Because of the rarity of malignant struma ovarii, there is considerable confusion concerning management. Optimal surgical management of welldifferentiated thyroid. A rare presentation of an infrequent tumor sonia chhabra, namita bhutani, sunita singh, mansi aggarwal, rajeev sen department of pathology, post graduate institute of medical sciences pgims. A struma ovarii is a monodermal variant of an ovarian mature teratoma containing. Struma ovarii is a monodermal variant of ovarian teratoma. Patients with malignant struma ovarii may respond to thyroidectomy followed by radioactive iodine therapy 2, 3. Thyroid tissue may be also found in the peritoneal cavity as in benign strumosis. This page was last edited on 19 november 2018, at 17. Struma ovarii is defined as ovarian goiter which comprises either entirely or predominantly thyroid tissue 50 %. The current study reports an unusual case of struma ovarii occurring in a 49 year. Struma ovarii accompanied by mature cystic teratoma of the. Struma ovarii associated with pseudomeigs syndrome and high. It is a relatively rare tumor which comprises 1% of all ovarian tumors and 2.
Malignant struma ovarii is a rare form of the ovarian germ cell tumors. All structured data from the file and property namespaces is available under the creative commons cc0 license. Mar 08, 2019 struma ovarii is a rare ovarian tumor defined by the presence of thyroid tissue comprising more than 50% of the overall mass. Since its first description in the early part of the twentieth century, struma ovarii has elicited considerable interest because of its many unique features. Posttherapy whole body scan after levothyroxine withdrawal revealed uptake in the thyroid bed, abdomen, and pelvis. Diagnosis of struma ovarii with medical imaging springerlink. Jun 20, 2008 to evaluate the clinical characteristics of struma ovarii. A report of two cases, american journal of clinical pathology, volume, issue 5, 1 may 1943, pages 271277. A case of papillary thyroid carcinoma in struma ovarii and. We hypothesized that in patients with thyroid cancer arising within struma ovarii, pelvic surgery alone would be sufficient, provided there is no evidence of gross extraovarian extension. Pdf malignant struma ovarii a blinded study of 86 cases. A 17yearold patient was diagnosed with papillary thyroid cancer in struma ovarii. Ther apy has ranged from radical surgery tah bso and. Mar 21, 2012 struma ovarii is a rare form of ovarian neoplasm in a form of mature teratoma and is composed predominantly of thyroid tissue.
It is defined by the presence of thyroid tissue comprising more than 50% of the overall mass. Poorly differentiated thyroid carcinoma arising in struma ovarii. Ovarian teratoma either composed predominantly or exclusively of benign thyroid tissue or with any amount of malignant thyroid tissue. The histologic features of ovarian strumal lesions sometimes cause diagnostic problems due to the confusion with other. Struma ovarii, as a monodermal variant of ovarian teratoma, constitutes 3% of ovarian teratomas. Struma ovarii exhibiting malignant histology are uncommon, and an aggressive clinical course in the form of initial extraovarian spread or recurrence is even more exceptional for these tumors. The morphological spectrum of the thyroid tissue ranges from that of normal thyroid to proliferative adenomalike lesions and thyroidtype carcinomas malignant transformation. Regarding the occurrence of malignancy in struma ovarii, the literature is confusing because many of the cases reported as malignant struma ovarii have not been accurately classified, and no large series has been carefully. It may occur with nongerminal epithelial ovarian neoplasms, but the coexistence of struma ovarii with serous cystadenoma is extremely uncommon with only 6 cases reported so far. A left salpingooophorectomy was performed and the patient has subsequently become pregnant. Struma ovarii with malignant transformation and germline kit.
Struma ovarii is a rare entity consisting of thyroid components that are part of a teratoma or dermoid in the ovary. Thyroidtype carcinoma of struma ovarii archives of. Department of pathology, upums, saifai, uttar pradesh, india. Ovarian sex cordstromal tumors archives of pathology. Our retrospective study covers the period from 1991 to 2000 during which two patients with the diagnosis of struma ovarii were reported in the institute of oncology sremska kamenica. Struma ovarii is a rare ovarian tumour accounting for less than 5% of all ovarian neoplasms. Includes a wide range of symptoms, such as ophtalmopathy, dermatopathy, fever, marked tachycardia, heart failure, tremor, nausea, vomiting, diarrhea, dehydration, restlessness, extreme agitation, delirium and coma endotext graves disease, cmaj 2003. A report of 96 cases thyroid tissue is a relatively frequent component of mature teratoma and can occur in 520 % of cases. Imaging features were compared with pathological results.
Our patient underwent thyroidectomy and treatment with radioactive iodine 5. Malignancy in struma ovarii is a rare form of ovarian germ cell tumour. Mature cystic teratoma with neurogenic components and struma ovarii. The risk of recurrence is higher in patients with a gross extraovarian. On gross examination, the formalinfixed specimen was 5. Nov 23, 2010 to analyze the imaging features of struma ovarii so, and to correlate the imaging results with the pathological findings so as to enhance the knowledge of the imaging diagnostics of this disease. Concomitant struma ovarii with serous cystadenoma in a. We are aware of two cases of struma salpingii, one of which was associated with struma ovarii. Jun 19, 2018 malignant struma ovarii is an ovarian teratoma containing at least 50% thyroid tissue which has the potential to metastasize and produce thyroid hormone. Histopathology revealed the presence of a papillary thyroid carcinoma arising. It most commonly occurs as part of a teratoma, but may occasionally be encountered with serous or mucinous cystadenomas. Struma ovarii is a rare ovarian tumor defined by the presence of thyroid tissue comprising more than 50% of the overall mass. Struma ovarii accounts for approximately 5 percent of all ovarian teratomas. Malignant struma ovarii is extremely rare and difficult to diagnose.
Originalarticle clinicopathological and immunohistochemical. Proliferative changes within struma can be misdiagnosed as cancer. Thyroidtype carcinoma arising in struma ovarii is rare. Struma ovarii accounts for 5% of ovarian teratomas. It may be part of a teratoma or cystadenoma and may also have a malignant character papillary thyroid carcinoma.
Malignant struma ovarii with peritoneal dissemination. The most common type is papillary carcinoma, followed by typical follicular carcinoma, and the new entity of follicular carcinomahighly differentiated follicular carcinoma of ovarian origin. Although the typical presentation is that of a pelvic mass, unusual clinical manifestations such as hyperthyroidism, ascites, and meigs syndrome have been recognised. Some tumors show both gross and microscopic features of a. Struma ovarii is a rare ovarian tumour that has been reported to represent 0. Md, a textbook titled endocrine pathology of the ovary,2 which had focused.
It is difficult determine a diagnosis prior to surgery. We present the case of a 34yearold woman with papillary carcinoma arising in struma ovarii. Given its rarity, management strategies are not wellestablished. Struma ovarii is an infrequent type of dermoid ovarian tumor that is usually benign and composed of at least 50% thyroid tissue. Ninetysix cases were diagnosed struma ovarii, including 10 cases of papillary thyroid carcinoma, 1 case of highly differentiated follicular carcinoma of ovarian origin hdfco, 5 cases of strumal carcinoid, and 80 cases of struma ovarii 53 cases of thyroidonly struma ovarii. Struma ovarii struma ovarii belongs to the group of monodermic and highly specific teratomas. The search of our database in the hospital of ben arous starting from 2005 to date has found only three cases of struma ovarii among a total of 35 dermoid tumors. Hence, diagnosis and management of malignant struma ovarii have not been clearly defined. This also includes cases of mature teratoma with less than 50 % thyroid tissue but harboring thyroidassociated malignancy.
Health, general cancer care and treatment diagnosis risk factors carcinoma radiotherapy health aspects. Struma ovarii containing thyroid type carcinoma must be distinguished from rare cases of papillary or follicular thyroid carcinoma metastatic to the ovary. Thyroid tissue must comprise more than 50 percent of the overall tissue to be classified as a struma ovarii. Files are available under licenses specified on their description page. Immunohistochemically it stained for thyroglobulin, which confirmed the thyroid epithelial nature of the neoplasm fig. Papillary thyroid cancer in a struma ovarii in a 17yearold. Struma ovarii, a rare neoplasm, is a monophyletic teratoma composed of thyroid tissue.
Struma ovarii is a specialized or monodermal teratoma predominantly composed of mature thyroid tissue. Cytologic evaluation of the ascitic fluid showed no evidence of malignant cells. Pdf clinical and histopathological study of struma ovarii. Coexisting brenner tumor and struma ovarii in the right ovary. Metastatic follicular struma ovarii complicating pregnancy. Antithyroid treatment was discontinued 1 month after surgery in light of the pathology result.
Interesting cases in gynecologic pathology university of utah. The final pathology revealed right benign struma ovarii with cystic and solid components. Struma ovarii comprises 14% of all dermoid tumors of the ovary, and very rarely presents in a malignant form, occurring in 0. Struma ovarii associated with pseudomeigs syndrome. The enigma of struma ovarii connecting repositories. A mature cystic teratoma having struma ovarii and neurologic elements along. To qualify as a struma ovarii tumors more than 50% of the tumor should be composed of thyroid tissue 7. Sep 16, 2015 thyroid tissue is a relatively frequent component of mature teratoma and can occur in 520 % of cases. Most commonly, they occur as part of a teratoma, but may occasionally be encountered with serous or mucinous cystadenomas. Follicular proliferative lesion arising in struma ovarii. The gross pathologic appearance of struma ovarii differs from that of mature cystic teratomas where struma ovarii consist of ambercolored thyroid tissue, with hemorrhage, necrosis, and fibrosis. In this case, in addition to the typical brenner tumor and struma ovarii, some nests composed of both brenner tumor and struma ovarii in one nest were found in the right ovarian tumor. Follicular proliferative lesion arising in struma ovarii ncbi. It is generally considered to account for less than 5% of.
We report a case of metastatic malignant struma ovarii discovered during pregnancy with lessons for evaluation and management. In strumal carcinoid, the carcinoid tissue is present in the struma. In such cases, the tumor mimics malignant ovarian tumor. Struma ovarii or monodermal teratoma, is a specialized ovarian neoplasm composed entirely of mature thyroid tissue. The clinical records, ct and mri features of twelve patients with pathologically proved so were retrospectively analyzed. Struma ovarii definition of struma ovarii by medical dictionary. Malignant transformation occurs in struma ovarii and coexisting incidental ptc in the thyroid. An unusual case of malignant struma ovarii causing. Struma ovarii is a rare ovarian tumor that was first described in 1899. The patient was subsequently performed left salpingooopherectomy and retroperi. Struma ovarii is an uncommon type of ovarian mature teratoma with a predominant thyroid component. We present a case of 64yearold woman who was admitted for evaluation of a slowly enlarging pelvic mass associated with pelvic organ prolapse for many years.
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