She had total thyroidectomy, with negative histology, followed by first i1 therapy 3. Us demonstrates a complex appearance with multiple cystic and solid areas, findings that reflect the gross pathologic appearance of the tumor. This study aimed to delineate the management of struma. Sep 16, 2015 thyroid tissue is a relatively frequent component of mature teratoma and can occur in 520 % of cases. Reexamination of pathology samples, with the help of immunohistochemical markers, concluded to a struma ovarii. Struma ovarii, as a monodermal variant of ovarian teratoma, was first described by boettlin in 1889 and gottschalk in 1899.
Proliferative struma differed from the usual struma ovarii in that they. Malignant transformation of struma ovarii is an even rarer occurrence and accounts for approximately 5% of struma ovarii 3, 5. Coexistence of malignant struma ovarii and cervical papillary. The excised ovarian mass showed evidence of struma derived papillary thyroid carcinoma. Since its first description in the early part of the twentieth century, struma ovarii has elicited considerable interest because of its many unique features.
It is defined by the presence of thyroid tissue comprising more than 50% of the overall mass. The clinical records, ct and mri features of twelve patients with pathologically proved so were retrospectively analyzed. The search of our database in the hospital of ben arous starting from 2005 to date has found only three cases of struma ovarii among a total of 35 dermoid tumors. Written by well known experts in endocrine pathology, this 580page book helps surgical pathologists, fellows, and residents master required knowledge in all areas of endocrine pathology, including thyroid, parathyroid, pituitary, adrenal, pancreas, skin, and inherited tumor syndromes. This phenomenon may indicate an embryological origin. Struma ovarii is a rare entity consisting of thyroid components that are part of a teratoma or dermoid in the ovary. Mar 08, 2019 struma ovarii is a rare ovarian tumor defined by the presence of thyroid tissue comprising more than 50% of the overall mass. Besides detection at early stage, a biologically low grade tumor was encountered as well. We report a case of pure struma ovarii tumor diagnosed by cytology during laparoscopic surgery. Struma ovarii accounts for approximately 5 percent of all ovarian teratomas. To qualify as a struma ovarii tumors more than 50% of the tumor should be composed of thyroid tissue 7. The morphological spectrum of the thyroid tissue ranges from that of normal thyroid to proliferative adenomalike lesions and thyroidtype carcinomas malignant transformation. On gross pathological examination, there was a left ovarian mass measuring 10. By continuing to use our website, you are agreeing to our use of cookies.
Journal of clinical imaging science struma ovarii with. On gross pathological examination, struma ovarii may be present as. Malignant transformation occurs in struma ovarii and coexisting incidental ptc in the thyroid. Gross pathology approximately 94% of the thyroidtype carcinomas arising in struma ovarii are unilateral and appear to involve the left ovary more commonly than the right ovary. The patient was subsequently performed left salpingooopherectomy and retroperi. The vast majority of struma ovarii are benign tumours. Concise, focused chapters, supported by tables, diagrams. Struma ovarii is an uncommon condition, in which thyroid tissue is the predominant or exclusive element in an ovarian teratoma. Histological malignancy in struma does not necessarily equate with biological malignancy, and the majority of thyroid. An unusual case of malignant struma ovarii causing. Because of its rarity, the diagnosis and management of the tumour have not been clearly defined. Struma ovarii is an infrequent type of dermoid ovarian tumor that is usually benign and composed of at least 50% thyroid tissue. May 30, 2017 struma ovarii is a rare monodermal germ cell tumor where the ovary is comprised of at least half thyroid tissue. Struma ovarii results from the presence of thyroid tissue that becomes hyperactive in an ovarian teratoma.
A struma ovarii is a rare form of monodermal teratoma that contains mostly thyroid tissue, which. Mar 21, 2012 struma ovarii is a rare form of ovarian neoplasm in a form of mature teratoma and is composed predominantly of thyroid tissue. Struma ovarii associated with pseudomeigs syndrome. In keeping with this definition, struma ovarii is an uncommon monodermal teratoma that constitutes approximately 3% of ovarian teratomas, 2% of germ cell tumors of the ovary, and 0. This also includes cases of mature teratoma with less than 50 % thyroid tissue but harboring thyroidassociated malignancy. The book has much to commend it, especially the extensive experience and enlightened erudition of the contributors, a dozen of. Part of the highly regarded diagnostic pathology series, this updated volume by drs. While management involves surgery, there is a paucity of data regarding the extent and approach of surgery, and postoperative management.
Struma ovarii is a rare ovarian teratoma predominantly composed of thyroid tissue. Struma ovarii is a rare tumor with an incidence of 0. Patients with malignant struma ovarii may respond to thyroidectomy followed by radioactive iodine therapy 2, 3. Malignant struma ovarii is a rare type of germ cell tumor that is most often diagnosed postoperatively. Papillary thyroid carcinoma, follicular and papillary growth patterns, 1. The patient was treated with a total hysterectomy and bilateral salpingooophorectomy, which revealed an. Malignancy in struma ovarii is a rare form of ovarian germ cell tumour. Struma ovarii is defined as ovarian goiter which comprises either entirely or predominantly thyroid tissue 50 %. The ultrasound us features of struma ovarii are nonspecific, but a heterogeneous, predominantly solid mass may be seen. Malignant transformation is rare, occurring in struma ovarii cases.
Struma ovarii is defined as a mature ovarian teratoma composed predominantly of thyroid tissue pathology 2007. To qualify as a struma ovarii tumours more than 50% of the tumour should be composed of thyroid tissue 7. Entirely cystic struma containing green gelatinous material also occurs who classification of tumours of the female reproductive organs, 4th edition, 2014. Nov 23, 2010 to analyze the imaging features of struma ovarii so, and to correlate the imaging results with the pathological findings so as to enhance the knowledge of the imaging diagnostics of this disease. Grouped with mature teratoma, as it is considered a welldeveloped mature teratoma it has been suggested they are distinct from teratomas. Struma ovarii, a rare neoplasm, is a monophyletic teratoma composed of thyroid tissue.
Outstanding imagesmore than 2,400 in allmake this an invaluable diagnostic aid for every practicing pathologist, resident, or fellow. It may be part of a teratoma or cystadenoma and may also have a malignant character papillary thyroid carcinoma. Although the typical presentation is that of a pelvic mass, unusual clinical manifestations such as hyperthyroidism, ascites, and meigs syndrome have. Pathology and obstetrics and gynecology, malmo university hospital, lund university, lund, sweden. Struma ovarii is a specialized or monodermal teratoma predominantly composed of mature thyroid tissue. Struma ovarii is the most common type of ovarian monodermal germ cell teratoma, accounting for nearly 3% of all ovarian teratoma. Struma ovarii is defined by that the tumor is composed either entirely or predominantly over 50% of thyroid tissue 2,3. The new expert consult platform combines authoritative, worldclass book content from elsevier and improved search, rich media, and social and community features from inkling, making it one of the most efficient tools available to health care professionals today.
Struma ovarii is a variant of a germ cell tumor composed predominantly of thyroid tissue. Vania nose is a visually stunning, easytouse reference covering 125 of the most common endocrine pathology diagnoses. Struma ovarii or monodermal teratoma, is a specialized ovarian neoplasm composed entirely of mature thyroid tissue. Imaging features were compared with pathological results. Some tumors show both gross and microscopic features of a. Struma ovarii is defined as ovarian goiter that is c we use cookies to enhance your experience on our website. Solid and cystic tumor, tumor with several nodules partially separated by gray whitish fibrous tissue, nodules appear tanbrown in color with small dark red areas, cystic spaces filled with yellowbrown or strawcolored fluid, and focal areas of calcification.
Ovarian teratoma either composed predominantly or exclusively of benign thyroid tissue or with any amount of malignant thyroid tissue. The enigma of struma ovarii connecting repositories. A 30year old nulliparous woman presented with acute right lower quadrant pain and underwent laparoscopic right salpingooophorectomy. Image were created or taken from wikimedia commons i created this. Struma ovarii with malignant transformation and germline kit. One of the patients had a novel braf mutation g469a, and a separate patient had a. Thyroidtype carcinoma of struma ovarii archives of. Cytologic evaluation of the ascitic fluid showed no evidence of malignant cells. Thyroid tissue is a relatively frequent component of mature teratoma and can occur in 520 % of cases. A 17yearold patient was diagnosed with papillary thyroid cancer in struma ovarii. A coexistence of struma ovarii with serous cystadenoma has only been reported in six cases so far 47. Poorly differentiated thyroid carcinoma arising in struma. Struma ovarii, papillary thyroid carcinoma, malignant struma ovarii.
A report of two cases, american journal of clinical pathology, volume, issue 5, 1 may 1943, pages 271277. Papillary thyroid cancer in a struma ovarii in a 17year. The book provides a ready repository of the clinical and pathologic characteristics of all sorts of thyroid lesions, be it ccell hyperplasia, lateral aberrant thyroid, intrathyroidal parathyroid, or even struma ovarii. Struma ovarii is a rare ovarian tumor defined by the presence of thyroid tissue comprising more than 50% of the overall mass. Our 1 st and 3 rd cases were opened as a case of suspected malignant teratoma, but histopathology revealed it to be benign struma ovarii. A, gross photograph of surgical specimen showing a yellow, solid, gelatinous mass. Struma ovarii has been found to coexist with other ovarian malignancies, most common being mucinous cystadenoma, followed by brenner tumour, thecoma, ovarian fibroma, and focal hilus cell hyperplasia. We present a case of 64yearold woman who was admitted for evaluation of a slowly enlarging pelvic mass associated with pelvic organ prolapse for many years. Diagnostic pathology and molecular genetics of the thyroid. Concomitant struma ovarii with serous cystadenoma in a. Health, general cancer care and treatment diagnosis risk factors carcinoma radiotherapy health aspects. Thyroid tissue must comprise more than 50 percent of the overall tissue to be classified as a struma ovarii. It most commonly occurs as part of a teratoma, but may occasionally be encountered with serous or mucinous cystadenomas. Clinical and histopathological study of struma ovarii.
D adenoma originating in struma ovarii, american journal of clinical pathology, volume 3. Part of the highly regarded diagnostic pathology series, this updated volume by dr. Here, we present a case of struma ovarii in a female presented with abdominal distension. Struma ovarii accounts for 5% of ovarian teratomas. Struma ovarii is an ovarian tumor defined by the presence of thyroid tissue comprising 50% of the overall mass. B, frozen section of the mass from a, showing absence of colloid material in the follicles of struma ovarii during tissue processing. The gross pathologic appearance of struma ovarii differs from that of mature cystic teratomas where struma ovarii consist of ambercoloured thyroid tissue, with haemorrhage, necrosis, and fibrosis.
Posttherapy whole body scan after levothyroxine withdrawal revealed uptake in the thyroid bed, abdomen, and pelvis. Struma ovarii definition of struma ovarii by medical dictionary. A rare presentation of an infrequent tumor sonia chhabra, namita bhutani, sunita singh, mansi aggarwal, rajeev sen department of pathology, post graduate institute of medical sciences pgims. Struma ovarii comprises 14% of all dermoid tumors of the ovary, and very rarely presents in a malignant form, occurring in 0. A case of papillary thyroid carcinoma in struma ovarii and. Despite its name, struma ovarii is not restricted to the ovary. Struma ovarii is an ovarian teratoma composed mainly of thyroid tissue, which can occasionally develop a malignant thyroid tumor. Strumal carcinoid, a neoplasm apparently unique to the ovary containing elements of both struma and carcinoid, has been misdiagnosed as malignant struma ovarii in the past. We present a case of papillary thyroid carcinoma arising in a struma ovarii of the left. Thyroid tissue may be also found in the peritoneal cavity as in benign strumosis. Malignant struma ovarii is a very rare tumor, with considerable disagreement concerning the necessary histologic features for malignancy. Immunohistochemically it stained for thyroglobulin, which confirmed the thyroid epithelial nature of the neoplasm fig.
The incidence of malignancy arising in patients with struma ovarii is rare. Struma ovarii associated with pseudomeigs syndrome and high. Ninetysix cases were diagnosed struma ovarii, including 10 cases of papillary thyroid carcinoma, 1 case of highly differentiated follicular carcinoma of ovarian origin hdfco, 5 cases of strumal carcinoid, and 80 cases of struma ovarii 53 cases of thyroidonly struma ovarii. Struma ovarii can mimic ovarian malignancy clinically, when presented with a complex ovarian mass, with ascites and an elevated ca125. The histologic features of ovarian strumal lesions sometimes cause diagnostic problems due to the confusion with other. Struma ovarii simulating ovarian sertoli cell tumor. Struma ovarii is a rare ovarian tumour that has been reported to represent 0. Sep 25, 2016 this is a brief video on neoplastic and nonneoplastic diseases of the ovaries. Antithyroid treatment was discontinued 1 month after surgery in light of the pathology result. Poorly differentiated thyroid carcinoma arising in struma ovarii. Nucci and esther oliva is an ideal pointofcare reference for the accurate diagnosis of the full range of nonneoplastic and neoplastic conditions of the female genital tract, including common and uncommon entities. A report of 96 cases thyroid tissue is a relatively frequent component of mature teratoma and can occur in 520. Diagnosis of struma ovarii with medical imaging springerlink.
Ovary and fallopian tube, left, salpingooophorectomy. It constitutes about less than 3% of ovarian teratomas. The gross pathologic appearance of struma ovarii differs from that of mature cystic teratomas where struma ovarii consist of ambercolored thyroid tissue, with hemorrhage, necrosis, and fibrosis. Struma ovarii is a mature teratoma and accounts for approximately 3% of all ovarian teratomas. Four percent of the germ cell tumors were calculated to be of struma ovarii 16382. More than 95% of gct are benign dermoid cysts mature cystic teratomas.
The final pathology revealed right benign struma ovarii with cystic and solid components. Discrete mass consisting of mature tissues that form welldeveloped structures with the normal anatomical relations. Thyroid tissue may demonstrate the same spectrum of pathological features as in the normal thyroid including benign and malignant changes. In such cases, the tumor mimics malignant ovarian tumor.
This tumor was first described in 1889 by boettlin, who observed the presence of thyroid follicular tissue in ovaries, and further reports thereafter were published by gottschalk. The stages of the malignant cases were recorded as ia and 1c. It is defined as the presence of thyroid tissue comprising greater than 50% of the cellular component in an ovarian tumor, virtually always a teratoma. We use cookies to offer you a better experience, personalize content, tailor advertising, provide social media features, and better understand the use of our services. Synchronous independent papillary thyroid carcinomas in struma. Struma ovarii of the ovary is a relatively rare tumor which comprises 1% of all ovarian tumors and 2. A case of struma ovarii diagnosed by cytology during.
Struma ovarii containing thyroid type carcinoma must be distinguished from rare cases of papillary or follicular thyroid carcinoma metastatic to the ovary. Struma ovarii is a rare ovarian tumor that was first described in 1899. Cureus papillary thyroid carcinoma in struma ovarii. The risk of recurrence is higher in patients with a gross extraovarian extension of the tumor. It is generally considered to account for less than 5% of. A struma ovarii is a rare form of monodermal teratoma that contains mostly thyroid tissue, which may cause hyperthyroidism. Note that the tumor is composed almost entirely of thyroid tissue. Struma ovarii so is a specialized monodermal teratoma.
Papillary carcinoma is the most frequent 70% thyroid carcinoma subtype. Struma ovarii is diagnosed when thyroid tissue accounts for 50% of the teratoma. Karseladze, highly differentiated follicular carcinoma arising from struma ovarii. In strumal carcinoid, the carcinoid tissue is present in the struma. Struma ovarii is an uncommon type of ovarian mature teratoma with a predominant thyroid component. Most commonly, they occur as part of a teratoma, but may occasionally be encountered with serous or mucinous cystadenomas. Our patient underwent thyroidectomy and treatment with radioactive iodine 5. Germ cell tumors gct originate from primordial germ cells and make up 30% of all ovarian tumors. The epub format uses ebook readers, which have several ease of. The prognosis with patients with a malignant struma ovarii is difficult to make because of inadequate followup of the reported cases and long clinical courses. Malignant gct make up 3% and 20% of all ovarian cancers in western countries and asianafrican countries respectively.