Thyroid carcinoma on an ovarian teratoma: a case report and review of the literature.
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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.
The authors report two cases of ovarian goiters; they insist upon their rarity and the difficulty of their pré-operatory diagnosis. Only histologic examination can affirm their goitrous origin. The treatment of ovarian goiters is surgical. The evolution is favorable except their exceptional malignant transformation.
Malignant Brenner tumour is a rare pathological entity. Apart from identification of typical benign, metaplastic and/or proliferating components, stromal invasion must be observed for diagnosis of Brenner tumour. A case of malignant Brenner tumour is described along with a brief review of strict criteria of diagnosis and its biological behaviour.
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An ovarian strumal carcinoid which synthesized peptide hormones, but did not induce the carcinoid syndrome, was analysed histochemically, immunohistochemically and ultrastructurally. Dot-immunobinding assays were performed in order to determine the endocrine gene expression. The amylase resistant colloid was found to be PAS-positive in the follicular portions of the tumour. Carcinoid cells showed Grimelius positive argyophilic granules in the subnuclear position. The Fontana-Masson argentaffin reaction was negative. Immunohistochemistry for adrenocorticotropic hormone (ACTH) revealed strong reactivity in the follicular areas of the carcinoid. The immunoreactivity for somatotropic release inhibiting factor (SRIF) was found positive in the trabecular portion of the carcinoid tumour, thyroglobulin in the follicles. Neuron-specific enolase, protein S-100 A/B, synaptophysin and chromogranin A evoked weak cytoplasmic immunostaining of the tumor cells. Dot-immunobinding assays substantiated these immunohistochemical results, except for the thermolabile protein S-100 A/B. Electron microscopy of tumor cells showed numerous electron-dense cytoplasmic granules, 250 to 350 nm in diameter, both in follicular and trabecular areas of the tumor. Plasma levels of tumor-associated ACTH, SRIF and thyroglobulin were measured by radioimmunoassay and were found to be within the normal range.
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Strumal carcinoid tumor is a very rare primary tumor of the ovary in which carcinoid is admixed with tissue resembling thyroid follicles. We report a 44-year-old women with benign strumal carcinoid tumor of the ovary and without any clinical symptoms. Histochemical and electron microscopical examinations of the tumor showed intracytoplasmic dense core secretory granules, indicating that this neoplasm is a pure carcinoid tumor with acinar differentiation resembling thyroid tissue.
Report about a rare case of strumal carcinoid tumor arising in the right and left ovary of a 79-year-old euthyroid woman. In the literature we found nearly always unilateral cases. There was no carcinoid syndrome. The tumor was a chance hit by the necropsy.
A rare observation of an unilateral ovarian tumour in a 62-year-old patient is presented. According to the clinical data and the results of the ultrasound examination the tumour was considered as a carcinoma. Hysterectomy with appendages and large omentum resection were performed. A tumour of the right ovary, 13 x 10 x 10 cm was found: cyst with a grey-brown soft node was observed in the cut surface. Histologically, the struma remnants were observed in the cyst wall and structures corresponding to the follicular carcinoma of the thyroid, the central parts of which had a structure of the C-cell thyroid carcinoma. Ultrastructural examination confirmed a light microscopic diagnosis of the malignant monodermal ovarian teratoma developing from the struma with areas of follicular solid C-cell carcinoma.
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A review of 13 ovarian strumal carcinoids in the files of the Armed Forces Institute of Pathology has established further evidence that these tumors have both endocrine and neuroendocrine differentiation. The two functional routes of differentiation occur even within individual tumor cells. Immunohistochemical reaction for thyroglobulin was positive in the strumal regions of all 12 cases tested. This positivity was also present in transitional zones where the thyroid follicles merged with nests of carcinoid cells. Electron microscopy performed in six cases showed cells with neuroendocrine granules in the thyroid follicles; these cells resemble the C-cells of the normal thyroid gland. An immunoperoxidase reaction for calcitonin, however, revealed no positivity in any of the cells corresponding to the neuroendocrine cells within the follicles or those in the carcinoid component. Variable positivity for serotonin was observed, however. It is proposed that cells within the struma that have morphologic similarities to the C-cells of the thyroid give rise to the carcinoid component. These cells appear capable of producing thyroglobulin as well as neuroendocrine granules.
A series of six ovarian strumal carcinoids was examined. The presence of thyroid follicular epithelium was conclusively proved by the presence of follicular cells immunohistochemically positive for thyroglobulin, and by the ultrastructural identification of non-neuroendocrine cells with features of thyroid epithelium lining the follicles. Progressive replacement of thyroid epithelial cells by carcinoid cells accounts for the predominance of neuroendocrine granule-containing cells and the scarcity of thyroid epithelial cells lining many of the follicles. A variety of neuroendocrine hormones and other immunoreactive substances was demonstrated within carcinoid cells, including somatostatin (five cases), chromogranin (five cases), serotonin (five cases), glucagon (four cases), insulin (two cases), and gastrin (one case). Only one case contained calcitonin-positive cells. None were carcinoembryonic antigen-positive or had amyloid deposits. The carcinoid element in five cases stained positively for prostatic acid phosphatase. While strumal carcinoid shares some features with medullary carcinoma of the thyroid gland, it has sufficient differences to warrant a separate designation.
The case of a 58-year-old Japanese female with strumal carcinoid of the ovary is described. Ultrastructural examinations revealed numerous neurosecretory-type granules in the cytoplasm of both thyroid and carcinoid components. Immunohistochemical studies showed immunoreactivities for thyroxin and thyroglobulin in the thyroid component. Several mucous glands were also observed in the tumor tissue. These morphological findings suggested that the follicles in the thyroid component were lined with thyroid follicular, carcinoid and mucous cells, and also supported the theory that this tumor may be derived from multidirectional differentiations of endodermal origin.
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