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International Journal of Surgery Case... Jul 2022Struma ovarii is a monodermal teratoma which characterized by the presence of thyroid tissue. The symptoms of this tumor are nonspecific and thus misdiagnosis and...
INTRODUCTION AND IMPORTANCE
Struma ovarii is a monodermal teratoma which characterized by the presence of thyroid tissue. The symptoms of this tumor are nonspecific and thus misdiagnosis and indifference to other ovarian lesions are very common.
CASE PRESENTATION
Herein, we described a case of struma ovarii that was successfully diagnosed and managed. The tumor is mimicking a malignant tumor based on ascites and tumor marker assessments. Although, thyroid function indices are normal.
CLINICAL DISCUSSION
The initial footprint of the tumor is mostly based on incidental imaging, but definitive diagnosis is possible based on pathological studies. Surgical resection of the tumor can be led to successful treatment and prognosis.
CONCLUSION
Struma ovarii is a rare tumor and also misdiagnosis is common. Regarding rarity of Struma Ovarii, the treatment option is debated. However, in postmenopausal cases with the aim of completely removing the symptoms, total abdominal hysterectomy with bilateral salpingo-oophorectomy can be occasionally indicative.
PubMed: 35779314
DOI: 10.1016/j.ijscr.2022.107318 -
Endocrine Connections Oct 2021The term 'hyperthyroidism' refers to a form of thyrotoxicosis due to inappropriate high synthesis and secretion of thyroid hormone(s) by the thyroid. The leading cause... (Review)
Review
The term 'hyperthyroidism' refers to a form of thyrotoxicosis due to inappropriate high synthesis and secretion of thyroid hormone(s) by the thyroid. The leading cause of hyperthyroidism in adolescents is Graves' disease (GD); however, one should also consider other potential causes, such as toxic nodular goitre (single or multinodular), and other rare disorders leading to excessive production and release of thyroid hormones. The term 'thyrotoxicosis' refers to a clinical state resulting from inappropriate high thyroid hormone action in tissues, generally due to inappropriate high tissue thyroid hormone levels. Thyrotoxicosis is a condition with multiple aetiologies, manifestations, and potential modes of therapy. By definition, the extrathyroidal sources of excessive amounts of thyroid hormones, such as iatrogenic thyrotoxicosis, factitious ingestion of thyroid hormone, or struma ovarii, do not include hyperthyroidism. The aetiology of hyperthyroidism/and thyrotoxicosis should be determined. Although the diagnosis is apparent based on the clinical presentation and initial biochemical evaluation, additional diagnostic testing is indicated. This testing should include: (1) measurement of thyroid-stimulating hormone receptor (TSHR) antibodies (TRAb); (2) analysis of thyroidal echogenicity and blood flow on ultrasonography; or (3) determination of radioactive iodine uptake (RAIU). A 123I or 99mTc pertechnetate scan is recommended when the clinical presentation suggests toxic nodular goitre. A question arises regarding whether diagnostic workup and treatment (antithyroid drugs, radioiodine, surgery, and others) should be the same in children and adolescents as in adults, as well as whether there are the same goals of treatment in adolescents as in adults, in female patients vs in male patients, and in reproductive or in postreproductive age. In this aspect, different treatment modalities might be preferred to achieve euthyroidism and to avoid potential risks from the treatment. The vast majority of patients with thyroid disorders require life-long treatment; therefore, the collaboration of different specialists is warranted to achieve these goals and improve patients' quality of life.
PubMed: 34596580
DOI: 10.1530/EC-21-0191 -
BMC Pregnancy and Childbirth May 2021Struma ovarii is a special type of ovarian dermoid cyst and accounts for approximately 2-3 % of all dermoid tumours. Benign struma ovarii may manifest as distant...
BACKGROUND
Struma ovarii is a special type of ovarian dermoid cyst and accounts for approximately 2-3 % of all dermoid tumours. Benign struma ovarii may manifest as distant metastasis, called peritoneal strumosis, which makes it biologically similar to malignancy, and has been reported in limited cases but never discovered during pregnancy.
CASE PRESENTATION
We report a patient with a history of right struma ovarii cystectomy. During pregnancy, pelvic masses with non-specific clinical presentation were found again. During the caesarean section, contralateral struma ovarii with dissemination of nodules in the peritoneal cavity was found, and pathology revealed that the masses were thyroid follicle ovarian goitres. DISCUSSION AND CONCLUSIONS: Recurrent benign struma ovarii with extraovarian dissemination is a rare aggressive clinical manifestation different from malignancy. It is emphasized that adequate assessment and complete resection of suspicious masses are of great importance.
Topics: Adult; Carcinoma, Papillary, Follicular; Cesarean Section; Cystectomy; Disease Progression; Female; Humans; Infant, Newborn; Neoplasm Invasiveness; Ovarian Neoplasms; Peritoneum; Pregnancy; Struma Ovarii; Ultrasonography, Doppler
PubMed: 33934699
DOI: 10.1186/s12884-021-03815-4 -
Endocrinology, Diabetes & Metabolism... Mar 2021Struma ovarii is a teratoma of the ovaries predominantly composed of thyroid tissue. Hyperthyroidism associated with struma ovarii is rare, occurring in approximately 8%...
SUMMARY
Struma ovarii is a teratoma of the ovaries predominantly composed of thyroid tissue. Hyperthyroidism associated with struma ovarii is rare, occurring in approximately 8% of cases. Due to the rarity of struma ovarii, available data are limited to case reports and small case series.We report on a 61-year-old female patient with known Hashimoto's thyroiditis on levothyroxine replacement therapy for years with transition to clinical and biochemical hyperthyroidism despite antithyroid medication with carbimazole (10 mg/day), new diagnosis of urothelial carcinoma and an adnexal mass suspicious of ovarian cancer. The patient underwent resection of the adnexal mass and histopathology revealed a mature teratoma predominantly composed of thyroid tissue showing high levels of sodium iodide symporter protein expression. Following struma ovarii resection and disappearance of autonomous production of thyroid hormones, the patient developed hypothyroidism with severely decreased thyroid hormone levels fT4 and fT3 (fT4 0.4 ng/dL, reference interval 0.9-1.7 and fT3 < 1.0 pg/mL, reference interval 2.0-4.4). This has previously been masked by continued thyroid-stimulating hormone suppression due to long-term hyperthyroidism pre-surgery indicating secondary hypothyroidism, in addition to primary hypothyroidism based on the known co-existing chronic lymphocytic thyroiditis of the orthotopic thyroid gland. Levothyroxine administration was started immediately restoring euthyroidism.This case illustrates possible diagnostic pitfalls in a patient with two concurrent causes of abnormal thyroid function.
LEARNING POINTS
Struma ovarii is an ovarian tumor containing either entirely or predominantly thyroid tissue and accounts for approximately 5% of all ovarian teratomas. In rare cases, both benign and malignant struma ovarii can secrete thyroid hormones, causing clinical and biochemical features of hyperthyroidism. Biochemical features of patients with struma ovarii and hyperthyroidism are similar to those of patients with primary hyperthyroidism. In such cases, thyroid scintigraphy should reveal low or absent radioiodine uptake in the thyroid gland, but the presence of radioiodine uptake in the pelvis in a whole body radioiodine scintigraphy. We give advice on possible diagnostic pitfalls in a case with two simultaneous causes of abnormal thyroid function due to the co-existence of struma ovarii.
PubMed: 33682680
DOI: 10.1530/EDM-20-0142 -
Frontiers in Medicine 2021Malignant struma ovarii (MSO) is an extremely rare ovarian malignant tumor and there is limited data on the survival outcomes and prognostic predictors of MSO. The...
Malignant struma ovarii (MSO) is an extremely rare ovarian malignant tumor and there is limited data on the survival outcomes and prognostic predictors of MSO. The objectives of this study were to investigate the disease-free survival (DFS), overall survival (OS), and disease-specific survival (DSS) rates of patients with MSO, and also evaluate the prognostic factors in this population. A retrospective study was conducted and 194 cases of MSO were selected. DFS was assessed by the logistic regression, OS by the Kaplan-Meier method, and DSS was evaluated by the Cox regression. The median age of these patients was 46.0 years; 142 cases (73.2%) were confined to the ovary and 52 cases (26.8%) had extraovarian metastasis at the initial diagnosis of MSO. During the follow-up, 75.3% of these patients showed no evidence of disease and 18.0% were alive with disease. Only 13 deaths occurred, with 10 attributed to MSO. The 5, 10, and 15-year OS rates were 91.4, 87.7, and 83.5%, respectively. The 5, 10, and 15-year DSS rates were 93.8, 90.0, and 85.7%, respectively. Logistic regression revealed that International Federation of Gynecology and Obstetrics (FIGO) stage IV was the only risk factor for DFS [ < 0.001; odds ratio (OR) 7.328; 95% CI 3.103-16.885, FIGO stage IV vs. stage I; = 0.021; OR 4.750, 95% CI 1.264-17.856, FIGO stage IV vs. stage II-III]. The multivariate Cox regression analysis showed that poor differentiation was the only risk factor for both OS ( = 0.005, OR 6.406; 95% CI 1.730-23.717) and DSS ( = 0.001, OR 9.664; 95% CI 2.409-38.760), while age ≥45 years was the prognostic predictor for OS ( = 0.038, OR 4.959; 95% CI 1.093-22.508). Survival outcomes were excellent in patients with MSO, irrespective of the treatment strategy, FIGO stage IV, age ≥45 years, and poor differentiation of tumors were the independent risk factors.
PubMed: 35004743
DOI: 10.3389/fmed.2021.774691 -
BMC Cancer Apr 2021Malignant struma ovarii (MSO) is a unique type of ovarian malignancy that data on the survival outcome is limited and management strategy remains controversial due to...
BACKGROUND
Malignant struma ovarii (MSO) is a unique type of ovarian malignancy that data on the survival outcome is limited and management strategy remains controversial due to its extreme rarity.
METHODS
To investigate the clinical characteristics and treatment options in patients with MSO confined to the ovary, while also evaluating the recurrent-free survival (RFS) and overall survival (OS) rate in this population, a retrospective study was conducted. One hundred twenty-five cases of MSO confined to the ovary were enrolled and their clinical characteristics, treatment strategies, and results of follow-up were analyzed. OS and RFS were assessed by Kaplan-Meier analyses and Cox regression models.
RESULTS
The most common pathological subtype in this cohort was papillary carcinoma (44.8%). Other reported subtypes, in order of prevalence, were follicular variant of papillary carcinoma, follicular carcinoma, and mixed follicular-papillary carcinoma. Surgical treatment options varied in this cohort that 8.0% of the patients received ovarian cystectomy, 33.6% underwent unilateral salpingo-oophorectomy (USO), 5.6% received bilateral salpingo-oophorectomy (BSO), 21.6% received total abdominal hysterectomy with BSO (TAH/BSO), and 17.6% were treated with debulking surgery; 20.0% of them received radioiodine therapy (RAI). Twenty-seven patients experienced recurrence with a median RFS of 14.0 years (95% confidence interval [CI], 9.5-18.5). The 5-year and 10-year recurrent rate were 27.1, 35.2%, respectively. Eight patients died during follow-up, with five attributed to MSO; the 5-year, 10-year, and 20-year OS rate was 95.3, 88.7 and 88.7%, respectively. However, the univariate and multivariate Cox regression showed no potential risk factor for RFS and OS.
CONCLUSION
Patients with MSO confined to the ovary had an excellent survival outcome, despite varied treatment strategies, and the recurrent rate was relatively high. We recommend USO as the preferred surgical option in this population since more aggressive surgery does not improve outcomes and the benefits of RAI are uncertain.
Topics: Adult; Aged; Biopsy; Clinical Decision-Making; Combined Modality Therapy; Disease Management; Female; Humans; Kaplan-Meier Estimate; Middle Aged; Neoplasm Grading; Neoplasm Metastasis; Neoplasm Staging; Ovarian Neoplasms; Prognosis; Proportional Hazards Models; Retrospective Studies; Struma Ovarii; Treatment Outcome
PubMed: 33836675
DOI: 10.1186/s12885-021-08118-7 -
AACE Clinical Case Reports 2021Malignant struma ovarii (SO) is a rare condition. Although there have been a few reported cases of malignant SO with coexisting Graves' disease (GD), the exact incidence...
OBJECTIVE
Malignant struma ovarii (SO) is a rare condition. Although there have been a few reported cases of malignant SO with coexisting Graves' disease (GD), the exact incidence of metastasis in these cases is not known. We report a rare case of metastatic malignant SO coexisting with GD.
METHODS
Clinical examination, pelvic ultrasound, and histopathology of the resected tumor were performed, followed by iodine-131 (I-131) and whole body scan. Antithyroglobulin titers were postoperatively followed.
RESULTS
A 43-year-old woman with a history of left ovarian cystic teratoma with SO resected 8 years ago and recently diagnosed GD presented with lower abdominal fullness. Pelvis ultrasound showed a 13.8-cm left adnexal mass, and she underwent left salpingo- oophorectomy. Histology confirmed an intraovarian thyroid tissue housing a highly differentiated follicular thyroid carcinoma, with metastatic peritoneal deposits. She underwent completion surgery and total thyroidectomy. Histology showed no evidence of intrathyroidal malignancy. I-131 therapy was administered, and posttherapeutic I-131 whole body scan revealed a remnant disease. She was started on suppressive levothyroxine therapy and remained clinically well at her 1-year follow-up with downtrending antithyroglobulin titers.
CONCLUSION
The coexistence of malignant SO and GD is very rare, and even rarer is the coexistence of metastasis malignant SO and GD. To the best of our knowledge, this is the first reported case of metastatic malignant SO in the setting of GD.
PubMed: 34307845
DOI: 10.1016/j.aace.2021.01.001 -
Archives of Pathology & Laboratory... May 2010Struma ovarii is a monodermal variant of ovarian teratoma. Thyroid-type carcinoma arising in struma ovarii is rare. The most common type is papillary carcinoma, followed... (Review)
Review
Struma ovarii is a monodermal variant of ovarian teratoma. Thyroid-type carcinoma arising in struma ovarii is rare. The most common type is papillary carcinoma, followed by typical follicular carcinoma, and the new entity of follicular carcinoma-highly differentiated follicular carcinoma of ovarian origin; other forms occur rarely. Consensus on the surgical and postoperative treatment of patients with thyroid-type carcinoma arising in struma ovarii has not been reached. Surgical treatment ranges from total abdominal hysterectomy, plus bilateral salpingo-oophorectomy with omentectomy, to conservative surgery, involving unilateral oophorectomy or strumectomy (cystectomy) for fertility preservation. Adjuvant therapy includes external radiotherapy, chemotherapy, thyroidectomy, and radioactive iodine ablation. Thyroid-type carcinomas arising in struma ovarii, especially the newly recognized entity-highly differentiated follicular carcinoma of ovarian origin-have a favorable prognosis.
Topics: Carcinoid Tumor; Carcinoma, Papillary; Diagnosis, Differential; Female; Humans; Ovarian Neoplasms; Struma Ovarii
PubMed: 20441513
DOI: 10.5858/134.5.786 -
Thyroid Research Aug 2022Struma ovarii (SO) is a rare ovarian teratoma containing predominantly thyroid tissue. In rare situations SO may develop malignancy. Most cases of malignant struma...
BACKGROUND
Struma ovarii (SO) is a rare ovarian teratoma containing predominantly thyroid tissue. In rare situations SO may develop malignancy. Most cases of malignant struma ovarii (MSO) are diagnosed after surgical removal, based on histopathological examination. There are still controversies regarding the extent of surgery and postoperative management in MSO, due to its unpredictable behavior, possible risk of metastasis and relatively high rate of recurrence.
CASE PRESENTATION
We present the case of a patient diagnosed with a right ovarian cyst discovered incidentally during routine ultrasound examination. Its rapid growth and pelvic MRI raised the suspicion of a neoplastic process. She underwent total hysterectomy and bilateral adnexectomy. The anatomopathological diagnosis was MSO with follicular variant of papillary thyroid carcinoma. Prophylactic total thyroidectomy was performed, followed by radioactive iodine ablation (RAI), and suppressive therapy with levothyroxine. At 1 year follow-up, the patient was disease free.
CONCLUSIONS
Even if latest literature reports consider that completion of local surgery with total thyroidectomy and RAI might be too aggressive in cases of MSO without extraovarian extension, in our case it was decided to follow the protocol for primary thyroid carcinoma, in order to reduce the recurrence risk.
PubMed: 35948940
DOI: 10.1186/s13044-022-00132-6