ABSTRACT
Resumen ANTECEDENTES: El estruma ovárico es una variedad infrecuente de teratoma quístico. CASO CLÍNICO: Paciente de 42 años de edad en quien durante una revisión ginecológica rutinaria se evidenció, por ecografía, un quiste anexial derecho complejo, bilobulado, de 10 cm compuesto por dos formaciones heterogéneas independientes, una de aspecto uniforme ecorrefringente de 52.6 mm y otra ecorrefringencia alternante de 36.7 mm. Se categorizó como teratoma quístico, lo que se confirmó por resonancia magnética nuclear. Se efectuó anexectomía derecha laparoscópica. El estudio anatomopatológico confirmó el diagnóstico microscópico de teratoma quístico maduro, que incluía a la tiroides (menos de 50% de todo el tumor), con un carcinoma papilar de patrón folicular (estruma ovárico). La cirugía ginecológica se complementó con histerectomía total, omentectomía, lavado peritoneal e inspección de la cavidad abdominal por vía laparotómica; se descartó la neoplasia residual. El estudio endocrinológico evidenció la normalidad de la tiroides y el diagnóstico ecográfico de un nódulo; posteriormente se confirmó que se trataba de hiperplasia benigna. Los marcadores tumorales tiroideos fueron negativos y, a pesar de ello, el comité de cáncer de tiroides acordó que se efectuara la tiroidectomía total y luego se indicara tratamiento con iodo radiactivo, sin evidenciar elementos neoplásicos malignos ni ganglios linfáticos afectados. CONCLUSIONES: Debido a la baja incidencia del estruma ovárico su tratamiento comprende a la cirugía ovárica y la tiroidectomía, y al yodo radioactivo en el caso de las variedades malignas; todo esto en un contexto de controversia consecuencia de la poca experiencia acumulada.
Abstract BACKGROUND: Struma ovarii represents a rare form of ovarial quistic teratom that contains thiroid tissue and affects mostly women between 40 and 60 years of age. Its diagnosis is based on the definitive pathological study of the piece, due to the fact that these kind of tumors lack any specific clinic and diagnostic features. CLINICAL CASE: 42 year old patient, in which during a routine gynecological examination a bilobed complex right adnexal cyst of 10 cm composed of two independent heterogeneous formations (a uniform appearance ecorrefringente of 52.6mm and one alternate ecorrefrigencia of 36.7 mm) is evidenced by ultrasound. It is categorized as cystic teratoma and confirmed by nuclear magnetic resonance. Adnexectomy is performed laparoscopically. The pathological study confirmed the microscopic diagnosis of mature cystic teratoma including thyroid tissue (less than 50% of the tumor) with papillary carcinoma follicular pattern: Struma Ovarii. Gynecological surgery was completed with a total hysterectomy, omentectomy, washing and inspection peritoneal abdominal cavity by laparotomy discarding residual neoplasia. Endocrinological study showed normal thyroid function and ultrasound diagnosis of a nodule: benign hyperplasia was confirmed later. Thyroid tumor markers were negative and despite this, the thyroid cancer committee agreed to perform a total thyroidectomy and a treatment with radioiodine, without evidence of malignant neoplastic elements and affected lymph nodes. CONCLUSIONS: Its treatment is still controversial due to its low incidence, and includes not only ovarial surgery but also thyroidectomy and radioactive iodine therapy in the event of a malignant tumor.
ABSTRACT
BACKGROUND: The accurate diagnosis of benign and malign thyroid tumors is very important for the clinical management of patients. The distinction of thyroid papillary carcinoma follicular variant and follicular adenoma can be difficult. AIM: To investigate the alternative methods like immunohistochemistry and exon 15 in the BRAF gene 1799 T/A mutation analyses for distinguishing thyroid tumors. MATERIALS AND METHODS: We applied immunohistochemical markers; CK19, HMWCK, Galectin‑3, HBME‑1 and Fibronectin and mutant allelespecific PCR amplification technique was used to determine 1799 T/A mutation within the BRAF gene. Formalin‑fixed parafin embedded tissues from 45 surgically total resected thyroids, included 26 thyroid papillary carcinoma follicular variant (FV‑TPC), 8 Follicular Adenoma (FA), 6 Minimal invasive follicular carcinoma (MIFC) and 5 Follicular Carcinoma (FC). STATISTICAL ANALYSES USED: Pearson Chi‑Square and Kruskal Wallis tests were performed. RESULTS: There was a positive correlation between FV‑TPC and HMWCK, CK 19, HBME1, Galectin 3, fibronectin (P < 0.05), but there was no correlation with FV‑TPC and BRAF gene mutation (P > 0.05). HBME‑1 and CK 19 stained strong and diffuse positive in FV‑TPCs but weak and focal in FAs. CONCLUSION: Our study suggests that morphologic features combined with immunohistochemical panel of HMWCK, CK19, HBME‑1, Galectin‑3 and fibronectin can help to distinguish benign and malign thyroid neoplasms and FV‑TPC from follicular adenomas. BRAF gene 1799 T/A mutation has been non‑specific but its detection can be a useful tool combined with immunohistochemistry for diagnosing FV‑TPC.