Int J Thyroidol.  2023 May;16(1):134-138. 10.11106/ijt.2023.16.1.134.

Coexistence of Papillary Thyroid Carcinoma and Strumal Carcinoid Arising from Struma Ovarii in Pregnant Women: a Case Report and Review

• Im M
• Kim D
• Ryang S
• Kim BH

• KMID: 2543023
• DOI: http://doi.org/10.11106/ijt.2023.16.1.134

Abstract

Mature cystic teratomas (MCTs) of the ovary can occur at any age; however, the most common period is childbearing age, accounting for 10-20% of ovarian tumors and 85-97% of germ cell tumors. Differentiated thyroid cancers from MCTs in pregnant women are rare. A 32-year-old pregnant women presented with left ovarian mass revealed following a transabdominal ultrasonography performed to confirm pregnancy. After delivery, left ovarian cystectomy was performed and mass was examined by pathologists. The result of pathological examination was a combined papillary thyroid carcinoma (PTC) and stromal carcinoid from a mature teratoma. Thyroid ultrasonography was performed to check for accompanying thyroid cancer. Two nodules with no suspected malignancy were observed in both lobes and no other adjuvant therapy was administered. We would like to report this extremely rare case along with a literature review.

Keyword

Malignant transformation; Mature cystic teratoma; Struma ovarii

Figure

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  Fig. 1 Representative images before and after the surgery. (A, B) Preoperative transabdominal ultrasonography revealed a left ovarian mass measuring 7.42×7.51×7.46 cm. (C, D) Postoperative Positron emission tomography/computed tomography (PET/CT) showed no metastasis or residual tumor. (E) Postoperative pelvic magnetic resonance imaging (MRI) showed 3.23×2.73 cm sized right ovarian teratoma.

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  Fig. 2 Mixed papillary thyroid carcinoma and strumal carcinoid arising from mature cystic teratoma. (A) Mature teratoma showing seromucinous glands, skin and cartilage. (B) Papillary thyroid carcinoma with nuclear grooves and inclusions. (C) Carcinoid component showing organoid structures with minimal cytologic atypia. (D) Positive immunohistochemistry for synaptophysin to carcinoid component (lower part). (E) Upper part showing papillary carcinoma and lower part with carcinoid component. Benign mucinous epithelium between them. (F) Left part showing papillary carcinoma and Right part with carcinoid component. Benign mucinous epithelium between them.

Reference

References

1. Serov SF. 1973. S. F. Serov, R. E. Scully, in collaboration with L. H. Sobin and pathologists in ten countries. World Health Organization;Geneva:

2. Kim JY. 2016; A carcinoid tumor arising from a mature cystic teratoma in a 25-year-old patient: a case study. World J Surg Oncol. 14:120. DOI: 10.1186/s12957-016-0867-8. PMID: 27098182. PMCID: PMC4839142.

3. Antovska VS, Trajanova M, Krstevska I, Gosheva I, Chelebieva J, Prodanova I. 2018; Ovarian strumal carcinoid tumour: case report. Open Access Maced J Med Sci. 6(3):540–3. DOI: 10.3889/oamjms.2018.138. PMID: 29610616. PMCID: PMC5874381.

4. Robboy SJ, Scully RE. 1980; Strumal carcinoid of the ovary: an analysis of 50 cases of a distinctive tumor composed of thyroid tissue and carcinoid. Cancer. 46(9):2019–34. DOI: 10.1002/1097-0142(19801101)46:9<2019::AID-CNCR2820460921>3.0.CO;2-W. PMID: 7427909.

5. Ioannidis A, Kourtidis L, Zatagias A, Chorti A, Gourvas V, Efthimiadis C, et al. 2021; Papillary thyroid carcinoma arising in struma ovarii. Med Case Rep Study Protoc. 2(6):e0112. DOI: 10.1097/MD9.0000000000000112.

6. Yoo SC, Chang KH, Lyu MO, Chang SJ, Ryu HS, Kim HS. 2008; Clinical characteristics of struma ovarii. J Gynecol Oncol. 19(2):135–8. DOI: 10.3802/jgo.2008.19.2.135. PMID: 19471561. PMCID: PMC2676458.

7. Salman WD, Singh M, Twaij Z. 2010; A case of papillary thyroid carcinoma in struma ovarii and review of the literature. Patholog Res Int. 2010:352476. DOI: 10.4061/2010/352476. PMID: 21151690. PMCID: PMC2991076.

8. Devi P, Aghighi M, Mikhail N. 2020; Papillary thyroid carcinoma in struma ovarii. Cureus. 12(4):e7582. DOI: 10.7759/cureus.7582.

9. Lopes Dias J, Cunha TM, Gomes FV, Calle C, Felix A. 2015; Neuroendocrine tumours of the female genital tract: a case-based imaging review with pathological correlation. Insights Imaging. 6(1):43–52. DOI: 10.1007/s13244-014-0378-5. PMID: 25592289. PMCID: PMC4330232.

10. Bidzinski M, Piatek S, Cwikla J, Nasierowska-Guttmejer A, Danska-Bidzinska A. 2021; Contemporary principles of diagnostic and therapeutic management in cervical and ovarian neuroendocrine tumors. Ginekol Pol. 92(4):312–7. DOI: 10.5603/GP.a2020.0189. PMID: 33751517.

11. Chun YK. 2015; Neuroendocrine tumors of the female reproductive tract: a literature review. J Pathol Transl Med. 49(6):450–61. DOI: 10.4132/jptm.2015.09.20. PMID: 26459408. PMCID: PMC4696532.

12. Devaney K, Snyder R, Norris HJ, Tavassoli FA. 1993; Proliferative and histologically malignant struma ovarii: a clinicopathologic study of 54 cases. Int J Gynecol Pathol. 12(4):333–43. DOI: 10.1097/00004347-199310000-00008. PMID: 8253550.

13. O'Connell ME, Fisher C, Harmer CL. 1990; Malignant struma ovarii: presentation and management. Br J Radiol. 63(749):360–3. DOI: 10.1259/0007-1285-63-749-360. PMID: 2379061.

14. Berghella V, Ngadiman S, Rosenberg H, Hoda S, Zuna RE. 1997; Malignant struma ovarii. A case report and review of the literature. Gynecol Obstet Invest. 43(1):68–72. DOI: 10.1159/000291823. PMID: 9015705.

15. Gainford MC, Tinker A, Carter J, Petru E, Nicklin J, Quinn M, et al. 2010; Malignant transformation within ovarian dermoid cysts: an audit of treatment received and patient outcomes. an Australia New Zealand gynaecological oncology group (ANZGOG) and gynaecologic cancer intergroup (GCIG) study. Int J Gynecol Cancer. 20(1):75–81. DOI: 10.1111/IGC.0b013e3181c7fccf. PMID: 20130506.

16. Kopf B, Rosti G, Lanzanova G, Marangolo M. 2005; Locally advanced ovarian carcinoid. J Exp Clin Cancer Res. 24(2):313–6.

17. DeSimone CP, Lele SM, Modesitt SC. 2003; Malignant struma ovarii: a case report and analysis of cases reported in the literature with focus on survival and I131 therapy. Gynecol Oncol. 89(3):543–8. DOI: 10.1016/S0090-8258(03)00141-0. PMID: 12798728.

18. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2016; 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 26(1):1–133. DOI: 10.1089/thy.2015.0020. PMID: 26462967. PMCID: PMC4739132.

19. Egan C, Stefanova D, Thiesmeyer JW, Lee YJ, Greenberg J, Beninato T, et al. 2022; Proposed risk stratification and patterns of radioactive iodine therapy in malignant struma ovarii. Thyroid. 32(9):1101–8. DOI: 10.1089/thy.2022.0145. PMID: 35765923.