Background/Aim: Malignant struma ovarii is an extremely rare tumor entity among ovarian tumors. In the presence of ascites and peritoneal metastases, the preoperative appearance may resemble the most common epithelial ovarian carcinoma (EOC) and accordingly, the surgical therapy may be identical if a preoperative histology diagnosis is not possible. The objective of this case report is to present a patient with histopathologically confirmed malignant struma ovarii who underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS and HIPEC) with the aim of complete tumor resection.Case Report: This study reports on a patient with preoperatively proven peritoneal metastasis of an 18 cm ovarian tumor with large struma ovarii and papillary thyroid carcinoma within the struma, who was treated with CRS and HIPEC after neoadjuvant chemotherapy. Conclusion: This disease has a significantly better prognosis than EOC, however, HIPEC could provide an additional effect in examining the presence of peritoneal metastasis.Struma ovarii is a monodermal teratoma among the germ cell tumors of the ovary mainly consisting of thyroid tissue (>50% of overall tissue) (1). This disease was first described by Gottschalk in 1899 (2). Struma ovarii is a very rare tumor, which represents 1% of all ovarian tumors and 2-5% of all ovarian teratomas (3, 4).Out of these, 5% can transform into malignant tumors (5). The clinical presentation is usually non-specific and difficult to recognize and is mostly discovered incidentally according to pathological findings. Due to its rarity, the perioperative management is not uniform and not completely clarified to date. There is no case report in the literature in which HIPEC has been performed on malignant struma ovarii. Herein a patient with malignant struma ovary of papillary carcinoma histology is presented. She was treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) after preoperatively proven peritoneal metastases and ascites in our tertiary referral center.
Zusammenfassung Einleitung Dysgerminome sind seltene maligne Keimzelltumoren des Ovars und in der Schwangerschaft eine Rarität. Neben ovariellen sind außerhalb der Schwangerschaft auch primär extraovarielle Dysgerminome des Mediastinums und Retroperitoneums beschrieben. Nach adäquater chirurgischer und systemischer Therapie besteht eine gute Prognose. Methodik Bericht eines primär extraovariell-intraabdominalen Dysgerminoms in der Schwangerschaft, systematische Literaturrecherche. Fallbericht Bei einer 35-jährigen II Gravida wird in der 20. Schwangerschaftswoche ein suspekter intraabdominaler Tumor festgestellt. Bei der folgenden Explorativlaparotomie wird bei unauffälligen Ovarien ein Tumorkonglomerat mit Darminfiltration reseziert und ein Dysgerminom diagnostiziert. In der 34. SSW wird eine primäre Sectio Caesarea durchgeführt, erneuter Tumorbefall komplett reseziert und folgend systemisch Bleomycin, Etoposid und Cisplatin appliziert. Nach 12 Monaten erfolgt bei zystischen Adnexen eine erneute Exploration mit Hysterektomie und Adnexektomie beidseits ohne Nachweis von Malignität. Nach nun 16 Monaten besteht weiter eine Komplettremission. Zusammenfassung Präsentiert wird die Erstbeschreibung eines primär extraovariell-intraabdominalen Dysgerminoms in der Schwangerschaft. Durch die Entscheidung, die zytoreduktive Operation während und die Systemtherapie erst nach Prolongation der Schwangerschaft durchzuführen, konnte größtmöglicher Benefit für das Kind mit der günstigen Prognose der Mutter vereint werden. Angesichts limitierter Datenlage müssen bei Dysgerminomen in der Schwangerschaft individuelle, interdisziplinäre Konzepte erstellt werden.
Aim: To present the extraperitoneal approach for the removal of peritoneal metastases in the right upper abdomen in patients with ovarian cancer and to evaluate safety and potential advantages with comparison with the traditional approach. Patients and Methods: Detailed description of the right upper quadrant peritonectomy as extraperitoneal approach. Procedure-specific short-term complications were retrospectively analyzed in a cohort of patients. Results: Sixty-four patients were included. Fullthickness diaphragmatic resection was performed in 17% of primary cases, and in 44% of the patients with recurrent ovarian carcinoma. The rate of complete cytoreduction (CC-0) was 70%. The most common postoperative complication was pleural effusion (32%). Conclusion: The extraperitoneal approach for peritonectomy of the right upper quadrant in patients with ovarian cancer is feasible, with improved access to the right subdiaphragmatic area. This enables a high rate of complete cytoreduction, and simplified and safe surgical dissection in an uncontaminated area under secured vascular structures. The early postoperative outcomes are comparable to those of the traditional transperitoneal approach.In industrialized countries, ovarian cancer is the leading cause of gynecological cancer-related mortality. The poor prognosis is attributed to the fact that two-thirds of patients have advanced-stage ovarian cancer at diagnosis (1). The majority of these women have extensive intra-abdominal disease with significant peritoneal involvement at the time of diagnosis, resulting in low overall cure rates. The most important prognostic factor remains the residual disease status after cytoreductive surgery (CRS) (2-4).In advanced-stage ovarian cancer, up to 40% of patients present with bulky metastases in the diaphragmatic peritoneal region, mainly on the right side (5-7). Metastases appear in this region as a consequence of transcoelomic tumorous implants from the floating malignant cells in the peritoneal fluid, which circulates clockwise in the peritoneal cavity (8).Maximal effort to achieve complete cytoreduction with the resection of diaphragmatic metastases is associated with improved survival (5,9,10). For this reason, gynecological oncologists commonly perform upper abdominal surgery (9,11). Not only in the primary but also in the recurrent setting, complete cytoreduction seems to deliver survival benefit. Recently results from the DESKTOP III trial, presented at the American Society of Clinical Oncology meeting in Chicago, highlighted a survival benefit in favor of secondary complete CRS in comparison to chemotherapy alone (12).Diaphragmatic peritonectomy and full-thickness resection constitute an effective way to remove diaphragmatic carcinomatosis and achieve complete cytoreduction. These interventions frequently result in intrathoracic and pulmonary complications, although long-term morbidity is uncommon. Diaphragmatic surgery is mostly limited to stripping. However, if the tumor infiltrates the muscle fibers of the diaphragm, ...
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