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Inoue K, Hoshino E, Shiratori T, Sasaki A, Kajihara T, Kozawa E. A large benign struma ovarii with atypical imaging findings. Radiol Case Rep 2024; 19:5447-5451. [PMID: 39285977 PMCID: PMC11403899 DOI: 10.1016/j.radcr.2024.08.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 08/09/2024] [Accepted: 08/10/2024] [Indexed: 09/19/2024] Open
Abstract
Struma ovarii is a mature ovarian teratoma characterized by the predominant presence of thyroid-tissue components. Typically, struma ovarii presents as relatively small masses (<10 cm) that often appear as multilocular cystic tumors with solid components. Herein, we report the unique case of a 44-year-old female with a large tumor including a solid mass. The solid components of the tumor comprised typical thyroid tissues with multiple small cystic structures containing colloid-like material. Given the rarity of struma ovarii, atypical imaging features can sometimes be misleading. This article highlights the unusual magnetic resonance imaging characteristics of a large struma ovarii, with a specific focus on the presence of solid components.
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Affiliation(s)
- Kaiji Inoue
- Department of Radiology, Saitama Medical University Hospital, Saitama, Japan
| | - Eri Hoshino
- Department of Radiology, Saitama Medical University Hospital, Saitama, Japan
| | - Taira Shiratori
- Department of Radiology, Saitama Medical University Hospital, Saitama, Japan
| | - Atsushi Sasaki
- Department of Pathology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Takeshi Kajihara
- Department of Obstetrics and gynecology, Saitama Medical University Hospital, Saitama, Japan
| | - Eito Kozawa
- Department of Radiology, Saitama Medical University Hospital, Saitama, Japan
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2
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Isozaki T, Matsuki M, Yamamoto A, Takahashi S, Mori H. A Case of Solid-Appearing Struma Ovarii: Pitfall in the Assessment Using Ovarian-Adnexal Reporting and Data System Magnetic Resonance Imaging Score. Cureus 2024; 16:e58176. [PMID: 38741801 PMCID: PMC11089586 DOI: 10.7759/cureus.58176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2024] [Indexed: 05/16/2024] Open
Abstract
Struma ovarii is a monodermal teratoma characterized by the presence of >50% thyroid tissue. It is mostly benign; therefore, preoperative diagnosis is important. It usually manifests as a multilocular cystic mass but rarely as a predominantly solid mass. On magnetic resonance imaging (MRI), solid-appearing struma ovarii showed early signal intensity enhancement on dynamic gadolinium-enhanced T1-weighted images, which histopathologically indicates the presence of thyroid tissue with abundant blood vessels. The Ovarian-Adnexal Reporting and Data System (O-RADS) MRI score is a validated classification worldwide for characterizing adnexal lesions. Based on the morphology, signal intensity, and enhancement of any solid tissue on the MRI, the scoring system can be used to classify adnexal lesions into five categories from score one (no adnexal mass) to score five (high risk of malignancy). An adnexal solid mass with a higher signal intensity than that of the myometrium 30-40 seconds after gadolinium (Gd) injection on non-dynamic contrast-enhanced (non-DCE) MRI was assigned a score of 5 (high risk of malignancy). We present a case of solid-appearing struma ovarii with a higher signal intensity than that of the myometrium 30 seconds after Gd injection on non-DCE MRI, and it was classified as score five preoperatively. Therefore, a total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed despite the presence of a benign ovarian mass. When an adnexal mass with a higher signal intensity than that of the myometrium 30-40 seconds after Gd injection on non-DCE MRI is encountered, struma ovarii should be included in the differential diagnosis, despite the O-RADS MRI score of five and management of the situation should be discussed.
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Affiliation(s)
- Takenori Isozaki
- Radiology, Jichi Medical University, School of Medicine, Tochigi, JPN
| | | | - Akane Yamamoto
- Obstetrics and Gynecology, Jichi Medical University, School of Medicine, Tochigi, JPN
| | - Suzuyo Takahashi
- Obstetrics and Gynecology, Jichi Medical University, School of Medicine, Tochigi, JPN
| | - Harushi Mori
- Radiology, Jichi Medical University, School of Medicine, Tochigi, JPN
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Tamura N, Murakami K, Ozaki R, Takeuchi S, Ochiai A, Kawasaki Y, Okada Y, Kitade M, Itakura A. Current state of management of struma ovarii and preoperative imaging features: A retrospective case series study of 18 patients at a single institution. J Obstet Gynaecol Res 2023; 49:1007-1011. [PMID: 36631946 DOI: 10.1111/jog.15545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/28/2022] [Indexed: 01/13/2023]
Abstract
AIM Even though 95% of struma ovarii are benign, it is often overtreated because of the difficulty to distinguish it from malignancy. In this study, our aim was to evaluate the current state of the preoperative diagnosis and the selection of the surgical procedure, and to improve preoperative diagnostic accuracy by retrospectively reviewing imaging findings. METHODS We retrospectively reviewed the clinical course and imaging characteristics of 18 patients who were diagnosed postoperatively with struma ovarii, pathologically, at our institution between 2015 and 2021. RESULTS The preoperative diagnoses included benign ovarian tumor in eight cases, borderline in four cases, and malignant in six cases. None of the cases were diagnosed as struma ovarii preoperatively. Of the seven patients who had confirmed a desire for future childbearing, four patients were suspected for borderline or malignant tumor preoperatively, and underwent abdominal adnexectomy. In patients without a desire for childbearing, laparoscopic surgery was performed in only 45% of the patients whose preoperative diagnosis was benign. On magnetic resonance imaging (MRI), 54% of the cases showed enhanced solid components, which is characteristic of malignant tumors, but diffusion restriction was observed in only 11%. On computed tomography (CT), 78% of the cases showed a high attenuation lesion reflecting thyroid tissue. CONCLUSIONS Struma ovarii is difficult to distinguish from malignancy preoperatively, making the choice of surgical approach complicated. A comprehensive evaluation of diffusion-weighted MRI and CT findings may improve the accuracy of preoperative diagnosis of struma ovarii.
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Affiliation(s)
- Nami Tamura
- Departments of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Keisuke Murakami
- Departments of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Rie Ozaki
- Departments of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Shiori Takeuchi
- Departments of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Asako Ochiai
- Departments of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Yu Kawasaki
- Departments of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Yukiko Okada
- Departments of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Mari Kitade
- Departments of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Atsuo Itakura
- Departments of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Tokyo, Japan
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Mitchell JR, Siegelman ES, Sundaram KM. MR Imaging of Germ Cell and Sex Cord Stromal Tumors. Magn Reson Imaging Clin N Am 2023; 31:65-78. [DOI: 10.1016/j.mric.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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5
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Zhong Y, Peng S, Yang Y. Liver Mass: Island-Like Sign. Gastroenterology 2022; 164:e9-e12. [PMID: 36502862 DOI: 10.1053/j.gastro.2022.11.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/14/2022] [Accepted: 11/17/2022] [Indexed: 01/12/2023]
Affiliation(s)
- Yandan Zhong
- Department of Liver Disease, Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China; and Clinical Infectious Disease Center of Nanjing, Nanjing, China.
| | - Shanshan Peng
- Department of Liver Disease, Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China; and Clinical Infectious Disease Center of Nanjing, Nanjing, China
| | - Yongfeng Yang
- Department of Liver Disease, Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China; and Clinical Infectious Disease Center of Nanjing, Nanjing, China
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6
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Leuștean L, Ungureanu MC, Preda C, Bilha SC, Obrocea F, Dănilă R, Stătescu L, Apostol Ciobanu DG. Management of malignant struma ovarii: is aggressive therapy justified? Case report and literature review. Thyroid Res 2022; 15:14. [PMID: 35948940 PMCID: PMC9367145 DOI: 10.1186/s13044-022-00132-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/22/2022] [Indexed: 12/02/2022] Open
Abstract
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.
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Affiliation(s)
- Letiția Leuștean
- Department of Endocrinology, "Grigore T. Popa" University of Medicine and Pharmacy Iasi, Iasi, Romania
| | - Maria-Christina Ungureanu
- Department of Endocrinology, "Grigore T. Popa" University of Medicine and Pharmacy Iasi, Iasi, Romania
| | - Cristina Preda
- Department of Endocrinology, "Grigore T. Popa" University of Medicine and Pharmacy Iasi, Iasi, Romania
| | - Stefana Catalina Bilha
- Department of Endocrinology, "Grigore T. Popa" University of Medicine and Pharmacy Iasi, Iasi, Romania.
| | | | - Radu Dănilă
- Department of Surgery, "Grigore T. Popa" University of Medicine and Pharmacy Iasi, Iasi, Romania
| | - Laura Stătescu
- Department of Dermatology, "Grigore T. Popa" University of Medicine and Pharmacy Iasi, Iasi, Romania
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Avesani G, Caliolo G, Gui B, Petta F, Panico C, Manna VL, Moro F, Testa AC, Scambia G, Manfredi R. Pearls and Potential Pitfalls for Correct Diagnosis of Ovarian Cystadenofibroma in MRI: A Pictorial Essay. Korean J Radiol 2021; 22:1809-1821. [PMID: 34668348 PMCID: PMC8546138 DOI: 10.3348/kjr.2020.1312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 05/20/2021] [Accepted: 07/03/2021] [Indexed: 12/28/2022] Open
Abstract
Ovarian cystadenofibroma is a benign ovarian tumor that is characterized by a consistent percentage of masses, which remain indeterminate in ultrasonography and require magnetic resonance (MR) investigation; they may mimic borderline or malignant lesions. Three main morphologic patterns, resembling different ovarian neoplasms, can be identified in cystadenofibromas: multilocular solid lesions, unilocular cystic lesions with parietal thickening, and purely cystic masses. However, a cystoadenofibroma has typical features, such as T2-weighted hypointensity associated with no restrictions in diffusion-weighted imaging (the so-called "dark-dark appearance") and progressive post-contrast enhancement (type I perfusion curve). The purpose of this study was to review the features of ovarian cystadenofibromas in MR imaging and to suggest pearls and pitfalls regarding their correct diagnosis.
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Affiliation(s)
- Giacomo Avesani
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Gianluca Caliolo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Benedetta Gui
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy.
| | - Federica Petta
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Camilla Panico
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Viviana La Manna
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A Gemelli, IRCCS, Rome, Italy
| | - Francesca Moro
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A Gemelli, IRCCS, Rome, Italy
| | - Antonia Carla Testa
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A Gemelli, IRCCS, Rome, Italy.,Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanni Scambia
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A Gemelli, IRCCS, Rome, Italy.,Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Riccardo Manfredi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy.,Department of Radiology, Catholic University of the Sacred Heart, Rome, Italy
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8
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Saleh M, Bhosale P, Menias CO, Ramalingam P, Jensen C, Iyer R, Ganeshan D. Ovarian teratomas: clinical features, imaging findings and management. Abdom Radiol (NY) 2021; 46:2293-2307. [PMID: 33394097 DOI: 10.1007/s00261-020-02873-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/12/2020] [Accepted: 11/18/2020] [Indexed: 12/11/2022]
Abstract
Ovarian teratomas are the most common type of germ cell tumors. There are three major subtypes of ovarian teratomas including mature, immature, and monodermal teratomas. Ultrasound, computed tomography and magnetic resonance imaging can demonstrate specific imaging findings for mature teratoma. Imaging features of immature and monodermal teratomas are less specific, but a combination of clinical features and imaging findings can help in the diagnosis. Imaging is also very helpful in guiding management. In this article, we review the epidemiology, histopathology, clinical presentation, imaging features and management of ovarian teratomas.
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Affiliation(s)
- Mohammed Saleh
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Priya Bhosale
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Christine O Menias
- Department of Radiology, Mayo Clinic in Arizona, 13400 E. Shea Blvd., Scottsdale, AZ, 85259, USA
| | - Preetha Ramalingam
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Corey Jensen
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Revathy Iyer
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Dhakshinamoorthy Ganeshan
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Unit 1473, 1515 Holcombe Boulevard, Houston, TX, 77030-4009, USA.
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9
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Rockson O, Kora C, Ramdani A, Basma A, Bouhout T, Serji B, El Harroudi T. Struma ovarii: two case reports of a rare teratoma of the ovary. J Surg Case Rep 2020; 2020:rjaa493. [PMID: 33343869 PMCID: PMC7737006 DOI: 10.1093/jscr/rjaa493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/29/2020] [Accepted: 10/31/2020] [Indexed: 11/15/2022] Open
Abstract
Struma ovarii is an extremely rare type of ovarian teratoma distinguished by the unusual presence of thyroid tissue. It is usually a benign condition; however, malignant transformation is sometimes detected. The diagnosis relies on histopathological examination and is infrequently made on routine investigations. We report two cases of struma ovarii: one benign and the other malignant. The first case involved a 27-year-old woman who underwent a right ovarian cystectomy for an incidental ultrasonographic finding of a solid right adnexal mass. The diagnosis of a benign struma was made after histopathological study. The second case involved a 68-year-old woman who underwent a right salpingo-oophorectomy for a right ovarian bulky mass and the histopathological diagnosis was consistent with that of a malignant struma. We examine the challenges involved in the diagnosis and management of this rare entity.
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Affiliation(s)
- Obed Rockson
- Department of Surgical Oncology, Mohammed VI University Hospital, Regional Oncology Center, Oujda, Morocco
| | - Christine Kora
- Department of Radiology, Mohammed VI University Hospital, Oujda, Morocco
| | - Abdelbassir Ramdani
- Department of Surgical Oncology, Mohammed VI University Hospital, Regional Oncology Center, Oujda, Morocco
| | - Aabdi Basma
- Department of Oncology, Mohammed VI University Hospital, Regional Oncology Center, Oujda, Morocco
| | - Tariq Bouhout
- Department of Surgical Oncology, Mohammed VI University Hospital, Regional Oncology Center, Oujda, Morocco
| | - Badr Serji
- Department of Surgical Oncology, Mohammed VI University Hospital, Regional Oncology Center, Oujda, Morocco
| | - Tijani El Harroudi
- Department of Surgical Oncology, Mohammed VI University Hospital, Regional Oncology Center, Oujda, Morocco
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10
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Koual M, Nguyen-Xuan HT, Deidier J, Le Frère-Belda MA, Bats AS. [Struma ovarii: A rare ovarian tumor to know]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2020; 48:837-839. [PMID: 32470557 DOI: 10.1016/j.gofs.2020.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Meriem Koual
- Faculté de médecine Paris Descartes, université de Paris, Paris, France; AP-HP, Centre, hôpital Européen Georges-Pompidou, chirurgie cancérologique gynécologique et du sein, Paris, France; Inserm UMR-S 1124, université de Paris, centre universitaire des Saints-Pères, Paris, France.
| | - Huyen-Thu Nguyen-Xuan
- Faculté de médecine Paris Descartes, université de Paris, Paris, France; AP-HP, Centre, hôpital Européen Georges-Pompidou, chirurgie cancérologique gynécologique et du sein, Paris, France
| | - Jonas Deidier
- Faculté de médecine Paris Descartes, université de Paris, Paris, France; AP-HP, Centre, hôpital Européen Georges-Pompidou, radiologie, Paris, France
| | | | - Anne-Sophie Bats
- Faculté de médecine Paris Descartes, université de Paris, Paris, France; AP-HP, Centre, hôpital Européen Georges-Pompidou, chirurgie cancérologique gynécologique et du sein, Paris, France; Inserm UMR-S 1147, université de Paris, centre universitaire des Saints-Pères, Paris, France
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11
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Khalife D, Nassif J, Nazha B, Khalifeh I, Khoury S, Khalil A. An unusual case of struma ovarii causing ovarian torsion during pregnancy. J OBSTET GYNAECOL 2019; 39:716-717. [PMID: 30880533 DOI: 10.1080/01443615.2018.1556252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Dalia Khalife
- a Department of Obstetrics and Gynecology , American University of Beirut Medical Center , Beirut , Lebanon
| | - Joseph Nassif
- a Department of Obstetrics and Gynecology , American University of Beirut Medical Center , Beirut , Lebanon
| | - Bassel Nazha
- b Department of Hematology and Oncology , Emory University School of Medicine , Atlanta , USA
| | - Ibrahim Khalifeh
- c Department of Pathology and Laboratory Medicine , American University of Beirut Medical Center , Beirut , Lebanon
| | - Sally Khoury
- a Department of Obstetrics and Gynecology , American University of Beirut Medical Center , Beirut , Lebanon
| | - Ali Khalil
- a Department of Obstetrics and Gynecology , American University of Beirut Medical Center , Beirut , Lebanon
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12
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Lamblin G, Gallice C, Bournaud C, Nadaud B, Lebail-Carval K, Chene G. [Benign struma ovarii: Report of 7 cases and review of the literature]. ACTA ACUST UNITED AC 2016; 44:263-8. [PMID: 26997461 DOI: 10.1016/j.gyobfe.2016.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 02/04/2016] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Struma ovarii is a monodermal teratoma composed of thyroid tissue, representing 0.85 to 1.3% of ovarian tumors. The objective of the present study is to report a continuous series of struma ovarii, with a comprehensive analysis of the literature. METHODS A retrospective study in the gynecological surgery department of Hôpital Femme-Mère-Enfant (Hospices Civils de Lyon, Lyon, France) assessed a continuous series of struma ovarii from the Lyon East Pathology Center database. Clinical and biological, imaging and pathological aspects were analyzed and the various forms of treatment described. RESULTS We identified 7 patients with struma ovarii from March 2008 to April 2015. Mean patient age was 49.7 years (28-70years). Three patients had a history of thyroid disease. CA-125 was elevated (51IU/mL) in only 1 patient. MRI and ultrasound imaging did not enable diagnosis of struma ovarii, which depended on pathologic examination. Conservative surgery for cystectomy or oophorectomy was performed for patients wishing to become pregnant (71%); nonconservative hysterectomy was performed in postmenopausal women (29%). CONCLUSIONS Struma ovarii is a rare, often asymptomatic condition in which diagnosis is difficult. Few series are described in the literature. Here we propose a management model for struma ovarii. Revision surgery and adjuvant therapy is indicated in case of malignant struma ovarii.
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Affiliation(s)
- G Lamblin
- Service de chirurgie gynécologique, université Claude Bernard-Lyon 1, hôpital Femme-Mère-Enfant, 59, boulevard Pinel, 69677 Lyon-Bron, France.
| | - C Gallice
- Service de chirurgie gynécologique, université Claude Bernard-Lyon 1, hôpital Femme-Mère-Enfant, 59, boulevard Pinel, 69677 Lyon-Bron, France
| | - C Bournaud
- Service de médecine nucléaire, groupement hospitalier Est, 59, boulevard Pinel, 69677 Lyon-Bron, France
| | - B Nadaud
- Service de pathologie Est (CPE), groupement hospitalier Est, 59, boulevard Pinel, 69677 Lyon-Bron, France
| | - K Lebail-Carval
- Service de chirurgie gynécologique, université Claude Bernard-Lyon 1, hôpital Femme-Mère-Enfant, 59, boulevard Pinel, 69677 Lyon-Bron, France
| | - G Chene
- Service de chirurgie gynécologique, université Claude Bernard-Lyon 1, hôpital Femme-Mère-Enfant, 59, boulevard Pinel, 69677 Lyon-Bron, France
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13
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Jalaguier-Coudray A, Jacquemier J, Villard-Mahjoub R, Delarbre B, Thomassin-Piana J. Pourquoi la macroscopie est-elle essentielle pour comprendre et analyser les tumeurs ovariennes ? IMAGERIE DE LA FEMME 2015. [DOI: 10.1016/j.femme.2015.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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14
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Dujardin MI, Sekhri P, Turnbull LW. Struma ovarii: role of imaging? Insights Imaging 2014; 5:41-51. [PMID: 24357453 PMCID: PMC3948908 DOI: 10.1007/s13244-013-0303-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 11/17/2013] [Accepted: 11/20/2013] [Indexed: 10/31/2022] Open
Abstract
As clinical features in struma ovarii patients in the absence of thyrotoxicosis are generally non-specific and resemble ovarian malignancy, preoperative radiological diagnosis becomes all the more relevant in order to avoid ovarian cancer type surgery (including bilateral salpingo-oophorectomy, hysterectomy, omentectomy and occasionally appendectomy) for this usually benign and rare ovarian mass. As struma ovarii is an uncommon entity, it is all the more important to perform state-of-the-art magnetic resonance (MR) imaging, including high-resolution imaging and diffusion-weighted imaging. The goal of this review paper is to give an update of the key findings of both benign and malignant struma ovarii and to present an unusual case of a purely cystic ovarian struma. Key Points • Clinical features in struma ovarii are generally non-specific and resemble ovarian malignancy.• Pre-operative radiological diagnosis is important to avoid ovarian cancer type surgery (bilateral salpingo-oophorectomy, hysterectomy, omentectomy and occasionally appendectomy).• State-of-the-art MR imaging might help to characterise this unusual ovarian mass.• Struma ovarii can occasionally present as a purely cystic lesion.• However, the role of imaging to identify struma ovarii preoperatively remains limited.
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Affiliation(s)
- Martine I. Dujardin
- Centre for MR Investigations, University of Hull in association with Hull York Medical School, Anlaby Road, Hull, HU3 2JZ East Yorkshire UK
| | - Priti Sekhri
- Hull and East Yorkshire Hospitals NHS Trust, Histopathology Department, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ UK
| | - Lindsay W. Turnbull
- Centre for MR Investigations, University of Hull in association with Hull York Medical School, Anlaby Road, Hull, HU3 2JZ East Yorkshire UK
- Centre for MR Investigations, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ UK
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15
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Poncelet E, Delpierre C, Kerdraon O, Lucot JP, Collinet P, Bazot M. Value of dynamic contrast-enhanced MRI for tissue characterization of ovarian teratomas: correlation with histopathology. Clin Radiol 2013; 68:909-16. [PMID: 23726654 DOI: 10.1016/j.crad.2013.03.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 03/24/2013] [Accepted: 03/29/2013] [Indexed: 10/26/2022]
Abstract
AIM To analyse the value of double contrast-enhanced (DCE) magnetic resonance imaging (MRI) in addition to conventional MRI to characterize ovarian teratomas subtypes with histological correlation. MATERIALS AND METHODS From January 2005 to December 2008, 38 women undergoing MRI and subsequent resection of ovarian teratomas were identified [40 mature cystic teratomas (MCT), two struma ovarii, three immature teratomas]. MRI images were analysed blindly by two radiologists according to morphological and vascular abnormalities. An experienced histopathologist reviewed all slides to determine the presence and histological composition of Rokitansky protuberances. RESULTS Thirty-one MCT (77%) had at least one small, regular Rokitansky protuberance presenting at an acute angle with the cyst wall. Ten out of 31 MCT did not display any enhancement on contrast-enhanced MRI related to sebaceous glands, adipose lobules, keratin, and pilosebaceous adnexa at histology. Three different time-intensity curve (TIC), types 1, 2, and 3, were related to presence of smooth muscular cells and fibrous, neuroglial, or thyroid tissue, respectively, found at histology of MCT. Type 3 TIC was also present in one struma ovarii and two immature teratomas. CONCLUSION TIC types are related to the specific content of the solid tissue of ovarian teratomas but cannot be used to differentiate benign and malignant ovarian teratomas.
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Affiliation(s)
- E Poncelet
- Departments of Radiology, Hôpital Jeanne de Flandre, Centre Hospitalier Régional Universitaire de Lille and Université de Lille Nord de France, Lille, France
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16
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Peyron N, Coulon A. Struma ovarii, pseudo-Meigs' syndrome and raised CA125, a rare association. Answer to May e-quid. Diagn Interv Imaging 2012; 93:643-7. [PMID: 22818078 DOI: 10.1016/j.diii.2012.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- N Peyron
- Service d'imagerie médicale, hospices civils de Lyon, hôpital de la Croix-Rousse, Lyon, France.
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Abstract
OBJECTIVE The purpose of this study is to investigate radiologic findings of struma ovarii, and to correlate both CT and MR findings. MATERIALS AND METHODS MR images of 26 cases were retrospectively reviewed. Post-contrast enhanced T1-weighted images were available in 17 patients. CT images, including seven non-contrast and eleven post-contrast studies, were available for review in 13 cases. RESULTS All 26 tumors appeared as well-defined cystic tumors with solid components, which were multilobulated surfaces in 19 and smooth surfaces in seven. Twenty-four was multicystic, whereas two were unilocular. The solid components were recognized as thickened septi or walls in 23 and a mass in three tumors. On T2-weighted images, loculi of prominent low intensity were recognized in 16 tumors. On T1-weighted images, the punctuate foci of high intensity were recognized in 24 tumors in or adjacent to the solid components. Ascites was present in only one lesion. In six of seven cases with non-contrast CT images, high attenuation areas were recognized. In five of these six tumors, high attenuation areas corresponded to the areas of prominent low intensity and the solid components on T2-weighted images. In seven cases with CT, curvilinear calcifications were recognized in the solid components. CONCLUSION Struma ovarii typically presents as a lobulated multicystic lesion with solid components. The tumors frequently include loculi of low intensity on T2-weighted images and punctuate foci of high intensity on T1-weighted images. On CT, high attenuation areas and calcifications in the solid components are common findings.
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18
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Alvarez DM, Lee V, Bhatt S, Dogra VS. Struma ovarii with papillary thyroid carcinoma. J Clin Imaging Sci 2011; 1:44. [PMID: 22315711 PMCID: PMC3272908 DOI: 10.4103/2156-7514.84322] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 08/09/2011] [Indexed: 11/22/2022] Open
Abstract
Struma ovarii is an uncommon condition, in which thyroid tissue is the predominant or exclusive element in an ovarian teratoma. Thyroid tissue may demonstrate the same spectrum of pathological features as in the normal thyroid including benign and malignant changes. We present a case of papillary thyroid carcinoma arising in a struma ovarii of the left ovary in a 21-year-old female.
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Affiliation(s)
- Daniel M Alvarez
- Interventional Radiology, Hospital San Jose Tec de Monterrey, Monterrey, Mexico, USA
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20
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Damarey B, Farine M, Vinatier D, Collinet P, Lucot J, Kerdraon O, Poncelet E. Tératomes ovariens matures et immatures : caractéristiques en échographie, TDM et IRM. ACTA ACUST UNITED AC 2010; 91:27-36. [DOI: 10.1016/s0221-0363(10)70003-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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21
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Abstract
BACKGROUND The purpose of this study was to evaluate computed tomographic findings of struma ovarii. METHODS Computed tomography (CT) scans of 13 pathologically proven struma ovarii were retrospectively reviewed by two radiologists in consensus. Scans were evaluated for the laterality, size, mass configuration, margins, internal architecture, presence of intracystic high attenuation lesions on precontrast scans, and cyst wall enhancement. RESULTS The mean size of the tumors was 11.4 cm (range 4.7-21.0 cm). Mainly cystic (n = 8, 61.5%) or cystic (n = 5, 38.5%) appearance was common to all the tumors. All tumors were unilateral and had smooth margins. The most common internal architecture in the tumors was multicystic architecture (n = 11, 84.6%). Eleven tumors (84.6%) showed a high attenuation lesion in the cyst portion of the mass on precontrast scans and the attenuation ranged from 92.2 to 120.5 Hounsfield units (HU) (mean, 106.8 +/- 8.8 HU). The cyst wall showed no (n = 7, 53.8%), moderate (n = 5, 38.5%), or marked (n = 1, 7.7%) enhancement after administration of contrast medium. CONCLUSIONS On CT scans, struma ovarii appeared most often as a smooth marginated multicystic mass with a high attenuation lesion on precontrast scans and no or moderate cyst wall enhancement.
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22
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Savelli L, Testa AC, Timmerman D, Paladini D, Ljungberg O, Valentin L. Imaging of gynecological disease (4): clinical and ultrasound characteristics of struma ovarii. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2008; 32:210-219. [PMID: 18636616 DOI: 10.1002/uog.5396] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVES To describe the clinical history and ultrasound findings in women with struma ovarii. METHODS Women with a histological diagnosis of struma ovarii who had undergone preoperative ultrasound examination were identified from the databases of five ultrasound centers. The tumors were characterized on the basis of ultrasound images, ultrasound reports and research protocols (when applicable) using the terms and definitions of the International Ovarian Tumor Analysis (IOTA) group. In addition, four authors reviewed all ultrasound images and described them using pattern recognition. RESULTS Of 31 patients identified, 16 had pure struma ovarii (one malignant), whereas in 15 patients the struma ovarii were 'impure', constituting the major part of a dermoid cyst (all benign, bilateral in one case). Median age was 40 (range, 18-80) years and 22 (71%) patients were of fertile age. Thirteen patients (42%) were asymptomatic, nine (29%) presented with pain, six (19%) with bloating, two (6%) with irregular bleeding and one (3%) with thyreotoxicosis. Most pure struma ovarii (11/16 cases, 69%) contained solid components, but cystic components were always present. The color content at Doppler examination varied from none to abundant. Four patients had ascites. Using pattern recognition the most specific feature of pure struma ovarii was the 'struma pearl', i.e. a smooth roundish solid area, similar, but not identical, to the 'round white ball' seen in dermoid cysts. 'Struma pearls' were present in six cases of pure struma ovarii. Most (10/16, 63%) cases of impure struma ovarii manifested ultrasound features compatible with a dermoid cyst, but six manifested ultrasound features similar to those of pure struma ovarii, 'struma pearls' being seen in three of these. CONCLUSIONS The sonographic features of struma ovarii vary. Struma ovarii may be suspected when a 'struma pearl' is seen. Whether 'struma pearls' are indeed a specific ultrasonographic feature of struma ovarii needs to be determined in a prospective study.
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Affiliation(s)
- L Savelli
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy.
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23
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Park SB, Kim JK, Kim KR, Cho KS. Imaging findings of complications and unusual manifestations of ovarian teratomas. Radiographics 2008; 28:969-983. [PMID: 18635624 DOI: 10.1148/rg.284075069] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
Ovarian teratomas can be associated with various complications and demonstrate a wide spectrum of clinical and imaging features. The complications include torsion (16% of ovarian teratomas), rupture (1%-4%), malignant transformation (1%-2%), infection (1%), and autoimmune hemolytic anemia (<1%). These complications require different therapeutic strategies; therefore, timely and accurate diagnosis of these complications is important for optimal patient treatment. In cases of complicated ovarian teratomas, the clinical manifestations provide only limited information and often overlap with those of other diseases. Furthermore, ovarian teratomas may have unusual clinical and imaging manifestations, thereby leading to misdiagnosis. These unusual manifestations include immature teratomas, monodermal teratomas (struma ovarii), combination tumors and collision tumors containing teratomas, and mature cystic teratomas without demonstrable fat or with pure fatty components. To provide adequate treatment and prevent misdiagnosis, it is necessary to be familiar with the imaging findings of both the complications and the unusual manifestations of ovarian teratomas.
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Affiliation(s)
- Sung Bin Park
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, South Korea
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Tsili A, Tsampoulas C, Charisiadi A, Kalef-Ezra J, Dousias V, Paraskevaidis E, Efremidis S. Adnexal masses: Accuracy of detection and differentiation with multidetector computed tomography. Gynecol Oncol 2008; 110:22-31. [PMID: 18486202 DOI: 10.1016/j.ygyno.2008.03.022] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2007] [Revised: 03/20/2008] [Accepted: 03/25/2008] [Indexed: 11/24/2022]
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Tanaka YO, Saida TS, Minami R, Yagi T, Tsunoda H, Yoshikawa H, Minami M. MR findings of ovarian tumors with hormonal activity, with emphasis on tumors other than sex cord-stromal tumors. Eur J Radiol 2007; 62:317-27. [PMID: 17403591 DOI: 10.1016/j.ejrad.2007.02.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2006] [Revised: 02/12/2007] [Accepted: 02/23/2007] [Indexed: 10/23/2022]
Abstract
Sex cord-stromal tumors including granulosa cell tumor, thecoma, Sertoli stromal cell tumor and steroid cell tumor are noted for their hormonal activity. However, there are many kinds of ovarian tumors other than sex cord-stromal tumors and tumor-like conditions with endocrine manifestations. Cross-sectional imaging, especially MR, can provide precise features of ovarian tumors and uterine morphological change even in a clinically latent excess of estrogen. In this article, we demonstrate typical imaging findings of ovarian tumors with hormonal activity. We also shortly explain the mechanism of the virilization and hyperestrogenism caused by ovarian tumors and tumor-like conditions.
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Affiliation(s)
- Yumiko Oishi Tanaka
- Department of Radiology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan.
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Kunstmann L, Fénichel P. Goitre ovarien: une forme particulière de tératome de l'ovaire. ACTA ACUST UNITED AC 2007; 35:49-54. [PMID: 17196426 DOI: 10.1016/j.gyobfe.2006.10.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2006] [Accepted: 10/23/2006] [Indexed: 11/17/2022]
Abstract
Struma ovarii, a rare form of ovarian tumor, represents less than 3% of ovarian teratomas. The peak frequency occurs during the fifth decade of life. Diagnosis is usually a surprise of pelvic ultrasound or histological analysis. Surgery is the main mode of treatment and prognosis is excellent. Struma ovarii can be associated with thyroid biology abnormalities, or exceptionally become malignant, and thus managed as a thyroid cancer.
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Affiliation(s)
- L Kunstmann
- Service d'endocrinologie et médecine de la reproduction, hôpital de l'Archet, CHU de Nice, BP 3079, 06202 Nice cedex 03, France
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27
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Jung DC, Kim SH, Kim SH. MR imaging findings of ovarian cystadenofibroma and cystadenocarcinofibroma: clues for the differential diagnosis. Korean J Radiol 2006; 7:199-204. [PMID: 16969050 PMCID: PMC2667602 DOI: 10.3348/kjr.2006.7.3.199] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective We wanted to assess the MR imaging findings of ovarian cystadenofibroma and cystadenocarcinofibroma, and we wanted to find clues for making the differential diagnosis between them. Materials and Methods The MR images of 12 pathologically proven cystadenofibromas and two cystadenocarcinofibromas were reviewed, with a focus on the internal architecture, signal intensity and enhancement. Results All the tumors appeared as multilocular cysts, except for a single unilocular cystic mass and a single solid mass. The previously reported characteristic MR findings of cystadenofibroma (a multilocular cystic mass with a T2-dark-signal-intensity solid component containing small cystic locules) were found in only 43% of the tumors (6/14). Diffuse or partial thickening of the cyst wall with T2-dark signal intensity without a definite solid component was as common as the previous reported findings (6/14). Two cystadenocarcinofibromas showed more prominent solid portions with higher T2-signal intensities and stronger enhancement than did the cystadenofibromas. Conclusion Diffuse or partial thickening of the cyst wall with dark-signal-intensity in multilocular cystic masses may suggest ovarian cystadenofibroma, and this type of appearance may be as common as the previously reported characteristic appearance. A prominent solid component with a higher T2-signal intensity and strong enhancement are the typical findings of cystadenocarcinofibroma.
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Affiliation(s)
- Dae Chul Jung
- Department of Radiology, Seoul National University College of Medicine, Seoul 110-744, Korea
| | - Sun Ho Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul 110-744, Korea
| | - Seung Hyup Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul 110-744, Korea
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28
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Byun JY. MR imaging findings of ovarian cystadenofibroma: clues for making the differential diagnosis from ovarian malignancy. Korean J Radiol 2006; 7:153-5. [PMID: 16969043 PMCID: PMC2667595 DOI: 10.3348/kjr.2006.7.3.153] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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Akai M, Isoda H, Sawada S, Matsuo I, Kanzaki H, Sakaida N, Okamura A, Kiyokawa T. A Case of Struma Uteri. AJR Am J Roentgenol 2005; 185:216-8. [PMID: 15972426 DOI: 10.2214/ajr.185.1.01850216] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Mikio Akai
- Department of Radiology, Kansai Medical University, 10-15, Fumizono-cho, Moriguchi, Osaka 570-8506, Japan.
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30
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Kim KA, Park CM, Lee JH, Kim HK, Cho SM, Kim B, Seol HY. Benign ovarian tumors with solid and cystic components that mimic malignancy. AJR Am J Roentgenol 2004; 182:1259-65. [PMID: 15100129 DOI: 10.2214/ajr.182.5.1821259] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Kyeong Ah Kim
- Department of Diagnostic Radiology and Medical Science Research Center, Guro Hospital, Korea University School of Medicine, 97 Gurodong-Gil, Guro-Ku, Seoul 152-703, South Korea
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31
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Abstract
This article presents an overview of ovarian cancer, which addresses the clinical roles of imaging studies, including US, CT, and MR imaging in the course of diagnosis and treatment of this important disease. US is the modality of choice in the evaluation of patients with suspected adnexal masses. Although its accuracy is not sufficient to avert surgery, morphological analysis of adnexal masses with US helps narrow the differential diagnosis, determining the degree of suspicion for malignancy, usually in concert with a serum CA-125 level. Combined morphological and vascular imaging obtained by US appear to further improve the preoperative assessment of adnexal masses. For uncertain or problematic cases, MR imaging helps to distinguish benign from malignant, with an overall accuracy for the diagnosis of malignancy of 93%. The accuracy of MR imaging in the confident diagnosis of mature cystic teratoma, endometrial cysts, and leiomayomas is very high. CT is not indicated for differential diagnosis of adnexal masses because of poor soft tissue discrimination, except for fatty tissue and for calcification, and the disadvantages of irradiation. In the staging of ovarian cancer, CT, US, and MR imaging all have a similarly high accuracy. Although it is difficult to suggest a simple algorithm for evaluating the state of women with adnexal masses, the correct preoperative diagnosis and staging of ovarian cancer with the use of any of these imaging studies will lead to an appropriate referral to a specialist in gynecologic oncology and offer a significant survival advantage for patients with ovarian cancer.
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Affiliation(s)
- Kaori Togashi
- Department of Diagnostic and Interventional Imageology, Graduate School of Medicine, Kyoto University, Shogoin-Kawaharacho 54, Sakyo-ku, 606-8507 Kyoto, Japan.
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García A, Castellví J, López M, Gil A, de la Torre J, Ramón y Cajal S. Malignant struma ovarii mimic clear cell carcinoma. Arch Gynecol Obstet 2004; 271:251-5. [PMID: 14986024 DOI: 10.1007/s00404-004-0605-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2003] [Accepted: 12/20/2003] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Struma ovarii are quite unusual lesions that represent less than 3% of all teratomas and its malignant transformation is very uncommon. The clinical manifestations are characteristic of pelvic tumor and the hormonal metabolism is not usually modified. Radiography, employing ultrasound procedures, is the most commonly used pre-surgical detection method but only histological examination makes the diagnosis. The malignance recognition by pathological study not always is easy; in this sense, it requires an exhaustive sampling of the lesion, being specially carefully in some aspects related with malignant transformation such as extending beyond the capsula and involving peripheral tissues. A thyroidal differentiation must be confirmed by immunohistochemical study and other local processes with similar histology should be ruled out. Given the exceptional character of malignant forms, there does not appear to be unanimous agreement on a standard therapy with a somewhat uncertain prognosis. CASE REPORT We show a case of a 22-year-old patient with an ovarian tumor that was discovered by ultrasound examination and surgically removed. The histologic study revealed struma ovarii with malignant transformation towards follicular carcinoma and unlike previously published cases, had a prevalence of clear cells. The patient was submitted to a second surgical staging intervention, with conservative surgery and follow-up controls being considered given that was a young woman with a desire to have children. Laparoscopy was employed as the best method capable to facilitate shorter convalescence. OUTCOME Clinical and analytical controls, measuring thyroglobulin levels, has been satisfactory up to the present.
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Affiliation(s)
- Angel García
- Department of Pathology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.
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Utsunomiya D, Shiraishi S, Kawanaka K, Lwakatare F, Tomiguchi S, Kido R, Katabuchi H, Okamura H, Yamashita Y. Struma ovarii coexisting with mucinous cystadenoma detected by radioactive iodine. Clin Nucl Med 2003; 28:725-7. [PMID: 12972992 DOI: 10.1097/01.rlu.0000082657.06194.b3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The authors describe a case of struma ovarii coexisting with mucinous cystadenoma. Ultrasonography and magnetic resonance imaging showed a multilocular cystic mass with a solid component. The ovarian tumor demonstrated uptake of I-123 sodium iodide, allowing a preoperative diagnosis of struma ovarii. In women with an unexplained increase in thyroid function and low I-123 uptake in the cervical thyroid gland, scintigraphy of the pelvis should be considered.
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Affiliation(s)
- Daisuke Utsunomiya
- Departments of Radiology, Kumamoto University School of Medicine, Japan.
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Volpi E, Ferrero A, Nasi PG, Sismondi P. Malignant struma ovarii: a case report of laparoscopic management. Gynecol Oncol 2003; 90:191-4. [PMID: 12821363 DOI: 10.1016/s0090-8258(03)00142-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Struma ovarii is a rare disease. Malignant transformation is even rarer. Data about its management are lacking. We describe the first reported case of a malignant struma ovarii treated and staged by laparoscopy. CASE A 49-year-old patient was operated by laparoscopy for a right ovarian teratoma. The patient did not show symptoms of hyperthyroidism. The ovarian teratoma was removed in a plastic bag and definitive histology showed foci of papillary adenocarcinoma in a struma ovarii. The patient was then staged by laparoscopic surgery undergoing left adnexectomy, multiple peritoneal and omental biopsies, and common iliac and paracaval lymph node sampling. Hysterectomy was not performed. The postoperative course was uneventful and the patient was released on the second day. Thyroglobulin level was monitored and the patient is free of disease after more than 1 year. CONCLUSION The preoperative diagnosis of malignant struma ovarii is difficult. Even with cautious evaluation of the patient, some risk of wrong diagnosis is possible. This is why a meticulous technique of laparoscopic surgery in removing the ovary is important. Laparoscopic staging may also intervene in very limited cases; the expertise to perform open staging of the patient is necessary but the postoperative course is fast.
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Affiliation(s)
- E Volpi
- Department of Gynecologic Oncology, University of Turin, Turin, Italy.
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35
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Kaji Y, Matsuo M, Matsuki M, Yoshida M, Hayashi M, Nanno H, Koshiyama M, Fujii H, Maruyama K, Takizawa O, Sugimura K. Cystic Ovarian Lesions in SSFP Diffusion Imaging. Magn Reson Med Sci 2002; 1:183-9. [PMID: 16082143 DOI: 10.2463/mrms.1.183] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE MR assessments of ovarian cystic lesions are usually based on morphological features, signal intensities and enhancement with contrast media. This study was performed to evaluate the usefulness of the steady-state free precession (SSFP) diffusion imaging of cystic ovarian lesions for analyzing cystic contents. MATERIALS AND METHODS Sixty-one ovarian cystic lesions in 37 patients were examined. The diffusion-related coefficient (DRC) and the ratio of the relative apparent diffusion coefficient of the lesion to that of subcutaneous fat tissue (rADC(L)/rADC(F)) were calculated from SSFP diffusion images. RESULTS The DRCs and the rADC(L)/rADC(F) ratios in endometrial cysts and in the fatty parts of dermoid cysts were significantly lower than in other cystic tumors. CONCLUSION SSFP diffusion imaging can be included in clinical practice to analyze ovarian cystic lesions within a short scan time; the DRC and the rADC(L)/rADC(F) ratio are useful for evaluating cystic contents.
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Affiliation(s)
- Yasushi Kaji
- Division of MR imaging, Department of Radiology, Tenri Hospital, Kobe University School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
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Abstract
Magnetic resonance imaging (MRI) of the pelvis can characterize a wide variety of ovarian lesions. We discuss MRI strategies for identification and characterization of ovarian neoplasms and correlate MRI findings with lesion gross pathological and histopathological structure.
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Affiliation(s)
- E S Pretorius
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104, USA.
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Abstract
Ovarian teratomas include mature cystic teratomas (dermoid cysts), immature teratomas, and monodermal teratomas (eg, struma ovarii, carcinoid tumors, neural tumors). Most mature cystic teratomas can be diagnosed at ultrasonography (US) but may have a variety of appearances, characterized by echogenic sebaceous material and calcification. At computed tomography (CT), fat attenuation within a cyst is diagnostic. At magnetic resonance (MR) imaging, the sebaceous component is specifically identified with fat-saturation techniques. The US appearances of immature teratoma are nonspecific, although the tumors are typically heterogeneous, partially solid lesions, usually with scattered calcifications. At CT and MR imaging, immature teratomas characteristically have a large, irregular solid component containing coarse calcifications. Small foci of fat help identify these tumors. The US features of struma ovarii are also nonspecific, but a heterogeneous, predominantly solid mass may be seen. On T1- and T2-weighted images, the cystic spaces demonstrate both high and low signal intensity. Familiarity with the US, CT, and MR imaging features of ovarian teratomas can aid in differentiation and diagnosis.
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Affiliation(s)
- E K Outwater
- Department of Radiology, University of Arizona, 1501 N. Campbell Ave., Rm. 1361, Tucson, AZ 85724-5067, USA.
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38
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Abstract
We report three cases of cystic struma ovarii not associated with any solid component. One case was a thin-walled unilocular mass, and the other two cases were multilocular cystic masses. An area of signal void on T2-weighted images and intermediate intensity on T1-weighted images was noted in the two multilocular cases. Preoperative diagnosis was difficult in each case, but struma ovarii should be included in differential diagnoses even in the case of a completely cystic ovarian mass.
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Affiliation(s)
- S Okada
- Department of Radiology, Nippon Medical School, Chiba-Hokuso Hospital, Chiba, Japan.
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Abstract
This study was performed to characterize MR findings of struma ovarii. In 10 patients, T1- and fast spin echo T2-weighted MR images were obtained in the axial, coronal, and sagittal planes using 1.5 T MR units, and they were retrospectively evaluated for the site, size, components, signal intensity, and contrast enhancement.MR images showed a unilateral complex mass with a multilobulated surface and thickened septa, corresponding pathologically to thyroid follicles and the stroma. Cystic portions had variable signal intensities on T1- and T2-weighted images. The contents of cystic components showing low signal intensities both on T1- and T2-weighted images were viscid gelatinous materials (n=4). Solid portions were relatively well-enhanced. In conclusion, struma ovarii has some characteristic MR appearance of a multilobulated complex mass with thickened septa, multiple cysts of variable signal intensities, and enhancing solid components.
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Affiliation(s)
- J C Kim
- Department of Diagnostic Radiology, Chungnam National University Hospital, 640 Dacesa-dong, Jung-ku, 301-721, Taejeon, South Korea.
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