Bilateral benign non functional struma ovarii with Pseudo-Meigs′ syndrome

Rana, Vandana; Srinivas, V.; Bandyopadhyay, Shovik; Ghosh, Suchandra; Singh, Yashpal

doi:10.4103/0377-4929.44978

Cited by 20 publications

(22 citation statements)

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“…Approximately 36.4% (4/11) cases coexisted with thyroid disease, 50% for hypo- and hyperthyroidism, respectively. All the cases except those reported by Rana et al (11) were initially suspected to be a malignant tumor. Complete remission of the ascites, hydrothorax, and CA 125 was obtained following surgery without any adjuvant therapy.…”

Section: Discussionmentioning

confidence: 98%

Coexistence of benign struma ovarii, pseudo-Meigs’ syndrome and elevated serum CA 125: Case report and review of the literature

Jin

Dong

et al. 2015

Oncology Letters

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Abstract. Struma ovarii is an uncommon ovarian teratoma comprised predominantly of mature thyroid tissue. The combination of pseudo-Meigs' syndrome, and elevation of CA 125 to the struma ovarii is a rare condition that can mimic ovarian malignancy. We reported a case of benign struma ovarii, presenting with the clinical features of advanced ovarian carcinoma: complex pelvic mass, gross ascites, bilateral pleural effusion and markedly elevated serum CA 125 levels. The patient underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy. Ascites and pleural effusion were not evident and the CA 125 levels returned to normal following surgical excision. A systematic review of reported cases of coexistent benign struma ovarii, pseudo-Meigs' syndrome and elevated serum CA 125 was performed. Struma ovarii accompanied by pseudo-Meigs' syndrome and elevated serum CA 125 should be considered in the differential diagnosis of ovarian epithelial cancer. IntroductionStruma ovarii is a rare ovarian neoplasm consisting almost exclusively of mature thyroid tissue (>50%) derived from germ cells in a mature teratoma (1). Few of these cases undergo malignant transformation (2). Meigs' syndrome refers to a solid benign ovarian neoplasm, such as fibroma or thecoma accompanied by ascites and hydrothorax which are required to completely resolve following removal of the tumor (3). Pesudo-Meigs' syndrome is often characterized by pleural effusion and ascites caused by a pelvic tumor other than an ovarian fibroma. Rare cases of ovarian tumors have been associated with pseudo-Meigs' syndrome, such as struma ovarii tumors, mucinous or serous cystadenomas, germ cell tumors and ovarian metastasis from colon and gastric cancers (2). When coexisting with pesudo-Meigs' syndrome and elevation of CA 125, struma ovarii is highly suspected as an ovarian malignancy. Struma ovarii mimicking advanced ovarian carcinoma can cause difficulties in preoperative diagnosis (1). Diagnosis of struma ovarii can only be made by conducting histopathology (4). The present study focused on a patient presenting with struma ovarii, who was initially thought to have an ovarian malignancy prior to surgery based on clinical, radiological findings and raised CA 125 levels. However, the frozen section and final histopathology reports revealed benign struma ovarii. A systematic review of the related literatures on struma ovarii presenting as pseudo-Meigs' syndrome with elevated serum CA 125 was also conducted. Written informed consent was obtained from the patient. Case reportOn April 3, 2014, a 52-year-old, Chinese female, premenopausal, gravida 3, para 1, was admitted to the United Hospital of Dezhou (Dezhou City, China), complaining of oppression in chest and shortness of breath for 5 days. The patient's previous menstrual period was March 31, 2014. The patient did not complain of any pain or changes in micturition or bowel movements. The patient's medical history included surgery for an ovarian tumor 26 years previously and surgery for a broad ligament tum...

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Section: Discussionmentioning

confidence: 98%

Coexistence of benign struma ovarii, pseudo-Meigs’ syndrome and elevated serum CA 125: Case report and review of the literature

Jin

Dong

et al. 2015

Oncology Letters

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“…a papillary and follicular carcinoma), which is ruled out via histological examination. 15 The criteria for malignancy in struma ovarii are the same as those of a thyroid carcinoma. 27 Nuclear features such as nuclear grooves are more clearly visible on scrape smears and their absence rules out a papillary carcinoma.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5]9,11,12,15,[17][18][19][20][21][22]24,25 Only three patients underwent conservative surgery. 13,14,23 In the present case, the patient underwent conservative surgery in the form of a salpingo-oophorectomy, as there was no evidence of malignancy according to the frozen section analysis.…”

Section: Discussionmentioning

confidence: 99%

“…10 The mean follow-up period was approximately 8 months, ranging from 1-36 months. 4,5,[9][10][11]15,17,18,20,[22][23][24][25] Most cases were treated via total abdominal hysterectomy and bilateral of colloid-filled follicles of various sizes, resembling thyroid follicles [ Figures 3B and C]. Based on analysis of the scrape smears and frozen section, a provisional diagnosis of struma ovarii was made.…”

Section: ‫ب�سيودو-ميغ�س‬ ‫متالزمة‬ ‫مع‬ ‫وجوده‬ ‫ولكن‬ ‫النادرة‬ ‫املmentioning

confidence: 99%

“…10 In all cases, the volume of ascitic fluid was over 1 L, except for five cases. 5,[12][13][14][15] The most common presenting symptom was abdominal distension. [2][3][4]9,10,12,13,[15][16][17][18][19][20][21][22] Pleural effusion was noted in 15 cases.…”

Section: ‫ب�سيودو-ميغ�س‬ ‫متالزمة‬ ‫مع‬ ‫وجوده‬ ‫ولكن‬ ‫النادرة‬ ‫املmentioning

confidence: 99%

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Struma Ovarii with Pseudo-Meigs’ Syndrome and Raised Cancer Antigen-125 Levels Masquerading as an Ovarian Carcinoma: Case report and literature review

Yadav

Tomar

Verma

et al. 2017

SQUMJ

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S truma ovarii are mature ovarian teratomas derived from one type of germ cell; these monodermal variants account for >5% of mature teratomas and 0.3-1% of ovarian tumours.1 These types of tumours predominantly consist of thyroid tissue (>50% of the overall ovarian mass) and the usual age of presentation is during the fifth and sixth decades of life.1 The reported rate of malignant transformation is 5-37%, in which the struma ovarii transforms into a thyroid-type carcinoma.2 The usual presentation of struma ovarii is as an abdominopelvic mass, although it may present with hyperthyroidism in approximately 5% of cases.3 Radiologically, a benign ovarian mass presenting with ascites and raised cancer antigen (CA)-125 levels can be misdiagnosed as a malignant ovarian tumour. 2,4,5 In such cases, a correct intraoperative diagnosis can prevent extensive surgery. Case ReportA 55-year-old female presented to the Lok Nayak Jai Prakash Narayan Hospital, New Delhi, India, in 2016 with progressively increasing abdominal discomfort, The monodermal teratoma struma ovarii is a rare ovarian tumour; however, struma ovarii presenting with pseudo-Meigs' syndrome and raised cancer antigen (CA)-125 levels is even rarer. In elderly patients, this presentation can potentially lead to a misdiagnosis of a malignant ovarian carcinoma, resulting in unnecessary extensive surgery. We report a 55-year-old female who presented to the Lok Nayak Jai Prakash Narayan Hospital, New Delhi, India, in 2016 with progressive abdominal discomfort, fatigue and abdominal distention. Clinical and radiological features were indicative of a malignant ovarian tumour and ascites. Serum CA-125 levels were elevated at 258 U/mL. A left-sided salpingo-oophorectomy was performed, after which the serum CA-125 levels normalised. There was no evidence of recurrence at a six-month follow-up. A frozen section procedure confirmed the diagnosis of a struma ovarii. This rare condition should be considered as a differential diagnosis in patients presenting with ovarian masses, ascites and raised CA-125 levels.

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