1/25. Follicular carcinoma in a functioning struma ovarii.We describe a case of follicular carcinoma in a functioning struma ovarii, which presented as an ovarian mass in a patient who had undergone a near-total thyroidectomy for a benign lesion. She underwent bilateral salpingo-oophorectomy and received radiotherapy and L-thyroxine treatment with no evidence of metastases in 4 years follow-up.- - - - - - - - - - ranking = 1keywords = struma ovarii, struma, ovarii (Clic here for more details about this article) |
2/25. Recombinant human thyrotropin for the diagnosis and treatment of a highly functional metastatic struma ovarii.The optimal treatment of metastatic thyroid cancer that produces high amounts of thyroid hormone has not been well defined. A 46-yr-old woman presented with a follicular thyroid carcinoma arising from a struma ovarii with hepatic metastases. After the removal of both the struma and the thyroid gland, the liver metastases showed evidence of a high degree of hormonogenesis. brain, chest, abdomen, and bone imaging was negative for additional metastases. Because iodine uptake by most thyroid carcinomas is quite low in the absence of high levels of ambient TSH, we used recombinant human TSH (rhTSH) (Thyrogen) to achieve a concentration of 131I activity in the tumor high enough for a significant cytotoxic effect. After rhTSH administration (0.9 mg im daily for 2 consecutive days), a 131I diagnostic whole body scan confirmed the existence of 17 discrete hepatic foci of 131I uptake. To calculate the amount of 131I that would deliver an absorbed radiation dose that would be optimally cytotoxic to the metastases (>8000 rad/lesion) and not to the normal liver, we performed lesion dosimetry. Analysis of dosimetric data showed that 15 of 17 lesions would receive an adequate radiation dose following the administration of 65 mCi of 131I. Additionally, we performed whole body dosimetry to assure that this dose would not cause bone marrow toxicity. The patient was reevaluated 6 months after therapy; the liver metastases showed significant, but partial, response. In conclusion, we used the combination of rhTSH with lesional and whole body dosimetry for the treatment of highly functional metastases from follicular thyroid carcinoma arising within a struma ovarii. This strategy can be applied to determine a safe and effective dose of 131I for the treatment of any thyroid cancer metastases that produce enough TH to preclude stimulation of endogenous pituitary TSH secretion.- - - - - - - - - - ranking = 1.229685869744keywords = struma ovarii, struma, ovarii (Clic here for more details about this article) |
3/25. Functioning liver metastases on an I-131 whole-body scan: a case of malignant struma ovarii.A 46-year-old women was examined for severe constipation. Pelvic examination revealed a large pelvic mass extending to the level of the umbilicus. Computed tomography showed a large multicystic, septated mass in the pelvis and a small amount of fluid in the cul de sac. In addition, multiple ill-defined, mixed-attenuation hepatic lesions were identified. A malignant ovarian neoplasm with liver metastases was considered, so the pelvic mass was resected. Interestingly, histopathologic analysis revealed malignant struma ovarii of the follicular type. biopsy of the liver lesions confirmed metastatic disease with similar histopathologic findings. All thyroid laboratory values were in the normal range. The patient then had a total thyroidectomy to optimize thyroid ablation therapy with I-131. This revealed a small follicular adenoma but no evidence of cancer. An I-131 whole-body scan was performed and showed uptake in multiple functioning liver metastases.- - - - - - - - - - ranking = 1keywords = struma ovarii, struma, ovarii (Clic here for more details about this article) |
4/25. Metastatic thyroid carcinoma in the presence of struma ovarii.A 27-year-old woman presented with metastatic follicular carcinoma of thyroid cell type. Assessment was complicated by recent surgery for "benign" struma ovarii. She underwent total thyroidectomy which failed to show a neoplasm, leaving the struma ovarii as the likely source of the metastasis.- - - - - - - - - - ranking = 1.2keywords = struma ovarii, struma, ovarii (Clic here for more details about this article) |
5/25. Cystic ovarian metastasis from papillary thyroid carcinoma: a case report.Ovarian metastasis from a primary thyroid carcinoma is rare. In this report we describe a woman who manifested the unusual occurrence of metastases of papillary thyroid carcinoma to the ovary. Both clinically and pathologically, such a presentation can be difficult to distinguish from benign cystic neoplasms of the ovary or cystic struma ovarii.- - - - - - - - - - ranking = 0.2keywords = struma ovarii, struma, ovarii (Clic here for more details about this article) |
6/25. Malignant struma ovarii: report of a case and review of the literature.Malignant struma ovarii is a very rare disease and therefore there is neither common agreement on treatment regimens nor sufficient follow-up experience. The case of a 38-year-old woman with malignant struma ovarii is described. The patient presented with a clinically silent ovarian neoplasm discovered incidentally during investigations for metrorrhagia. The ovarian mass was resected and the tumor was found to be a teratoma. Within the teratoma a papillary thyroid carcinoma of the follicular variant was found. Subsequently, in order to make follow-up of the patient possible by thyroglobulin measurement and radioiodine whole body scintigraphy, near-total thyroidectomy was performed and the thyroid was found to be normal on histology. Whole body radioiodine scintigraphy with (131)I and ablation of the thyroid remnant by the administration of 80 mCi (131)I was performed. The patient recovered uneventfully and is now well.- - - - - - - - - - ranking = 1.2keywords = struma ovarii, struma, ovarii (Clic here for more details about this article) |
7/25. Malignant struma ovarii: a case report of laparoscopic management.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.- - - - - - - - - - ranking = 1.4285035471108keywords = struma ovarii, struma, ovarii (Clic here for more details about this article) |
8/25. Ovarian strumal carcinoid in association with multiple endocrine neoplasia, type IIA.Strumal carcinoid is an unusual form of monodermal ovarian teratoma with thyroid-like follicles admixed with typical carcinoid tumor patterns. We encountered a case of this neoplasm in a patient with multiple endocrine neoplasia, type IIA (Sipple's syndrome), including a medullary thyroid carcinoma diagnosed 24 years previously. During evaluation of bilateral adrenal pheochromocytomas, a unilateral left ovarian strumal carcinoid was discovered. Subsequently, the patient had a parathyroid adenoma excised. The ovarian tumor was immunohistochemically reactive for neuron-specific enolase, chromogranin, synaptophysin, and serotonin, but did not stain for calcitonin. The follicular structures stained for thyroglobulin. This unusual case shows that ovarian strumal carcinoid, like carcinoid tumors at other sites, may arise in association with multiple endocrine neoplasia.- - - - - - - - - - ranking = 0.17811521846407keywords = struma (Clic here for more details about this article) |
9/25. Spindle cell transformation of papillary carcinoma: an aggressive entity distinct from anaplastic thyroid carcinoma.Spindle cells are not routinely encountered in the context of thyroid pathology and are most often present in anaplastic thyroid carcinoma, medullary thyroid carcinoma, and benign conditions such as Riedel struma or de Quervain granulomatous thyroiditis. Only a few publications have reported papillary thyroid carcinoma admixed with a prominent spindle cell component. While these tumors are clearly distinct from anaplastic thyroid carcinoma, prognostication as to their oncologic potential is not yet established. We describe a unique case of spindle cell transformation of papillary thyroid carcinoma. The blandness of the spindle cells was so impressive as to dissuade us from a malignant diagnosis on preoperative biopsies. However, this patient unfortunately died shortly after transformation of this papillary thyroid carcinoma. We conclude that this peculiar and rare spindle cell transformation should be regarded as a potentially lethal variant of papillary thyroid carcinoma.- - - - - - - - - - ranking = 0.029685869744012keywords = struma (Clic here for more details about this article) |
10/25. Thyrotoxic adenoma followed by atypical hyperthyroidism due to struma ovarii: clinical and genetic studies.OBJECTIVE: Atypical forms of hyperthyroidism represent a diagnostic challenge for clinicians. struma ovarii is an ovarian teratoma and constitutes a rare cause of ectopic thyroidal hormonal production. We describe a case of struma ovarii that combined two different sources of hyperthyroidism in the same patient and report genetic studies in order to contribute a better understanding of the autonomy and tumorigenesis of the struma ovarii. CASE REPORT: A 73-year-old nulliparous woman presented a thyroid toxic adenoma that was successfully treated with 10 mCi radioiodine. Unexpectedly, a new onset of hyperthyroidism prompted us to look for a second etiology. A whole-body scan with (123)I detected a pelvic hyperfixation suggesting struma ovarii, and a thyroid differentiated left ovarian teratoma 3 cm in size was surgically removed. We screened for mutations of thyroid-stimulating hormone receptor and Gs-alpha protein genes, as these mutations are common in thyroid adenomas. We did not identify any mutations. Androgen receptor study demonstrated a monoclonal status. comparative genomic hybridization did not reveal any chromosomal abnormality. However, loss of heterozygosity analysis showed several structural abnormalities, compared with the majority of benign ovarian teratomas, which show a normal karyotype. CONCLUSIONS: This is the first well-documented report of thyrotoxic struma ovarii revealed after treatment of a single thyroid toxic adenoma. We have shown in this case that struma ovarii originates from a single germ cell, and, albeit benign, this tumor presents several chromosomal abnormalities. struma ovarii-induced hyperthyroidism is likely to be mediated by mechanisms different from those of the classical thyroid toxic adenoma.- - - - - - - - - - ranking = 1.8570070942215keywords = struma ovarii, struma, ovarii (Clic here for more details about this article) |
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