoma arising in an MCT. At 18 weeks of gestation, she underwent left salpingo-oophorectomy, and was diagnosed as having stage Ic malignant transformation of the MCT, and was observed closely without postoperative adjuvant chemotherapy. She delivered a healthy baby at 41 weeks of gestation. No evidence of recurrence was observed 14 months after the initial laparoscopic surgery. Conclusion  Although a thorough staging procedure , histopathologic evaluation, and long-term follow-up are indispensable, patients with early stage I squamous cell carcinoma in MCT may safely undergo conservative surgery.     

Cushing's syndrome secondary to ectopic ACTH secretion from carcinoid tumor within an ovarian mature teratoma: a case report and review of the literature

A 46-year-old woman with Cushing's syndrome secondary to ectopic adrenocorticotropic hormone (ACTH) secretion caused by primary ovarian mature teratoma with carcinoid components was presented in our case. The patient manifested sustained hypercortisolemia without circadian rhythm and a lack of suppression of either low-dose dexamethasone suppression test (LDDST) or high-dose dexamethasone suppression test (HDDST). There was no evidence of a pituitary mass or secretion of other hormones. After careful clinical evaluation, no other tumor masses were found. Resection of the ovarian tumors led to sharp reduction of serum ACTH and cortisol concentrations. Immunohistochemistry showed positivity in CgA, Syn, CK, NSE. To the best of our knowledge, there are rare reports of an ACTH-secreting carcinoid components located in an ovarian mature teratoma, and bilateral ovarian mature teratoma makes it rarer.     

Primary ovarian small cell carcinoma of the pulmonary type: a case report and review of the literature

Small cell carcinoma of the ovary is a rare type of ovarian carcinoma with a poor prognosis. Two types should be distinguished: the hypercalcemic type and the pulmonary type. We report the case history of a 54-year-old woman with both a Stage IIIC small cell carcinoma, pulmonary type and a well-differentiated endometrioid adenocarcinoma of the left ovary in combination with a Brenner tumor in the right ovary. A review of the literature on small cell carcinoma of the ovary is given and the findings of our patient are brought into perspective in terms of both histopathogenesis and treatment outcome.     

Growing teratoma syndrome vs chemotherapeutic retroconversion: case report and review of the literature

BACKGROUND: Immature ovarian teratoma is the third most common germ cell tumor (GCT) following dysgerminoma and endodermal sinus tumor. The treatment of choice during childbearing age for immature teratoma composes of unilateral oophorectomy and in case of metastatic disease postoperative chemotherapy (BEP). Finding a solid mass in the peritoneal or chest cavity during routine follow up raises the suspicion of distance recurrence. DiSaia was the first to describe the appearance of benign distant metastasis during routine follow up. He termed this phenomenon "chemotherapeutic retroconversion". Latter, Logothetis described what seems to be a similar phenomenon in testicular non-seminomatous germ cell tumor (NSGCT) that he called the "growing teratoma syndrome". CASE: We present a case of a 12-year-old girl treated for growing teratoma syndrome after primary ovarian GCT. CONCLUSION: Review of the literature shows that this syndrome and the "chemotherapeutic retroconversion" are probably the same phenomenon.     

Primary ovarian trabecular carcinoid tumor: a case report and literature review

Introduction  

Carcinoid tumors are uncommon neoplasms in the diffuse peripheral endocrine system. Ovarian carcinoids are rare and can be primary or transplanted. Primary ovarian carcinoids make up approximately 0.5–1.7% of all carcinoid tumors.