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Graves' disease and coexisting struma ovarii: struma expression of thyrotropin receptors and the presence of thyrotropin receptor stimulating antibodies.

Struma ovarii is a rare cause of hyperthyroidism and particularly rare in patients with coexisting Graves' disease. We describe a 28-year-old female who presented with symptoms and signs of hyperthyroidism (free thyroxine [FT(4)] 39 pmol/L, thyrotropin [TSH] < 0.05 mU/L) and associated ophthalmopathy, consistent with Graves' disease. The patient relapsed twice: once after initial successful management with carbimazole and subsequently after subtotal thyroidectomy. Radioisotope scanning showed focal uptake bilaterally in the neck and believing this was the source of thyroid hormone excess, carbimazole was restarted. A left ovarian mass was found on ultrasound during the investigation of unrelated nephrotic syndrome resulting from focal segmental glomerulosclerosis. A 555-g struma ovarii was removed surgically. Hypothyroidism developed postoperatively (FT(4) 9.7 pmol/L, TSH 36 mU/L). Circulating TSH receptor stimulating antibodies were positive and immunohistochemical studies confirm the presence of TSH receptors on the struma ovarii. The demonstration of TSH receptors on the struma ovarii increases previous speculation that struma ovarii growth and function may be augmented by the circulating TSH receptor stimulating antibodies of Graves' disease.

Adult↗

Case report: Malignant struma ovarii.

Struma ovarii are specialized teratomas consisting of thyroid tissue with various microscopic features, ranging from benign to malignant. We report a rare form of malignant struma ovarii, composed exclusively of a follicular variant of papillary thyroid carcinoma with capsular invasion, which occurred in a 65-yr-old woman.

Aged↗

[Primary hyperthyroidism after excision of a Struma ovarii].

Struma ovarii is a teratoma composed of thyroid tissue and can be a rare cause of hyperthyroidism. We report a 35 years old woman with a left ovarian mass whose pathology revealed a Struma ovarii. This tumor was partially excised initially to avoid fertility problems and after a successful gestation, the tumor was completely removed during a cesarean section. Sixty days after delivery a hypothyroidism was diagnosed. Levothyroxine was started and euthyroidism was achieved.

Adult↗

Malignant struma ovarii.

Malignant struma ovarii is a very rare tumor, with considerable disagreement concerning the necessary histologic features for malignancy. The prognosis with patients with a malignant struma ovarii is difficult to make because of inadequate follow-up of the reported cases and long clinical courses. In most cases the patients responded well to surgical treatment but sometimes patients have died from malignant struma ovarii, in particular, if there is metastasis. There is evidence that radioactive iodine is effective in treating metastatic struma. The present case reports the use of intraperitoneal chronic phosphate for metastatic intraperitoneal disease, with thyroid suppression. Long-term follow-up will be necessary to properly evaluate this therapy. Prophylactic administration of thyroid hormone should be considered in cases of malignant struma ovarii.

Adult↗

Pseudo-Meigs syndrome and elevated CA125 associated with struma ovarii.

BACKGROUND: Struma ovarii is a rare form of ovarian neoplasm composed entirely and predominantly of thyroid tissue. The association of pseudo-Meigs syndrome, elevation of CA125 and hyperthyroidism to struma ovarii is a rare condition. CASE: We report an unusual presentation of a postmenopausal woman with benign struma ovarii associated with pseudo-Meigs syndrome, hypertiroidism, and elevated CA125 serum level, and a large complex right pelvic mass thereby mimicking an ovarian cancer. CONCLUSIONS: Struma ovarii is a rare cause of ascites, hydrothorax, elevated CA125, and hyperthyroidism. This rare condition should be considered in the differential diagnosis in patients with ascites and pleural effusions but with negative cytology.

Aged↗

Malignant struma ovarii.

Malignant struma ovarii is a rare form of ovarian germ cell tumors. Because of its rarity, diagnosis and management of the tumor has not been clearly defined. A 52-year-old female with follicular variant of papillary carcinoma arising in struma ovarii is presented. There was no evidence of clinical malignancy or metastases. However on the basis of histopathologic findings, the case was diagnosed as malignant struma ovarii. It was accepted as stage Ia tumor and no other treatment was considered after radical excision. Due to its fairly good prognosis, surgical excision has been the preferred treatment for those who do not have disseminated disease. Nevertheless, long-term follow-up is necessary to determine the course of the disease.

Diagnosis, Differential↗

Hypothyroidism due to Hashimoto thyroiditis post struma ovarii excision.

Struma ovarii is a rare ovarian teratoma that may produce hyperthyroidism. The association with Hashimoto thyroiditis HT, however is rare and has been reported in only one case. We report a case of HT following the resection of struma ovarii tumor, after which the patient became frankly, hypothyroid with elevated thyroid stimulating hormone and low thyroxin levels. Her thyroid peroxidase antibodies were positive. She improved after initiation of levothyroxine replacement therapy. We believe her euthyroid status preoperatively was due to thyroid hormone secretion by struma ovarii itself.

Autoantibodies↗

Radiotherapy with iodine-131 in recurrent malignant struma ovarii.

Malignant struma ovarii is a very rare disease and, therefore, there is neither common agreement on treatment regimens nor sufficient follow-up experience. We present a case of a 49-year-old woman with malignant struma ovarii of the follicular type, who received ablative radioiodine treatment after thyroidectomy and surgical removal of the primary tumour. During follow-up examinations an increasing thyroglobulin level was found, caused by a tumour relapse with suspected urinary bladder infiltration on CT and proven uptake of radioiodine on whole-body scanning with iodine-131. After administration of 6GBq 131I, complete tumour regression was achieved with no evidence of a new relapse during a 30-month follow-up period. Correspondingly, repeated thyroglobulin measurements were all negative. This case demonstrates the benefit of combined surgical and radioiodine treatment of malignant struma ovarii for both monitoring and therapy of relapse or metastases; thus, the same therapeutic regimen as is employed in primary differentiated thyroid carcinoma may be recommended.

Biomarkers, Tumor↗

Malignant struma ovarii.

Malignant struma ovarii is a very rare tumor, belonging to the group of germ cell tumors. The diagnosis is difficult and there is no agreement in the literature concerning the necessary histologic features for malignancy. A case report is presented and the problems of diagnosing are discussed.

Adenocarcinoma↗

Struma ovarii and hyperthyroidism.

Struma ovarii is a teratoma of the ovaries that contains a large amount of thyroid tissue. Like the cervical thyroid gland, this ectopic thyroid tissue can become autonomous. We present a case of hyperthyroidism caused by thyroid tissue in a large ovarian cystic teratoma and provide detailed endocrinological, radiological, and pathological preoperative and postoperative data. This is also the first documented case of struma ovarii in association with a secreting pituitary tumor. In addition, we provide a retrospective pathological analysis of 1390 surgically removed ovarian tumors at 2 major academic centers.

Adult↗

Diagnosis and treatment of disseminated struma ovarii with malignant transformation.

Struma ovarii are specialized teratomas consisting of thyroid tissue. They may demonstrate all pathologic features seen in the thyroid gland. Malignant transformation of thyroid tissue in struma ovarii is uncommon and is rarely recurrent or metastatic. We report the diagnosis and treatment of a recurrent struma ovarii with malignant transformation, and intraperitoneal, retroperitoneal, and hepatic metastases.

Female↗

Asymptomatic struma ovarii: a case report.

Struma ovarii is a rare ovarian neoplasm. This tumor is generally benign, although malignant transformation has been reported. The preoperative diagnosis is generally difficult. Thyroid hormones may be produced and in a few cases asymptomatic women may develop definitive clinical hypothyroidism after resection of struma ovarii. We report a case of a 39-year-old woman who underwent laparoscopic resection of an asymptomatic right ovarian mass. The pathologic diagnosis was struma ovarii. The postoperative period was uneventful and her thyroid function remained normal.

Adult↗

Pseudo-Meigs' syndrome associated with malignant struma ovarii: a case report.

BACKGROUND: Malignant struma ovarii is a rare tumor, consisting of a struma ovarii with malignant transformation. The association of a malignant struma ovarii with pseudo-Meigs' syndrome and elevated Ca-125 levels has been never reported. CASE: A 66-year-old woman presented with monolateral ovarian mass, ascites, hydrothorax, and elevated Ca-125 levels. Optimal medical staging was performed. Definitive histological examination revealed a malignant struma ovarii. The immediate and complete resolution of symptoms and rapid decline of both Ca-125 and thyroglobulin levels to normal value were achieved post-operatively. After counseling, strict follow-up was planned, and no adjuvant therapy was administered. CONCLUSION: We report the first case of pseudo-Meigs' syndrome associated with malignant struma ovarii and elevated Ca-125 levels. The choice of not performing adjuvant therapy is feasible after optimal surgery and adequate staging procedure given to the usually clinical benign course and the low incidence of metastases in malignant struma ovarii. Careful patient counseling is required.

Aged↗

Metastatic malignant struma ovarii. Two case reports.

Struma ovarii is an ovarian germ cell tumor consisting mainly of thyroid tissue. Five percent of struma ovarii are malignant, and of these only five percent metastasize. The rarity of this disease has resulted in difficulty in agreeing on treatment regimes and in limited imaging experience. The authors report two cases and highlight the imaging and monitoring difficulties encountered in their management. The authors conclude that I-131 has a role to play both therapeutically and in monitoring these patients, but that biochemical testing is a more reliable indicator of disease status.

Adolescent↗

Hypothyroidism following struma ovarii tumor resection: a case report.

Struma ovarii is an infrequent ovarian tumor, and there are only few reports with detailed data of thyroid function. In several cases, malignant struma ovarii have been shown to produce hyperthyroidism, but there is no reported case of hypothyroidism following struma ovarii tumor resection. A 62-year-old white woman underwent right ovary resection that had a pathologic diagnosis of struma ovarii. After 6 days, she developed weakness, myalgia, somnolence, nausea, and arterial hypotension. Laboratory tests showed a high level of thyroid-stimulating hormone (TSH) and a decreased level thyroxin. Thyroxin replacement therapy was initiated, and the patient became completely asymptomatic. This is the first reported case of a previously asymptomatic woman who developed a definite clinical hypothyroidism after resection of a struma ovarii tumor.

Female↗

[Struma ovarii. A case report].

Struma ovarii is a rare ovarian tumor composed entirely or in part of thyroid tissue. Pathogenesis is unclear. Diagnosis rests on the histologic study. A case is reported. Specific features of struma ovarii are discussed based on a review of the literature. The treatment is surgical and the outcome generally favorable.

Female↗

Benign and malignant struma ovarii.

Three cases of struma ovarii are reported, two of which were benign, and one which was malignant. Immunoperoxidase studies confirmed that the tumors secreted triiodothyronine and thyroxine, but no carcinoembryonic antigen nor alpha-fetoprotein. In the case of the malignant struma ovarii, the patient's thyroid was histologically normal, and thus the possibility of a metastasis to the ovary from a primary thyroid carcinoma was excluded.

Aged↗