Because of its rarity, diagnosis and management of the tumor has not been clearly defined. A report of 96 cases thyroid tissue is a relatively frequent component of mature teratoma and can occur in 520 % of cases. Overview protected resident responsibilities protected histology pickups protected general. This also includes cases of mature teratoma with less than 50 % thyroid tissue but harboring thyroidassociated malignancy. It is usually seen between 40 and 60 years and accounts for about 5 % of all cases of ovarian teratomas. It is difficult determine a diagnosis prior to surgery. Thyroidtype carcinoma arising in struma ovarii is rare. Immunohistochemically it stained for thyroglobulin, which confirmed the thyroid epithelial nature of the neoplasm fig. Malignant struma ovarii is a rare form of the ovarian germ cell tumors. Thyroid tissue may demonstrate the same spectrum of pathological features as in the normal thyroid including benign and malignant changes. Although the typical presentation is that of a pelvic mass, unusual clinical manifestations such as hyperthyroidism, ascites, and meigs syndrome have been recognised. It is a rare tumor which comprises 1% of all ovarian tumors and 2. Malignant transformation of struma ovarii is an even rarer occurrence and accounts for approximately 5% of struma ovarii 3, 5.
We present the case of a 34yearold woman with papillary carcinoma arising in struma ovarii. Our retrospective study covers the period from 1991 to 2000 during which two patients with the diagnosis of struma ovarii were reported in the institute of oncology sremska kamenica. For a teratoma to be classified as struma ovarii, it must contain greater than 50% thyroid tissue. Diagnostic pathology of ovarian tumors offers a focus on the pathology of ovarian neoplasia with detailed clinically relevant information for practicing pathologists not found in other more general volumes of gynecologic pathology. Upon the last recurrence, a trabecular carcinoid tumor developed in a mature teratoma associated with the liver. Gross pathology of ovary 9 images papillary serous carcinoma of ovary. Originalarticle clinicopathological and immunohistochemical. Physiologic cysts are generic types of hormonally active cysts that result from the stimulation of the ovary by hormones. But, as the gynecologic pathologists at johns hopkins have discovered through years of research and diagnostic experience, ovarian cancer is neither simple nor is it straightforward. It is generally considered to account for less than 5% of. Struma ovarii with follicular thyroidtype carcinoma and. Radiation oncologyovaryepithelial ovarian wikibooks, open. Discussion struma ovarii comprises 14% of all dermoid tumors of the ovary, and very rarely presents in a malignant form, occurring in 0. Thyroid tissue can be observed in 515% of dermoid tumors but to designate the tumor as struma ovarii, it must comprise more than 50% of the ovarian tissue.
Tumors of the ovary and maldeveloped gonads atlas of tumor pathology, second series, fascicle 16 9789998155916. Patients with malignant struma ovarii may respond to thyroidectomy followed by radioactive iodine therapy 2, 3. This important work focuses almost entirely on strategies for accurate diagnosis and histologic subclassification. Struma ovarii associated with pseudomeigs syndrome and.
The clinical records, ct and mri features of twelve patients with pathologically proved so were retrospectively analyzed. Thyroid type carcinoma can occur in 5% of struma ovarii. However, the guidelines for diagnosis of primary thyroid carcinoma are mostly used currently for the diagnosis of thyroidtype carcinoma arising in struma ovarii. Struma ovarii so is a variant of dermoid tumors which completely or mainly composed of thyroid tissues. Taken from the acclaimed second edition of pulmonary pathology, these five core chapters on benign and malignant pulmonary and pleural tumors now comprise an authoritative text in their own right. Struma ovarii, papillary thyroid carcinoma, malignant struma ovarii. Struma ovarii is a rare entity consisting of thyroid components that are part of a teratoma or dermoid in the ovary. The era of gross pathology had three more illustrious. Struma ovarii is the presence of thyroid tissue as a major cellular component in an ovarian tumor, nearly always a teratoma. A case of struma ovarii diagnosed by cytology during. University of stellenbosch, cape town, south africa corresponding author, email.
Coexistence of malignant struma ovarii and cervical. Struma ovarii is a specialized or monodermal teratoma predominantly composed of mature thyroid tissue. It is an uncommon neoplasm, usually asymptomatic with an unknown risk of malignant transformation. These findings were misdiagnosed for an ovarian malignancy. This book is a printed edition of the special issue forest pathology and plant health that. The most common type is papillary carcinoma, followed by typical follicular carcinoma, and the new entity of.
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. Most cases of malignant struma ovarii have been diagnosed on the basis of histological criteria alone, with only about 20 cases presenting clinically. Division of fertilityin vitro fertilization, department of obstetrics and gynecology, carmel medical center, faculty of medicine, technion haifa, israel. A rare ovarian teratoma article introduction struma ovarii is a unique variant of the monodermal teratomas of the ovary, which is entirely composed of thyroid tissue. Gross pathology manual by the university of chicago department of pathology. The ct features could show solid, cystic, or cysticsolid characteristics. Obstetrics and gynecologyovarian neoplasia wikibooks, open. It most commonly occurs as part of a teratoma, but may occasionally be encountered with serous or mucinous cystadenomas. It may be part of a teratoma or cystadenoma and may also have a malignant character papillary thyroid carcinoma. Ct findings of struma ovarii are characterized by the presence of high attenuation area and calcifications 15. Benign ovarian cysts in reproductiveage women undergoing.
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. Struma ovarii is a rare variant of the mature ovarian teratoma composed of more than 50% thyroid tissue. Struma ovarii represents a rare type of teratoma that is formed entirely of thyroid tissue. Optimal cytoreductive surgery was performed, with no gross residual disease evident at the time of closure. 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. On gross pathological examination, there was a left ovarian mass measuring 10. The current study reports an unusual case of struma ovarii occurring in a 49 year. The most common type is papillary carcinoma, followed by typical follicular carcinoma, and the new entity of follicular carcinomahighly differentiated follicular carcinoma of ovarian origin.
Its clinical presentation is very variable, ranging from benign asymptomatic tumors to tumors with distant metastases. Section of surgical pathology, department of pathology and laboratory medicine, hospital of the university of pennsylvania, philadelphia, pennsylvania 19104 received malignant struma ovarii is a very rare tumor, with considerable. Struma ovarii is mostly common between the ages of 40 and 60 years and accounts for approximately 3% of ovarian teratomas and 0. The presence of the rete ovarii was detected in 55 of the 64 ovaries 85. The criterion for histopathological diagnosis of malignant struma ovarii has varied over the years. Final pathological diagnosis was confirmed as struma ovarii based on the.
Our patient underwent thyroidectomy and treatment with radioactive iodine 5. Struma ovarii simulating ovarian sertoli cell tumor. Sushma rajesh gulhane, assistant professor, department of pathology, esi pgimsr, mumbai93. Diagnosis of struma ovarii with medical imaging springerlink.
Struma ovarii associated with pseudomeigs syndrome and high. Due to difficulties in assessing the rare biological nature and the discrepancies in the reported cases, a consensus on the appropriate treatment has not been definitively reached. Division of gynecologic oncology, department of obstetrics and gynecology, and the. Cytologic evaluation of the ascitic fluid showed no evidence of malignant cells. They present as the most common type of ovarian enlargement on young women. The criteria for diagnosis should follow the diagnostic criteria of cervical thyroid carcinoma.
Posttherapy whole body scan after levothyroxine withdrawal revealed uptake in the thyroid bed, abdomen, and pelvis. Struma ovarii is an uncommon condition, in which thyroid tissue is the predominant or exclusive element in an ovarian teratoma. Imaging features were compared with pathological results. Malignancy is defined by various criteria in different studies, principally differing on classifying struma ovarii as either an ovarian or as a thyroid tumor. The most common presenting symptom is a pelvic mass.
First, careful gross examination by finding the darkred thyroid like. 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. This case illustrates the importance of longterm followup for patients with gts of the ovary, where the recurrent masses can appear many years after the primary tumor. Struma ovarii accompanied by mature cystic teratoma of the. Struma ovarii differential diagnoses medscape reference. The latest tnm and figo staging for ovarian cancer has been discussed earlier here. Journal of clinical imaging science struma ovarii with. In the us, ovarian cysts are found in nearly all premenopausal women, and in up to 14. The gross pathology revealed an 8cm ovary that was solid surrounded by small cysts peripherally, an omentum that had a multiple nodules with hemorrhage and cystic degeneration throughout, and a thyroid that was grossly unremarkable. Tumors of the ovary and maldeveloped gonads atlas of. A few case studies have described associated thyrotoxicosis. In such cases, the tumor mimics malignant ovarian tumor.
Struma ovarii is a rare ovarian tumor defined by the presence of thyroid tissue comprising more than 50% of the overall mass. When presented with the task of editing a volume on such a wide when presented with the task of editing a volume on such a wide and and diverse diverse topic topic as as ovarian ovarian pathology, pathology, it it is is difficult difficult to to know know how how to to limit limit the the range range of of subjects subjects to to be be covered covered when when there there are are so so many. Malignant struma ovarii is a rare type of germ cell tumor that is most often diagnosed postoperatively. It is a rare tumor which comprises 14% of all benign ovarian tumors1.
Struma ovarii is a rare benign tumor which represents 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 ambercoloured thyroid tissue, with haemorrhage, necrosis, and fibrosis. Struma ovarii associated with pseudo meigssyndrome cogprints. Here we report a 46yearold case of the struma ovarii, presented with ascites, hydrothorax, right ovarian mass and elevated serum ca 125 level. Struma ovarii struma ovarii belongs to the group of monodermic and highly specific teratomas. Struma ovarii is an infrequent type of dermoid ovarian tumor that is usually benign and composed of at least 50% thyroid tissue. Textbook of pathology, 6th edition mosc medical college hospital. Pathology and obstetrics and gynecology, malmo university hospital, lund. Eventhough it is a neoplasm consisting of thyroid tissue, only. Struma ovarii, as a monodermal variant of ovarian teratoma. Since its first description in the early part of the twentieth century, struma ovarii has elicited considerable interest because of its many unique features. Malignant follicular thyroid carcinoma arising in struma. Us demonstrates a complex appearance with multiple cystic and solid areas, findings that reflect the gross pathologic appearance of. Malignant struma ovarii is a rare form of ovarian germ cell tumors.
Diagnosing a disease may seem simple and straightforward. 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. The malignant struma ovarii is even more rare, and makes up 5% of all cases of struma ovarii. Jul, 2005 mature cystic teratomas represent 4050% of ovarian neoplasias from which 0. We provide 1 original jpeg or tiff and 1 highquality optimized image without our logo. Follicular proliferative lesion arising in struma ovarii ncbi. Struma ovarii, a rare neoplasm, is a monophyletic teratoma composed of thyroid tissue. Struma ovarii is a rare ovarian tumor that was first described in 1899. Struma ovarii is a rare ovarian tumour that has been reported to represent 0. Morphological and pathological aspects of the rete ovarii in.
The authors report the result of a retrospective study of 7 cases of struma ovarii, four malignant and three benign cases, removed surgically at the salah azaiez institute, tunis, tunisia, over a period of 20 years 19802000. Hence, diagnosis and management of malignant struma ovarii have not been clearly defined. Malignant struma ovarii is a rare ovarian neoplasm that is usually asymptomatic and infrequently diagnosed preoperatively. The final pathology revealed right benign struma ovarii with cystic and solid components. Our case was a female patient, 40 years old, who was presented with vaginal bleeding, abdominal. To qualify as a struma ovarii tumors more than 50% of the tumor should be composed of thyroid tissue 7. Struma ovarii may manifest variant pathologic features presenting in the thyroid gland. 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. Thyroid tissue may be also found in the peritoneal cavity as in benign strumosis. Sep 16, 2015 thyroid tissue is a relatively frequent component of mature teratoma and can occur in 520 % of cases. Jul 29, 2010 the association of pseudomeigs syndrome, elevation of ca 125 to the struma ovarii is a rare condition. Pathology most likely arise from the surface epithelium covering the ovary contiguous with peritoneal mesothelium malignant transformation likely occurs within epithelium that becomes trapped within ovarian inclusion cysts during ovulation. Struma ovarii is defined as ovarian goiter which comprises either entirely or predominantly thyroid tissue 50 %. Follicular proliferative lesion arising in struma ovarii.
So far only nine cases have been reported in english literature through medline search. Examples of singleuser license include conferences, seminars, presentations, and onetime teaching courses. Preoperative diagnosis of struma ovarii is difficult as the symptoms, clinical presentation and image on ultrasound are often similar to that of ovarian. In strumal carcinoid, the carcinoid tissue is present in. Metastatic follicular struma ovarii complicating pregnancy. Ovarian pathology 8 ovarian pathology physiologic cysts. Thyroidtype carcinoma of struma ovarii archives of.
Examples of multiuser license include books, book chapters, educational material, and other publications with multiple copies. Armed forces institute of pathology rawalpindi cystic struma ovarii. We report three cases of different clinical presentations of struma ovarii, to attempt to define the clinical features and characteristics of this tumor with respect to ultrasonographic findings, histological characteristics and way of optimal management. Malignant struma ovarii is extremely rare and difficult to diagnose. The appearance is similar to that of a thyroid adenoma. Struma ovarii is a monodermal variant of ovarian teratoma. As also observed in other mammals, the rete ovarii of sheep is morphologically divided into three portions. Struma ovarii or monodermal teratoma is a specialized ovarian neoplasm which mainly constitutes mature thyroid tissue. 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. Malignant struma ovarii is rarely seen and has an incidence of approximately 0. The ultrasound us features of struma ovarii are nonspecific, but a heterogeneous, predominantly solid mass may be seen. It is defined by the presence of thyroid tissue comprising more than 50% of the overall mass. 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. We report a case of pure struma ovarii tumor diagnosed by cytology during laparoscopic surgery.
The natural history and optimal treatment regimen for the disease are essentially unknown due to the small numbers of published cases. Most commonly, they occur as part of a teratoma, but may occasionally be encountered with serous or mucinous cystadenomas. An ovarian cyst is any collection of fluid, surrounded by a very thin wall, within an ovary most ovarian cysts are functional in nature and harmless benign. Pathologic aspect of struma ovarii, a thyroid tissue in direct contact with the ovarian parenchyma, b thyroid follicles at high magnification. The terms malignant struma ovarii and peritoneal strumosis should no longer be used. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Struma ovarii so is a slowgrowing ovarian neoplasm with thyroid tissue as its predominant component. We present a case of papillary thyroid carcinoma arising in a struma ovarii of the left ovary in a 21. The highdensity cysts might be a characteristic feature of struma ovarii on ct. Although the typical presentation is that of a pelvic mass, unusual clinical manifestations such as hyperthyroidism, ascites, and meigs syndrome have. Struma ovarii, as a monodermal variant of ovarian teratoma, constitutes 3% of ovarian teratomas. Here, we will discuss pathology of ovarian tumors in. Proliferative changes within struma can be misdiagnosed as cancer. This important work focuses almost entirely on strategies for accurate diagnosis and histologic subclassification, and the clinical correlates of these.
A 46yearold female presented for her annual gynecologic exam during which a pelvic mass was appreciated on physical examination. Clinical finding and thyroid function in women with struma. Thyroid tissue is a relatively frequent component of mature teratoma and can occur in 520 % of cases. Struma ovarii with a focus of papillary thyroid cancer. Over 850 illustrations gross dissection specimens, photomicrographs, electron micrographs. To qualify as a struma ovarii tumours more than 50% of the tumour should be composed of thyroid tissue 7. We report a case of a 52yearold woman with the typical signs and symptoms of hyperthyroidism, in whom the diagnosis of struma ovarii was missed. A simple cyst is a sac containing fluid or semisolid material. Riti tusharkanti sinha, consultant pathologist, department of. Clinical and histopathological study of struma ovarii. At a glance struma ovarii usually refers to the presence of significant amount of thyroid tissue in ovarian tumors, typically monodermal teratomas.
Struma ovarii is the presence of thyroid tissue as the predominant component in an ovarian teratoma. Thyroid tissue must comprise more than 50 percent of the overall tissue to be classified as a struma ovarii. This important work focuses almost entirely on strategies for accurate diagnosis and histologic subclassification, and the clinical. Benign ovarian cysts in reproductiveage women undergoing assisted reproductive technology treatment.
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