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Murayama D, Toda S, Okubo Y, Hayashi H, Iwasaki H. Ovarian goiter detected during post-operative follow-up of papillary thyroid cancer: a case report. J Surg Case Rep 2023; 2023:rjad012. [PMID: 36711437 PMCID: PMC9874187 DOI: 10.1093/jscr/rjad012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 01/03/2023] [Indexed: 01/26/2023] Open
Abstract
A 70-year-old female without any past medical history underwent total thyroidectomy and central neck dissection for papillary thyroid cancer (PTC) (pT3bN1aM0 pStage II). Her post-operative thyroglobulin (Tg) level remained high (around 100 ng/mL), which increased to 366 ng/mL 5 years after surgery. Computed tomography revealed metastasis to the left III and right Vb and VI lymph nodes and an incidental ovarian tumor. Transvaginal ultrasonography and magnetic resonance imaging suspected malignancy, resulting in total hysterectomy and bilateral adnexal resection. A pathological diagnosis of ovarian goiter with no malignancy was then established. For lymph node metastasis of PTC, right neck dissection and left III lymph node resection were performed. Post-operative blood examination showed a significant decrease in the Tg level (5.9 ng/mL). In conclusion, systemic imaging or I-131 remnant ablation should be performed after total thyroidectomy, as evident in the present case in which Tg levels did not decrease after total thyroidectomy.
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Affiliation(s)
- Daisuke Murayama
- Correspondence address. Department of Breast and Thyroid Surgery, Aizawa Hospital, 2-5-1 Honjo, Matsumoto, Nagano 390-8510, Japan. Tel: +81263-33-8600; Fax: +81263-32-6763; E-mail:
| | - Soji Toda
- Department of Breast and Endocrine Surgery, Kanagawa Cancer Center, 2-3-2 Nakao Asahi-ku, Yokohama, Kanagawa 241-8515, Japan
| | - Yoichiro Okubo
- Department of Pathology, Kanagawa Cancer Center, 2-3-2 Nakao Asahi-ku, Yokohama, Kanagawa 241-8515, Japan
| | - Hiroyuki Hayashi
- Department of Pathology, Yokohama Municipal Citizen’s Hospital, 1-1 Mitsuzawanishimachi Kanagawa-ku, Yokohama, Kanagawa 221-0855, Japan
| | - Hiroyuki Iwasaki
- Department of Breast and Endocrine Surgery, Kanagawa Cancer Center, 2-3-2 Nakao Asahi-ku, Yokohama, Kanagawa 241-8515, Japan
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Wang S, He X, Yang H, Chen L. Struma Ovarii Associated with Ascites and Elevated CA125: Two Case Reports and Review of the Literature. Int J Womens Health 2022; 14:1291-1296. [PMID: 36101557 PMCID: PMC9464449 DOI: 10.2147/ijwh.s379128] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/25/2022] [Indexed: 11/23/2022] Open
Abstract
Struma ovarii is a rare variety of specialized monodermal mature ovarian teratoma, it is composed predominantly of thyroid tissue. Ascites is present in one third of patients. The combination of struma ovarii, marked ascites and elevated CA125 is a rare condition, which may mimic ovarian cancer. We described two cases presenting with pelvic mass, ascites and elevated serum CA125 levels, frozen section and final pathology turned out to be struma ovarii. Ascites disappeared and the level of CA125 returned to normal level after operation. One of the cases was associated with pleural effusion, leading to a condition called pseudo-Meigs' syndrome. Then we reviewed the related literatures to explore the possible mechanism of ascites and pleural effusion, the reason of CA125 elevation and imaging manifestations of struma ovarii. In conclusion, struma ovarii should be considered in the differential diagnosis preoperatively, when presented with pelvic mass, ascites and an elevated CA125 level.
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Affiliation(s)
- Shaoyu Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, People's Republic of China
| | - Xinqin He
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, People's Republic of China
| | - Huijuan Yang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, People's Republic of China
| | - Lihong Chen
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, People's Republic of China
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Malignant Struma Ovarii with Raised Serum CA 125 and CEA Levels: A Case Report with Literature Review. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2020. [DOI: 10.1007/s40944-020-0375-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Fujiwara S, Tsuyoshi H, Nishimura T, Takahashi N, Yoshida Y. Precise preoperative diagnosis of struma ovarii with pseudo-Meigs' syndrome mimicking ovarian cancer with the combination of 131I scintigraphy and 18F-FDG PET: case report and review of the literature. J Ovarian Res 2018; 11:11. [PMID: 29391043 PMCID: PMC5796437 DOI: 10.1186/s13048-018-0383-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 01/26/2018] [Indexed: 12/11/2022] Open
Abstract
Background Struma ovarii is a rare ovarian neoplasm that often appears malignant on conventional imaging. Pseudo-Meigs’ syndrome with ascites, pleural effusion, and elevated serum CA 125 levels is much rarer and leads to misdiagnosis of ovarian cancer and unnecessary extended surgery. Case presentation A 50-year-old woman with abdominal distention and dyspnoea was referred to our hospital. Ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) showed a polycystic ovarian tumor with a solid component, pleural effusion, and massive ascites with negative cytology. Her serum CA 125 level was 1237 U/ml, indicating the presence of ovarian cancer. Based on increased uptake of 131I but no uptake of 18F–FDG in the tumor, the preoperative diagnosis was struma ovarii with pseudo-Meigs’ syndrome, which was confirmed histologically. She had no evidence of ascites and pleural effusion six months after surgery. Conclusions To date, there have been no systematic reviews focused on preoperative diagnosis with imaging modalities. The combination of 131I scintigraphy and 18F–FDG PET/CT in addition to conventional imaging modalities can provide the precise preoperative diagnosis of struma ovarii with pseudo-Meigs’ syndrome mimicking ovarian cancer, leading to the appropriate treatment strategy.
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Affiliation(s)
- Sayaka Fujiwara
- Department of Obstetrics and Gynecology, Kizawa Memorial Hospital, 590 Shimokobi, Kobi-cho, Minokamo-shi, Gifu, 505-8503, Japan
| | - Hideaki Tsuyoshi
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Fukui, 23-3 Shimoaizuki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan.
| | - Toshiya Nishimura
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Fukui, 23-3 Shimoaizuki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Nozomu Takahashi
- Department of Obstetrics and Gynecology, Kizawa Memorial Hospital, 590 Shimokobi, Kobi-cho, Minokamo-shi, Gifu, 505-8503, Japan
| | - Yoshio Yoshida
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Fukui, 23-3 Shimoaizuki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
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Hwang JY, Lee MH, Lee JH, Kim DH, Song SH. A Case of Unilateral Endometriosis Coexisting with Struma Ovarii in Bilateral Ovarian Teratoma. J Minim Invasive Gynecol 2017; 25:941-943. [PMID: 29223697 DOI: 10.1016/j.jmig.2017.11.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 11/29/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Ji Young Hwang
- Department of Obstetrics and Gynecology, CHA Gumi Medical Center and Comprehensive Gynecologic Cancer Center, Seoul, Republic of Korea
| | - Min Hee Lee
- Department of Obstetrics and Gynecology, CHA Gumi Medical Center and Comprehensive Gynecologic Cancer Center, Seoul, Republic of Korea
| | - Jin Hee Lee
- Department of Radiology, CHA Gumi Medical Center and Comprehensive Gynecologic Cancer Center, Seoul, Republic of Korea
| | - Dong Hoon Kim
- Department of Pathology, CHA Gumi Medical Center and Comprehensive Gynecologic Cancer Center, Seoul, Republic of Korea
| | - Seung Hun Song
- Comprehensive Gynecologic Cancer Center, Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, Republic of Korea.
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Simi Raj TJ, Chitrathara K, Mahadevan P, Sanam P, Subramanian A. Struma Ovarii Presenting with Pseudo-Meig’s Syndrome and Elevated CA 125 Levels. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2016. [DOI: 10.1007/s40944-016-0084-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Jin C, Dong R, Bu H, Yuan M, Zhang Y, Kong B. Coexistence of benign struma ovarii, pseudo-Meigs' syndrome and elevated serum CA 125: Case report and review of the literature. Oncol Lett 2015; 9:1739-1742. [PMID: 25789033 PMCID: PMC4356400 DOI: 10.3892/ol.2015.2927] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 01/21/2015] [Indexed: 01/01/2023] Open
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.
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Affiliation(s)
- Chengjuan Jin
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Ruiying Dong
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Hualei Bu
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Mingyuan Yuan
- Department of Obstetrics and Gynecology, Jiaozhou Central Hospital of Qingdao, Qingdao, Shandong 266300, P.R. China
| | - Youzhong Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Beihua Kong
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
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Andrés Cordón JF, Pinal Fernández I, Willekens Morales R, Arderiu Freixa MA. Derrame pleural recidivante y marcada elevación de CA-125 en una paciente con un seudosíndrome de Meigs secundario a un estruma de ovario. Med Clin (Barc) 2013; 140:237. [DOI: 10.1016/j.medcli.2012.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 07/02/2012] [Accepted: 07/05/2012] [Indexed: 11/15/2022]
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Jiang W, Lu X, Zhu ZL, Liu XS, Xu CJ. Struma ovarii associated with pseudo-Meigs' syndrome and elevated serum CA 125: a case report and review of the literature. J Ovarian Res 2010; 3:18. [PMID: 20670426 PMCID: PMC2923141 DOI: 10.1186/1757-2215-3-18] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2010] [Accepted: 07/29/2010] [Indexed: 12/20/2022] Open
Abstract
The association of pseudo-Meigs' syndrome, elevation of CA 125 to the struma ovarii is a rare condition. So far only nine cases have been reported in English literature through MEDLINE search. Here we report a 46-year-old case of the struma ovarii, presented with ascites, hydrothorax, right ovarian mass and elevated serum CA 125 level. These findings were misdiagnosed for an ovarian malignancy at the first impression. Immediate resolution of the ascites, hydrothorax and normalization of the serum CA 125 level were followed by ovarian mass removal. Struma ovarii could be a rare cause of ascites, hydrothorax, ovarian mass and elevated CA 125. This rare condition should be considered in the differential diagnosis in patents with ascites and pleural effusions but with negative cytology.
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Affiliation(s)
- Wei Jiang
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, P,R, China.
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Coexistence of struma ovarii with marked ascites and elevated CA-125 levels: case report and literature review. Arch Gynecol Obstet 2008; 279:753-7. [DOI: 10.1007/s00404-008-0794-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Accepted: 08/28/2008] [Indexed: 11/25/2022]
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