Papillary thyroid cancer arising in struma ovarii

Malignant struma ovarii is a rare clinical entity that poses a therapeutic challenge, as there is no 'gold standard' of care. We aimed to develop evaluation and treatment guidelines by reviewing presentation and outcomes of the available literature. We present a 60-year-old female with papillary thyroid carcinoma arising in a mature teratoma, and our multidisciplinary approach to care and follow-up. We examined 59 cases for characteristics, including rates of metastasis and recurrence, and response to surgical and adjuvant treatment. We found higher rates of metastasis and recurrence than traditionally reported, and found no recurrence in patients treated with oophorectomy, thyroidectomy, and I-131 radioablation. A multimodal approach to the treatment of malignant struma ovarii may improve survival and decrease risk of recurrence.     

Asymptomatic struma ovarii: a case report

Struma ovarii is a rare ovarian neoplasm. This tumor is generally benign, although malignant transformation has been reported. The preoperative diagnosis is generally difficult. Thyroid hormones may be produced and in a few cases asymptomatic women may develop definitive clinical hypothyroidism after resection of struma ovarii. We report a case of a 39-year-old woman who underwent laparoscopic resection of an asymptomatic right ovarian mass. The pathologic diagnosis was struma ovarii. The postoperative period was uneventful and her thyroid function remained normal.     

Malignant struma ovarii: a case report

Malignant transformation of struma ovarii is exceptional (less than 1%). The histolological diagnosis of malignancy is difficult especially in the well differentiated forms. Immunohistochemistry is highly contributive in the anaplastic forms. The prognosis is relatively favorable except for the metastatic and undifferentiated forms. We report a case of malignant struma ovarii with metastasis observed in a 65-year-old woman who died rapidly from her disease. In light of this observation, we discuss the diagnositic, management and outcome features of these particular tumors.     

Malignant struma ovarii

Malignant struma ovarii is a very rare tumor, with considerable disagreement concerning the necessary histologic features for malignancy. The prognosis with patients with a malignant struma ovarii is difficult to make because of inadequate follow-up of the reported cases and long clinical courses. In most cases the patients responded well to surgical treatment but sometimes patients have died from malignant struma ovarii, in particular, if there is metastasis. There is evidence that radioactive iodine is effective in treating metastatic struma. The present case reports the use of intraperitoneal chronic phosphate for metastatic intraperitoneal disease, with thyroid suppression. Long-term follow-up will be necessary to properly evaluate this therapy. Prophylactic administration of thyroid hormone should be considered in cases of malignant struma ovarii.     

Malignant struma ovarii

Malignant struma ovarii is a very rare tumor, belonging to the group of germ cell tumors. The diagnosis is difficult and there is no agreement in the literature concerning the necessary histologic features for malignancy. A case report is presented and the problems of diagnosing are discussed.     

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

Struma ovarii is a rare form of ovarian neoplasm and its malignant transformation is even rarer. Because of its rarity, there is no consensus about its diagnosis and management in the literature. A 53-year-old woman with left adnexial mass underwent total abdominal hysterectomy with bilateral salpingo-oopherectomy. Postoperatively, she was diagnosed with a malignant struma ovarii. Postoperative thyroid ultrasonography revealed a 0.5-cm solid nodule in the thyroid gland and total thyroidectomy was done. Pathology report was nodular hyperplasia of benign character. She is currently disease-free for 1 year but long-term follow-up with thyroglobulin levels is necessary due to reports of increasing recurrence rates. This study was accepted as a poster presentation at the VII International Congress of the Turkish-German Gynecological Association, Antalya, Turkey, 16–20 May 2007.     

Malignant struma ovarii with thyrotoxicosis

BACKGROUND: Malignant struma ovarii is seldom diagnosed preoperatively due to the rarity of the disease itself and the even rarer complications of thyrotoxicosis. CASE: A 48-year-old woman presented with symptoms of hyperthyroidism and a pelvic tumor raising the possibility of ovarian malignancy. Hormonal findings revealed increased thyroid function, but the thyroid gland was normal in size and texture. Thus, she was diagnosed preoperatively as having a hormone-producing malignant struma ovarii. At surgery, a FIGO stage Ia ovarian papillary adenocarcinoma of the thyroid was found. An immunohistochemical tumor stain for thyroglobulin was positive and the ovarian venous thyroglobulin level was extremely high. Findings of hyperthyroidism disappeared over several weeks. CONCLUSION: Malignant struma ovarii can be diagnosed preoperatively. Complications of thyrotoxicosis should be kept in mind when evaluating an ovarian tumor.     

Malignant struma ovarii: a case report of laparoscopic management

BACKGROUND: Struma ovarii is a rare disease. Malignant transformation is even rarer. Data about its management are lacking. We describe the first reported case of a malignant struma ovarii treated and staged by laparoscopy. CASE: A 49-year-old patient was operated by laparoscopy for a right ovarian teratoma. The patient did not show symptoms of hyperthyroidism. The ovarian teratoma was removed in a plastic bag and definitive histology showed foci of papillary adenocarcinoma in a struma ovarii. The patient was then staged by laparoscopic surgery undergoing left adnexectomy, multiple peritoneal and omental biopsies, and common iliac and paracaval lymph node sampling. Hysterectomy was not performed. The postoperative course was uneventful and the patient was released on the second day. Thyroglobulin level was monitored and the patient is free of disease after more than 1 year. CONCLUSION: The preoperative diagnosis of malignant struma ovarii is difficult. Even with cautious evaluation of the patient, some risk of wrong diagnosis is possible. This is why a meticulous technique of laparoscopic surgery in removing the ovary is important. Laparoscopic staging may also intervene in very limited cases; the expertise to perform open staging of the patient is necessary but the postoperative course is fast.     

Bilateral struma ovarii: a case mimicking an ovarian neoplasm

We present a case of bilateral struma ovarii which developed postoperatively and was histopathologically diagnosed after the patient was hospitalized for investigation and treatment of tumoral anexal bilateral formations. There was no evidence of clinical malignancy or metastases. Data from the literature, together with histopathologic, diagnostic and therapeutic aspects of the disease were checked again taking into account the scarcity of this lesion, especially bilaterally.     

Malignant struma ovarii. A case report and literature review

A woman developed papillary adenocarcinoma in a struma ovarii. The focus of malignancy was within a benign struma found at laparotomy for a pelvic mass. The patient had a previous history of bilateral cystic teratomas. The tumor was composed of papillae of crowded, pleomorphic cells with minimal cytoplasm but a wide range of chromatin patterns. Immunoperoxidase staining for thyroglobulin revealed positive regions in both the benign and malignant areas of tumor. A 15-year review of cystic teratomas in the state of Colorado revealed a frequency of 0.3% for malignant struma ovarii.     

Conservative therapy for malignant struma ovarii. A case report

BACKGROUND: Thyrocarcinoma in struma ovarii is rare. Treatment options include salpingo-oophorectomy, complete surgical resection and/or adjuvant therapy. CASE: A young woman presented with a pelvic mass. Unilateral salpingo-oophorectomy was performed with findings of malignant thyroid tissue. No adjuvant therapy was administered. CONCLUSION: Conservative surgical approaches should be considered in patients with malignant struma ovarii who wish to maintain fertility.     

A case of struma ovarii in a 92-year-old woman

A case of struma ovarii in a 92-year-old patient with altered thyroid function is reported.     

Coexistence of brenner tumor and struma ovarii: case report

BACKGROUND: There has been controversy regarding the histogenesis of Brenner tumors. It is generally accepted that Brenner tumors are derived directly from ovarian surface epithelium, which undergoes metaplasia to form the typical urothelial-like components, whereas some investigators assume that Brenner tumors arise from immature germ cells. CASE: We describe a well-documented case of the coexistence of struma ovarii regarded as a form of teratoma and Brenner tumor in the same ovary. Immunohistologically, not only columnar cells of thyroid follicles, but also transitional cells of Brenner nests were positive for thyroglobulin. CONCLUSIONS: In the present case, Brenner tumors and thyroid elements coexisted and were positive for thyroglobulin. While there is strong evidence that pure Brenner tumors originate mostly from the ovarian surface, at least Brenner tumors associated with teratomatous elements may have a germ cell origin.     

Malignant struma ovarii with Graves' disease

BACKGROUND: Malignant struma ovarii is a rare tumor, consisting of a struma ovarii with malignant change. Because of the rarity of the tumor, only a few reports with detailed data of thyroid function of the patient have been published. CASE: Medical and surgical treatments were performed in a case of malignant struma ovarii with Graves' disease and data from thyroid function tests were analyzed. After removal of the tumor, rapid improvement of thyroid function was observed and thyroglobulin level decreased. CONCLUSION: This case demonstrates the possible, if not dominant, contribution from the malignant struma ovarii to the hyperthyroidism of the patient.