Ovarian Strumal Carcinoid: Case Report, Systematic Literature Review and Pooled Analysis

Clinical, pathological characteristics, and therapeutic outcomes of primary ovarian carcinoid tumors: a case series of 15 cases

BACKGROUND

The exact characteristics of primary ovarian carcinoid tumors remain largely unknown because of the rarity of the cases. This study aimed to investigate the clinical features, pathological characteristics, and therapeutic outcomes of patients with primary ovarian carcinoid tumors.

METHODS

This retrospective case series included patients with primary ovarian carcinoid tumors diagnosed between January 2009 and December 2023 at the First Affiliated Hospital of Wenzhou Medical University.

RESULTS

Fifteen patients were included. They were 45.8 ± 2.7 years at diagnosis. Eight tumors were located in the left ovary, while seven were in the right. All patients were stage I. Microscopically, nine tumors were classified as strumal carcinoid, two as insular carcinoid, three as trabecular carcinoid, and one as mixed. Synaptophysin (Syn) was positive in 14 cases, chromogranin A (CgA) in 10, CD56 in eight, thyroid transcription factor 1 (TTF-1) in five, and thyroglobulin (TG) in six. Twelve patients had a Ki67 index ≤ 7%. All 15 patients underwent surgery, with eight retaining fertility. Among them, one patient underwent comprehensive staging surgery, four underwent lateral adnexectomy, and three underwent cyst stripping. Seven patients underwent total hysterectomy and bilateral adnexectomy, including two patients undergoing comprehensive staging surgery. Three patients received intravenous chemotherapy. One patient was lost to follow-up. The remaining patients were followed up for 48-148 months; they were without recurrences and alive at the last follow-up.

CONCLUSIONS

Primary ovarian carcinoid tumors present with atypical symptoms and signs. Surgical intervention may be an optimal choice for treatment, leading to favorable prognostic outcomes.

A rare case report of primary ovarian carcinoid presenting with constipation

Background

Ovarian carcinoids are exceptionally rare. This report discusses an unprecedented case of a primary ovarian mixed insular and trabecular carcinoid, presenting with constipation.

Case Presentation

A 47-year-old female presented with a four-month history of constipation. A comprehensive abdominal CT with contrast revealed a large mass in the pelvic region, measuring 8.6×9.7×9.3cm. Consequently, the patient was referred for further evaluation. Intraoperative exploration uncovered a 10.0×9.0 cm mass in the left ovary. Initial histopathological assessment suggested a sex cord-stromal cell tumor, leading to a left ovariectomy and bilateral salpingectomy. Final histopathological analysis post-surgery identified the mass as a mixed insular and trabecular carcinoid. The patient was diagnosed with stage Ia, T1aN0M0 primary ovarian mixed insular and trabecular carcinoid.

Conclusions

Diagnosis of carcinoids predominantly relies on postoperative histopathological examination. As of now, There is no established standard treatment, emphasizing the necessity for ongoing patient monitoring.

Diagnostic challenges in primary ovarian carcinoid: Insights from radiological imaging-A case study

Primary ovarian carcinoid (POC) is a very rare subset of ovarian tumors, presenting diagnostic challenges due to its inconclusive radiological imaging. In this case study, we present a 30-year-old nulliparous female with subfertility complaints and irregular menstrual cycles, who was initially misdiagnosed with an ovarian cyst. Subsequent comprehensive imaging, including Color Doppler, revealed high vascularity, and prompting suspicion of malignancy. Surgical resection and histopathological evaluation ultimately confirmed the presence of a rare Carcinoid tumor, insular type. This case emphasizes a multidisciplinary approach to the early detection and accurate diagnosis of POCs.

Diagnostic and therapeutic challenges of a rare large ovarian strumal carcinoid in pregnancy, about a case report

INTRODUCTION

Ovarian strumal carcinoid is a rare type of germ cell tumor. It usually affects perimenopausal and postmenopausal women. Very few cases of stromal carcinoid have been reported in the literature in women of childbearing age, particularly during pregnancy. The clinical presentation of the tumor, and in particular its non-specific clinical and radiological appearance and rarity, explain the difficulties in diagnosis and management.

PRESENTATION OF CASE

Herein, we describe a rare case of a 36-year-old patient who was followed-up in our outpatient clinic for organic cyst of the ovary. The ultrasound revealed a multilocular regular cystic mass with a modestly thickened wall and fine septations. The MRI indicated a right ovarian cyst with solid tissue. The levels of tumor markers were normal. The patient was lost to follow-up and did not return until six months later. She was admitted in our Department with acute ovarian torsion and underwent emergency surgery at 17 weeks' gestation. A laparoscopic cystectomy of the right ovary was provisionally performed. Pathology revealed an ovarian strumal carcinoid tumor.

DISCUSSION

Patients with ovarian stromal carcinoid have an excellent prognosis. Ovarian strumal carcinoid 's primary therapy method is operation. The majority of original ovarian carcinoid tumors progress slowly, and practically all thyroid carcinoid tumors are clinical stage I with a positive prognosis.

CONCLUSION

In the absence of standardized treatment, the association of carcinoid strumal tumor with pregnancy, underlines the need for early diagnosis and appropriate multidisciplinary management, taking into account both the maternal and fetal prognosis.

Incidence, clinical characteristics, and survival outcomes of ovarian strumal diseases: a retrospective cohort study

BACKGROUND

Struma ovarii (SO) is a rare tumor and may transform into ovarian strumal carcinoid (OSC) and/or malignant struma ovarii (MSO), but the incidence, clinical characteristics, and survival outcomes have not been well defined.

METHODS

We conducted a retrospective study of patients with ovarian strumal diseases treated in the our hospital between 1980 and 2022. Subgroup analyses of SO, OSC, and MSO were subsequently performed.

RESULTS

A total of 275 cases (2.14%) were identified in a cohort of 12,864 patients with ovarian teratomas, where SO, OSC, and MSO accounted for 83.3%, 12.0%, and 4.7% of cases, respectively. There were no significant differences in age, tumor sizes, elevated tumor markers, and ascites among the three subgroups. At initial treatment, all patients with SO or OSC had FIGO stage I disease except one SO patient presenting metastatic disease, ten patients had MSO confined to the ovary, whereas other three patients had metastatic diseases. Two patients with SO respectively relapsed at peritoneum and anterior mesorectum, while none of the OSC patients presented tumor recurrence or death despite different surgical procedures employed. The 5-year recurrence-free survival rate was 88.9%, and only one death occurred at 9.5 years after diagnosis in patients with MSO. Radioiodine therapy showed satisfactory therapeutic efficacy, but these patients showed poor responses to the chemotherapy.

CONCLUSION

2.14% of ovarian teratoma could be classified as SO, of which 12.0% and 4.7% of SO may transform into OSC and MSO, repsectively. The survival outcomes were excellent even after SO transformed into OSC or MSO.

SYNOPSIS

SO occupied 2.14% of ovarian teratoma, where 12.0% and 4.7% of SO may transform into OSC and MSO, respectively, and had excellent survival outcomes.

Conservative treatment of borderline ovarian tumors: a retrospective study

Borderline ovarian tumors (BOTs) are a group of tumors with histological aspects and intermediate biological evolution between benign and malignant tumors, characterized by epithelial proliferation, lack of stromal invasion and nuclear atypia. BOTs account for approximately 10-15% of epithelial ovarian carcinomas. The interest in fertility preservation is very important as most BOTs are diagnosed in patients less than 40 years of age. Since borderline tumors occur in young, fertile women, the therapeutic approach depends on both staging and the need to preserve ovarian function and fertility. Treatment of BOT is primarily surgical, but recently fertility-preserving surgery has become more important. If infertility persists, ovarian induction or in vitro fertilization (IVF) may be suggested in selected cases.

Strumal Carcinoid Tumor of the Ovary: Report of Rare Occurrence with Review of Literature

The primary ovarian carcinoid tumor is a very rare ovarian tumor, which accounts for approximately 0.5% to 1.7% of all carcinoids and 1% of ovarian cancer. According to its histopathological features, it can be divided into four categories: insular, trabecular, strumal, and mucinous, among which insular carcinoid is common in Western countries. By comparison, the chain-typed and trabecular carcinoid seem to be common in Asian countries. To date, about 150 cases have been reported in the world, and 40% of them are strumal carcinoid tumor of the ovary (SCTO), which is a highly specialized teratoma differentiated from the monomer, and often characterized by the coexistence of thyroid follicular tissue and carcinoid tissue with the neuroendocrine function. Preoperative diagnosis may be difficult due to the very insidious nature of the disease and its multiple imaging manifestations. We reported the case of a 39-year-old woman with a 5-year clinical history. Gynecologic examination and ultrasonic testing revealed an enlarged ovary with a diameter of about 60 mm, accompanied by a hypoechoic area, which was suspected to be a benign teratoma. Ca-125, AFP, free T4, TSH, and other diagnostic indicators were normal. During the laparoscopic oophorocystectomy of the left ovary, a smooth and solid tumor with the size of 6 × 6 × 5 cm was found in the right ovary. During the operation, a mature cystic teratoma containing a struma was frozen, then the oophorocystectomy of the left ovary was performed. According to the Federation International of Gynecology and Obstetrics (FIGO) in 2014, histopathological examination showed a mature teratoma with thyroid carcinoid stage Ic, and Douglas's cystic hygroma cytopathology was negative. One year after the operation, the patient was tumor-free, with Ca-125, FT4, and TSH being within the normal range. Specific diagnostic tools and serological monitoring of malignant tumors of the ovary have low specificity and sensitivity in the diagnosis of this rare malignant tumor of the ovary. Female patients with habitual constipation, chronic abdominal colic, diarrhea, and endocrine dysfunction also need to be alert to this rare malignant tumor of the ovary.