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Dissanayake A, Liu AY, Gooderham PA, MacKenzie-Feder J. Metastatic malignant struma ovarii to the pituitary presenting as a sellar mass and responding to total thyroidectomy with adjuvant radioactive iodine therapy. BMJ Case Rep 2024; 17:e259391. [PMID: 38834312 DOI: 10.1136/bcr-2023-259391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024] Open
Abstract
Malignant struma ovarii (MSO) is a rare ovarian teratoma composed primarily of thyroid tissue. Common sites of metastasis include peritoneum, bone, liver, lung, gastrointestinal tract and omentum. We present a woman in her 50s with a history of remote oophorectomy presenting with hypopituitarism and a 2.7 cm sellar mass. Trans-sphenoidal surgery for presumed pituitary macroadenoma achieved near total resection and resultant pathology surprisingly showed ectopic thyroid tissue. The patient acquired her ovarian pathology report from Southeast Asia which showed struma ovarii of the left ovary. The pituitary mass was thus determined to be a metastatic lesion from MSO. She underwent total thyroidectomy and radioactive iodine ablation therapy with good initial response and no regrowth of the tissue or emergence of distant metastases after 5 years of annual follow-up. To our knowledge, this is the first reported case of MSO to the pituitary.
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Affiliation(s)
- Ashini Dissanayake
- Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Angela Y Liu
- Division of Endocrinology ; Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter A Gooderham
- Division of Neurosurgery ; Department of Surgery, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jessica MacKenzie-Feder
- Division of Endocrinology ; Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
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Asa SL, Ezzat S. Endocrine tumors of the female reproductive tract. Mol Cell Endocrinol 2024; 582:112123. [PMID: 38135144 DOI: 10.1016/j.mce.2023.112123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/08/2023] [Accepted: 12/09/2023] [Indexed: 12/24/2023]
Abstract
Endocrine cells responsible for hormone secretion are found in virtually every organ system. The diverse neoplasms arising from endocrine cells in the female reproductive tract are not well recognized as a distinct component of endocrine oncology. Here, we integrate cellular origins with native anatomical residence to help classify neoplasms of this system. The neoplasms include steroidogenic tumors that arise usually in ovarian stroma, neuroendocrine neoplasms that can arise from normal neuroendocrine cells throughout the female reproductive tract or in ovarian germ cell tumors, and thyroid follicular cell proliferations that are exclusively a component of an ovarian teratoma and may be malignant. The neuroendocrine neoplasms run the full spectrum from indolent neuroendocrine tumors to aggressive poorly differentiated neuroendocrine carcinomas. While many of these lesions are identified as incidental findings in surgically resected tissues, others present with inappropriate hormone excess. An important consideration is the distinction of primary disease from metastatic malignancy. Genetic disorders including those caused by germline mutations of the FOXL2, GNAS, DICER1, STK11 and MEN1 genes can present with primary endocrine neoplasms of the female reproductive tract.
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Affiliation(s)
- Sylvia L Asa
- Department of Pathology, University Hospitals Cleveland Medical Center, Case Western Reserve University, United States.
| | - Shereen Ezzat
- Department of Medicine, Endocrine Oncology, Princess Margaret Hospital, University Health Network, University of Toronto, United States
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Ayhan S, Kilic F, Ersak B, Aytekin O, Akar S, Turkmen O, Akgul G, Toyran A, Turan T, Kimyon Comert G. Malignant struma ovarii: From case to analysis. J Obstet Gynaecol Res 2021; 47:3339-3351. [PMID: 34219334 DOI: 10.1111/jog.14902] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 05/22/2021] [Accepted: 06/06/2021] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the clinico-pathologic features, treatment options, prognostic factors, and survival outcomes of malignant struma ovarii based on a systematic literature review in association with our case study. METHODS A systematic review of the medical literature was performed to identify articles about malignant struma ovarii from January 1983 until July 2020. We evaluated 178 cases. RESULTS The 5-year progression-free survival (PFS) and overall survival (OS) of the entire cohort was 72.5% and 91%, respectively. In univariate analysis, younger age (<43 years), whole strumal cyst diameter >95 mm, presence of a histologic type other than papillary classic-type thyroid carcinoma within the tumor and lymphovascular space invasion were related to poor PFS. Patients who received radioactive iodine ablation (RIA) before the treatment failure had significantly higher PFS than those who did not receive RIA (94.9% vs. 64.8%, p = 0.041, respectively). In univariate analysis, PFS was significantly higher in patients who underwent gynecologic surgery followed by thyroidectomy and RIA compared with those who had surgical treatment only (94.5% vs. 64.3%, p = 0.05, respectively). However, this result could not be identified as an independent prognostic factor in multivariate analysis (p = 0.207). Younger age and absence of capsular involvement were related to significantly increased OS. Histologic type was the only independent prognostic factor for PFS (hazard ratio: 3.30, 95% confidence interval: 1.122-9.748; p = 0.030) CONCLUSION: The most common histologic subtype was the papillary classic type. The presence of a histologic type other than the classic papillary thyroid carcinoma within the tumor was an independent adverse prognostic factor.
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Affiliation(s)
- Sevgi Ayhan
- Department of Gynecologic Oncology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Fatih Kilic
- Department of Gynecologic Oncology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Burak Ersak
- Department of Gynecologic Oncology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Okan Aytekin
- Department of Gynecologic Oncology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Serra Akar
- Department of Gynecologic Oncology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Osman Turkmen
- Department of Gynecologic Oncology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Giray Akgul
- Department of Surgical Oncology, Gulhane Education and Research Hospital, Ankara, Turkey
| | - Atahan Toyran
- Department of Gynecologic Oncology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Taner Turan
- Department of Gynecologic Oncology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Gunsu Kimyon Comert
- Department of Gynecologic Oncology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
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Struma ovarii with atypical features and synchronous primary thyroid cancer: a case report and review of the literature. Arch Gynecol Obstet 2019; 300:1693-1707. [DOI: 10.1007/s00404-019-05329-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 10/10/2019] [Indexed: 10/25/2022]
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Moayerifar M, Koohmanaee S, Moayerifar M, Nakhochari AM, Rad AH, Dalili S. Malignant struma ovarii in an 11-year-old girl. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2017.09.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Liu J, Marcaccio MJ, Young JEM, Aziz T, Wat J, Asa SL. Pancreatic Struma with Papillary Thyroid Carcinoma: a Diagnostic Dilemma. Endocr Pathol 2017; 28:91-94. [PMID: 28078619 DOI: 10.1007/s12022-016-9462-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Jerry Liu
- Department of Pathobiology and Laboratory Medicine, University of Toronto, Toronto, ON, Canada
- Department of Pathology, University Health Network, 200 Elizabeth Street, 11th floor, Toronto, ON, M5G 2S3, Canada
| | - Michael J Marcaccio
- Department of Surgery, Hamilton Health Sciences Center, Juravinski Hospital and McMaster University, Hamilton, ON, Canada
| | - J E M Young
- Department of Surgery, Hamilton Health Sciences Center, Juravinski Hospital and McMaster University, Hamilton, ON, Canada
| | - Tariq Aziz
- Department of Pathology, Hamilton Health Sciences Center, Juravinski Hospital and McMaster University, Hamilton, ON, Canada
| | - Josephine Wat
- Department of Radiology, Hamilton Health Sciences Center, Juravinski Hospital and McMaster University, Hamilton, ON, Canada
| | - Sylvia L Asa
- Department of Pathobiology and Laboratory Medicine, University of Toronto, Toronto, ON, Canada.
- Department of Pathology, University Health Network, 200 Elizabeth Street, 11th floor, Toronto, ON, M5G 2S3, Canada.
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Malignant Struma Ovarii With a Predominant Component of Anaplastic Carcinoma. Int J Gynecol Pathol 2016; 35:357-61. [DOI: 10.1097/pgp.0000000000000265] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lee W, Yi NJ, Kim H, Choi Y, Park M, Hong G, Choi JY, Chung HH, Lee KW, Park DJ, Min HS, Chung JK, Suh KS. Metastatic follicular struma ovarii complicating pregnancy: a case report and review of the literature. KOREAN JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY 2012; 16:123-7. [PMID: 26388921 PMCID: PMC4575007 DOI: 10.14701/kjhbps.2012.16.3.123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 07/28/2012] [Accepted: 08/01/2012] [Indexed: 11/25/2022]
Abstract
A 35-year-old woman was determined to have an ovarian cyst and underwent a right ovarian cystectomy at 10 weeks of gestation. A histopathological examination revealed follicular carcinoma arising in a teratoma. No evidence of metastasis was found after delivery. She underwent a total thyroidectomy, followed by radioactive iodine (RAI) therapy. However, her serum thyroglobulin level increased to 1,437 ng/ml (normal range: 0-52 ng/ml) after 10 months. Radioiodine scintigraphy and abdominal computed tomography revealed liver metastasis and peritoneal seeding. She underwent debulking surgery of the liver, right salpinx, and peritoneal seeding nodules. A pathological examination showed metastatic follicular carcinoma with focal poorly differentiated features. Adjuvant RAI therapy was restarted, and her serum thyroglobulin levels returned to normal. In conclusion, metastatic lesions were successfully treated with a combination of debulking surgery and RAI therapy. Close medical follow-up monitoring serum thyroglobulin levels is mandatory in such patients.
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Affiliation(s)
- Woohyung Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Nam-Joon Yi
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeyoung Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Youngrok Choi
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Minsu Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Geun Hong
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - June Young Choi
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Hoon Chung
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Kwang-Woong Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Do-Joon Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hye Sook Min
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - June-Key Chung
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung-Suk Suh
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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Marti JL, Clark VE, Harper H, Chhieng DC, Sosa JA, Roman SA. Optimal surgical management of well-differentiated thyroid cancer arising in struma ovarii: a series of 4 patients and a review of 53 reported cases. Thyroid 2012; 22:400-6. [PMID: 22181336 DOI: 10.1089/thy.2011.0162] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Well-differentiated thyroid cancer arising in struma ovarii is rare. The optimal management of this entity remains undefined. Unilateral cystectomy, unilateral salpingo-oophorectomy (USO), or total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH/BSO), in addition to total thyroidectomy and radioactive iodine (RAI) ablation, have been employed by various groups. We hypothesized that in patients with thyroid cancer arising within struma ovarii, pelvic surgery alone would be sufficient, provided there is no evidence of gross extra-ovarian extension. METHODS We review a series of four patients from a single institution and 53 cases from the literature, comparing the extent of treatment and outcomes. Our literature review focused on low-risk patients with struma ovarii confined to the ovary, without evidence of gross extra-ovarian spread or distant metastases. Cumulative recurrence rate was determined by using the Kaplan-Meier method. RESULTS We report the treatment of four patients with well-differentiated thyroid cancer arising within struma ovarii. Patients underwent USO, BSO, or TAH/BSO. One patient underwent prophylactic total thyroidectomy in anticipation of RAI treatment, and was found to have a synchronous papillary thyroid carcinoma. All patients clinically remain without evidence of disease at a median follow-up of 9 (range 0.8-13) years. Treatment strategies in 53 cases from a review of the literature varied. The pooled cumulative recurrence rate of 57 cases with struma ovarii confined to the ovary was 7.5% at 25 years. CONCLUSIONS Thyroid cancer arising in struma ovarii is rare. Controversy exists regarding the extent of pelvic resection and management of the thyroid gland. In our series of four patients, all patients are alive without evidence of disease, and the 25-year recurrence rate of 57 cases was low (7.5%), despite a variety of approaches to surgical resection and adjuvant treatment. Extensive pelvic surgery and prophylactic total thyroidectomy to facilitate RAI therapy may be reserved for patients with gross extra-ovarian extension or distant metastases.
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Affiliation(s)
- Jennifer L Marti
- Division of Endocrine Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut 06520, USA
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Jean S, Tanyi JL, Montone K, Mcgrath C, Lage-Alvarez MM, Chu CS. Papillary thyroid cancer arising in struma ovarii. J OBSTET GYNAECOL 2012; 32:222-6. [DOI: 10.3109/01443615.2011.645921] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Agrawal A, Nation J, Duggan MA. Papillary Thyroid Carcinoma Arising in a Struma Ovarii: A Case Report and Analysis of Cases Reported in the Literature. ACTA ACUST UNITED AC 2010. [DOI: 10.3816/coc.2010.n.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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12
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Shaco-Levy R, Bean SM, Bentley RC, Robboy SJ. Natural History of Biologically Malignant Struma Ovarii: Analysis of 27 Cases With Extraovarian Spread. Int J Gynecol Pathol 2010; 29:212-27. [DOI: 10.1097/pgp.0b013e3181bfb133] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Typical thyroid-type carcinoma arising in struma ovarii: a report of 4 cases and review of the literature. Int J Gynecol Pathol 2008; 27:496-506. [PMID: 18753973 DOI: 10.1097/pgp.0b013e31816a74c6] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Struma ovarii has elicited considerable interest because of its many unique features since Ludwig Pick first elucidated its relationship to teratoma in the early part of the 20th century. In this article, we report 3 cases of papillary and 1 of follicular thyroid carcinoma; 2 of these cases were associated with mature cystic teratoma. Metastases occurred in 2 patients, and 1 died of neoplasm. In regard to the occurrence of thyroid-type carcinoma in struma ovarii, precise terminology should be used, and the expression malignant struma ovarii was avoided as a diagnostic term. Upon review of the literature, papillary carcinoma and follicular carcinoma are the most frequent types of malignancy to occur in ovarian struma; other forms of thyroid carcinoma occur only rarely. The diagnostic criteria for cases of papillary carcinoma are similar to those described in the cervical thyroid gland and are based primarily on nuclear and architectural features. In reference to follicular carcinoma, invasion into the surrounding ovarian tissue, vascular invasion, or metastasis is evidence of malignancy. Histological malignancy in a struma does not necessarily equate with biological malignancy, and the majority of thyroid-type carcinomas do not spread beyond the ovary. Occasionally, metastases of ovarian struma have an innocuous histological appearance, and such cases are referred to as highly differentiated follicular carcinoma of ovarian origin (HDFCO). Because its histological appearance resembles that of nonneoplastic thyroid, HDFCO characteristically cannot be diagnosed until the neoplasm spreads beyond the ovary. In this article, we apply the term typical thyroid carcinoma to those forms of thyroid malignancy arising in ovarian struma that closely resemble the types described in the cervical thyroid gland to distinguish them from HDFCO. Typical follicular carcinoma is more aggressive than the somewhat more common papillary carcinoma, and HDFCO is the least aggressive of these tumor types. Cases of thyroid-type carcinoma arising in the ovary sometimes lack evidence of preexisting struma. The more aggressive thyroid-type neoplasms can arise in thyroid tissue within a mature cystic teratoma, or they may overgrow and replace the struma. Primary thyroid-type carcinoma must be distinguished from rare instances of ovarian metastases that originate in the cervical thyroid gland and the less differentiated forms from other ovarian neoplasms such as clear cell adenocarcinoma and tumors with an oxyphilic appearance. In the differential diagnosis with other ovarian neoplasms, cases of thyroid-type carcinoma associated with strumal carcinoid should not be diagnosed as malignant strumal carcinoid because the latter diagnosis might lead to suboptimal therapy.
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Salvatori M, Dambra DP, D'Angelo G, Conte LL, Locantore P, Zannoni G, Campo V, Campo S. A case of metastatic struma ovarii treated with 131I therapy: focus on preservation of fertility and selected review of the literature. Gynecol Endocrinol 2008; 24:312-9. [PMID: 18584410 DOI: 10.1080/09513590802095787] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Struma ovarii is a rare monodermal ovarian teratoma composed predominantly of mature thyroid tissue. We describe herein the case of a 22-year-old woman who underwent a right salpingo-oophorectomy for struma ovarii at the age of 12 years, who was admitted 8 years later with signs and symptoms of a left pelvic tumor. Laparoscopy detected a left ovarian endometriotic cyst and multiple nodules on the pelvic peritoneum, right lateral abdominal wall, diaphragm, vesical plica and liver. The diagnosis was abdominal and pelvic widespread dissemination of recurrent struma ovarii, with features consistent with the follicular variant of papillary thyroid carcinoma. The patient was treated with a combination of conservative surgery and two 131I administrations (cumulative activity of 350 mCi after dosimetric evaluation). Because of the high degree of hormonogenesis shown by the metastases, the first administration was performed following use of recombinant human (rh) thyroid-stimulating hormone (TSH) to reach adequate TSH levels. To avoid the 'stunning effect' and to obtain high-quality scintigraphy, a whole-body scan was performed with 123I after rh-TSH and before the 131I therapy. We also discuss the potential role and the possible benefit of using gonadotropin-releasing hormone analogs and ovarian tissue cryopreservation to preserve fertility in women treated with 131I for pelvic metastases from malignant struma ovarii.
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Affiliation(s)
- Massimo Salvatori
- Institute of Nuclear Medicine, Catholic University of Sacred Heart, Rome, Italy.
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Abstract
Struma ovarii is a rare monodermal ovarian teratoma in which thyroid tissue is the predominant or exclusive element. Malignant transformation is known to occur, usually as classical papillary thyroid carcinoma (PTC). However, the recognition of follicular variant PTC raises the possibility of similar malignancy arising in struma ovarii. We examined 13 cases of struma ovarii to determine if these lesions can exhibit histological, immunohistochemical, and/or molecular features of follicular variant PTC. Ten of these had atypical histology, cytologic features of PTC, and all ten showed diffuse positivity for CK19; eight of these were also positive for HMBE-1. Mutational analysis for BRAF identified no V600E mutations. However, seven of the ten cases with features of follicular variant PTC exhibited a rearranged in transformation (RET)/PTC rearrangement by reverse transcriptase polymerase chain reaction (RT-PCR). The three cases considered to be benign based on histologic and cytologic criteria were negative for CK19 and HBME-1 by immunohistochemistry, and had no evidence of BRAF mutation or ret/PTC-1 and ret/PTC-3 rearrangements. These results indicate that follicular variant PTC can occur in struma ovarii and that such lesions exhibit the same morphologic and immunohistochemical profile as follicular variant PTC in thyroid. The application of molecular testing to verify the diagnosis can be valuable, as these lesions may harbor ret/PTC gene rearrangements.
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MESH Headings
- Adult
- Aged
- Biomarkers, Tumor/metabolism
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary, Follicular/genetics
- Carcinoma, Papillary, Follicular/metabolism
- Carcinoma, Papillary, Follicular/secondary
- Carcinoma, Papillary, Follicular/surgery
- Cohort Studies
- DNA Mutational Analysis
- Female
- Humans
- Keratin-19/metabolism
- Middle Aged
- Ovarian Neoplasms/genetics
- Ovarian Neoplasms/metabolism
- Ovarian Neoplasms/secondary
- Ovarian Neoplasms/surgery
- Proto-Oncogene Proteins B-raf/genetics
- Proto-Oncogene Proteins c-ret/genetics
- Retrospective Studies
- Struma Ovarii/etiology
- Struma Ovarii/genetics
- Struma Ovarii/metabolism
- Struma Ovarii/surgery
- Thyroid Neoplasms/pathology
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Affiliation(s)
- Odette Boutross-Tadross
- Department of Pathology and Laboratory Medicine, McMaster Medical School, Hamilton, ON, Canada
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