Int J Thyroidol.  2023 Nov;16(2):184-189. 10.11106/ijt.2023.16.2.184.

A Case of Malignant Struma Ovarii with Cervical Papillary Thyroid Carcinoma

• Oh JE
• Kim GH
• Jeon GH
• Kim DW
• Kim K
• Kim JS
• Byeon HK

• KMID: 2548746
• DOI: http://doi.org/10.11106/ijt.2023.16.2.184

Abstract

Struma ovarii (SO) is a rare ovarian teratoma, which is diagnosed when thyroid tissue accounts for more than 50% of the teratoma. The majority of SO are benign, but malignant tumors have been reported in a small percentage of cases. Five percent of SO cases have been proven to be malignant and, as in the thyroid gland, papillary carcinoma is the most common histotype arising in SO. Because this tumor is rare, there are no guidelines regarding the management of this cancer. Usually, total thyroidectomy followed by radioiodine treatment is the treatment of choice in metastatic malignant struma ovarii, but therapeutic decisions should be made individually based on clinical and pathological data. We recently experienced a case of a 45-year-old woman finally confirmed as malignant struma ovarii with cervical thyroid cancer. Therefore, we present this unique case with a review of the literature.

Keyword

Struma ovarii; Malignant struma ovarii; Papillary thyroid carcinoma; Struma ovarii with malignant transformation

Figure

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  Fig. 1 Pathology of the surgical specimen from the oophorectomy previously done at another hospital showing malignant struma ovarii. (A) Microscopically, the tumor is composed of variably sized thyroid follicles with colloid (arrow) (Hematoxylin & Eosin staining [HE], ×40). (B) The tumor cells show mild nuclear membrane irregularity and nuclear clearing in some follicles (arrowhead) (H&E, ×200).

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  Fig. 2 (A, B) Contrast enhanced abdomen and pelvic CT findings. Metastatic lymph nodes are noted in left paraaortic area (arrow in A, arrowhead in B). (C) Coronal T2-weighted enhanced MRI findings. Metastatic lymph nodes are noted in left paraaortic area (arrowheads).

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  Fig. 3 PET-CT findings. (A) Focally increased FDG uptakes in right infrathyroidal area (arrowhead). (B) Focally increased FDG uptakes in left pelvic cavity (arrow). (C) Right thyroid US. (D) Left thyroid US. Normal in size without abnormal focal lesion.

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  Fig. 4 Pathology of the surgical specimen from para-aortic lymph node showing metastatic carcinoma. (A) The tumor (right area) shows variable sized follicles with papillary fronds (H&E, ×40). (B) Tumor cells show round to ovoid nuclei with mild nuclear membrane irregularity, coarse chromatin, and eosinophilic to clear cytoplasm (H&E, ×400).

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  Fig. 5 Intraoperative photographs. (A) Operative field after total thyroidectomy and central lymph node dissection. Left recurrent laryngeal nerve (arrow) preserved. (B) Right recurrent laryngeal nerve (arrowhead) preserved. (C) Surgical specimen.

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  Fig. 6 Pathology of the surgical specimen from thyroid showing papillary microcarcinoma without lymph node metastasis. (A) The tumor (center) shows variable sized follicles with papillary fronds (H&E, ×40). (B) Tumor cells show round to ovoid nuclei with nuclear enlargement, nuclear membrane irregularity, and chromatin clearing (H&E, ×400).

Reference

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