A Hormonally Active Malignant Struma Ovarii

Lara, Carolina; Cuenca, Dalia; Salame, Latife; Padilla-Longoria, Rafael; Mercado, Moisés

doi:10.1155/2016/2643470

Cited by 14 publications

(16 citation statements)

References 16 publications

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“…Most patients with SO present no clinical symptoms and are diagnosed incidentally. In some patients, as it was in the two presented cases, they may cause symptoms similar to those typical of other ovarian tumours, such as low abdominal pain, nausea, vaginal bleeding and abnormal menstrual cycles [5,6]. Sometimes, the first symptom is palpable abdominal mass [5,7,13].…”

Section: Discussionmentioning

confidence: 64%

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The role of immunohistochemical examination in diagnosis of papillary thyroid cancer in struma ovarii

Szczepanek‐Parulska

Pioch

Cyrańska-Chyrek

et al. 2015

Folia Histochem Cytobiol.

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Introduction. Struma ovarii (SO) is a monodermal teratoma in which thyroid tissue comprises more than 50% of the tumour. Papillary thyroid cancer (PTC) in SO is a rare finding, as only 5% of SO cases undergo malignant transformation. Malignant SO is usually asymptomatic and infrequently diagnosed preoperatively. Because of its rarity, there is no consensus about diagnosis and management, while treatment and follow-up procedures are not clearly established. Material and methods. Herewith, we report two cases of PTC in SO. The first patient was a 25-year-old woman diagnosed with bilateral ovarian tumours. The second patient, 19-year-old woman, presented with unilateral ovarian mass. Both patients were qualified for surgical excision of the tumours. Histopathological specimens underwent both conventional histopathological assessment and immunohistochemical staining. Results. In the first patient histopathology revealed SO with two foci of PTC. Immunohistochemically a positive expression of CK7, CK19, p63 and thyroglobulin (Tg) confirmed the diagnosis. She underwent total thyroidectomy in 2016 in order to enable ablative radioiodine therapy and facilitate further thyroglobulin monitoring. Unfortunately, the patient was lost from follow-up. In the second patient, histopathological diagnosis was follicular variant of PTC in SO. Postoperatively, a pelvic CT revealed osteolytic lesion 6 cm in size, being a metastatic change. The patient underwent unilateral ovariectomy, total thyroidectomy and multiple cycles of radioiodine therapy. Currently, 9 years following the diagnosis, the patient achieved disease remission. Conclusions. PTC in SO still remains a diagnostic and therapeutic challenge. Immunostaining for CK7, CK19, p63 and Tg might be helpful in histopathological diagnosis. The decision on the need of total thyroidectomy and radioiodine therapy should be made individually. However, thyroid remnant ablation increases the sensitivity and specificity of follow-up testing using serum Tg level as a tumour marker.

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Section: Discussionmentioning

confidence: 64%

“…Struma ovarii is usually a benign tumour, being histologically and pathologically identical to normal thyroid tissue found in typical localization. Less than 5% of these tumours undergo malignant transformation [2,[6][7][8]. The age at presentation of SO is usually between 40 and 60 years [3,9,10].…”

Section: Introductionmentioning

confidence: 99%

The role of immunohistochemical examination in diagnosis of papillary thyroid cancer in struma ovarii

Szczepanek‐Parulska

Pioch

Cyrańska-Chyrek

et al. 2015

Folia Histochem Cytobiol.

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“…In a patient with NHL and unexplained hypertension, RNA extraction from a lymph node demonstrated increased CYP11B2 mRNA expression, confirming that hyperaldosteronism was paraneoplastic (Mulatero et al 2001). Struma ovarii is a rare subtype of ovarian cancer representing <1% of all ovarian malignancies (Lara et al 2016). It represents a monodermal teratoma composed of mature thyroid tissue; thyroid tissue must comprise more than 50 percent of the overall ovarian tissue to be classified as a struma ovarii.…”

Section: Endocrine Paraneoplastic Syndromes Secondary To the Secretiomentioning

confidence: 88%

“…The mechanism underlying the functioning status of the tumour is still unclear, but the presence of thyroid stimulating hormone receptor (TSHr) is thought to play a role. It represents the only known malignancy that secretes ectopic TSH (Lara et al 2016). Gestational trophoblastic diseases comprise hydatidiform moles, invasive moles, choriocarcinomas and placental site trophoblastic tumours.…”

Section: Endocrine Paraneoplastic Syndromes Secondary To the Secretiomentioning

confidence: 99%

Paraneoplastic endocrine syndromes

Dimitriadis

Angelousi

Weickert

et al. 2017

Endocrine-Related Cancer

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The majority of neoplasms are responsible for symptoms caused by mass effects to surrounding tissues and/or through the development of metastases. However, occasionally neoplasms, with or without endocrine differentiation, acquire the ability to secrete a variety of bioactive substances or induce immune cross-reactivity with the normal tissues that can lead to the development of characteristic clinical syndromes. These syndromes are named endocrine paraneoplastic syndromes when the specific secretory components (hormones, peptides or cytokines) are unrelated to the anticipated tissue or organ of origin. Endocrine paraneoplastic syndromes can complicate the patient's clinical course, response to treatment, impact prognosis and even be confused as metastatic spread. These syndromes can precede, occur concomitantly or present at a later stage of tumour development, and along with the secreted substances constitute the biological 'fingerprint' of the tumour. Their detection can facilitate early diagnosis of the underlying neoplasia, monitor response to treatment and/or detect early recurrences following successful initial management. Although when associated with tumours of low malignant potential they usually do not affect long-term outcome, in cases of highly malignant tumours, endocrine paraneoplastic syndromes are usually associated with poorer survival outcomes. Recent medical advances have not only improved our understanding of paraneoplastic syndrome pathogenesis in general but also enhanced their diagnosis and treatment. Yet, given the rarity of endocrine paraneoplastic syndromes, there is a paucity of prospective clinical trials to guide management. The development of well-designed prospective multicentre trials remains a priority in the field in order to fully characterise these syndromes and provide evidence-based diagnostic and therapeutic protocols.

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“…Lara et al [11], reported a case aged 36 years old with malignant struma ovarii in 2016. They performed a left salpingoopherectomy with omentectomy.…”

Section: Discussionmentioning

confidence: 99%

Follicular Variant of Papillary Thyroid Carcinoma Arising in a Mature Cystic Teratoma of the Ovary

Özay¹,

Özay²,

Acar³

et al. 2016

J Gynecol Res Obstet

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Mature cystic teratomas form approximately 20% of all ovarian tumours. Of these, approximately 15% include benign thyroid tissue. When thyroid tissue comprises more than 50% of the ovarian teratoma, it is termed ''struma ovarii''. The exact incidence of malignancy in struma ovarii is hard to evaluate, because of its uncommon nature. The aim of this study is to report a rare case of follicular variant of papillary thyroid carcinoma arising in mature cystic teratoma of the right ovary. A 43-year-old premenopausal female, gravida 3, para 2 was admitted to Dokuz Eylul University Hospital with an incidental ultrasonographic fi nding of a complex solid echogenic right ovarian mass during her annual gynecological examination. The preoperative diagnosis was dermoid cyst. The patient underwent laparoscopic surgery. At exploration, the left ovary, the left fallopian tube, and the uterus were normal. The right ovary was enlarged, white and smooth ovarian semisolid mass was noted. Histopathologic evalutation revealed a tumor of follicular variant of papillary thyroid carcinoma arising in a mature cystic teratoma. The case was discussed at the multidisciplinary oncology meeting. Postoperatively, the thyroid function tests, thyroid gland sonogram were requested. The results were normal. A total body scanning with I 131 was done. The test revealed no residual intrabdominal/pelvic carcinoma. Total abdominal hysterectomy, bilateral salpingooophorectomy, peritoneal washings, bilateral pelvic-paraaortic lymphadenectomy, partial omentectomy and peritoneal biopsies were performed. In conclusion, the treatment modalities for malignancy in struma ovarii or mature cystic teratoma depend on the stage of the disease and fertility desire.

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A Hormonally Active Malignant Struma Ovarii

Cited by 14 publications

References 16 publications

The role of immunohistochemical examination in diagnosis of papillary thyroid cancer in struma ovarii

The role of immunohistochemical examination in diagnosis of papillary thyroid cancer in struma ovarii

Paraneoplastic endocrine syndromes

Follicular Variant of Papillary Thyroid Carcinoma Arising in a Mature Cystic Teratoma of the Ovary

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