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Objective:To examine the ultrasonographic and clinical features of post-menopausal struma ovarii(PMOS).Methods:Clinical presentations and transvaginal sonography(TVS)data of 7 PMOS patients diagnosed during surgery were retrospectively analyzed and compared with histopathological results.Results:The ages of 7 patients ranged from 52 to 77 years(60.1±8.0 years, median age: 59 years, natural menopause age: 49.9±1.8 years). Ultrasound imaging data showed all adnexal masses were unilateral(1 on the left side, 6 on the right side). The focal lesions were irregular, round or elliptic in shape, measuring 2.8-9.5 cm, with either clear or unclear margins.Two PMSO cases were diagnose as teratoma on ultrasound, showing mixed echogenic patterns, with echoless interior regions and poor sound transmission.Color doppler flow imaging found no blood flow signal inside and around the mixed echogenic areas.Five cases were misdiagnosed on ultrasound, with 2 as postmenopausal ovarian endometrial cyst and 3 as ovarian cystadenocarcinoma.All patients recovered well after surgery.By the end of the follow-up, no recurrence of struma ovarii was found in the 7 cases.Conclusions:PMSO is a rare monodermal teratoma, can be easily misdiagnosed and needs to be differentiated from postmenopausal ovarian endometrial cyst, mature teratoma, ovarian cystadenocarcinoma and other types of lesions.A mass >5 cm may exhibit characteristic ultrasonographic manifestations, including protruding thyroid nodules, cyst wall calcification, etc.A solid portion of the cystic mass with blood flow may suggest a diagnosis of struma ovarii.
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Struma ovarii is a highly specialized form of monoderal ovarian teratoma, in which thyroid tissue has exceeded all other tissues or only thyroid tissue malignant struma ovarii is a very rare disease. Studies have confirmed that the pathogenesis is basically consistent with primary thyroid cancer. Preoperative diagnosis is difficult and the diagnosis should be based on postoperative paraffin pathology. It’s important to emphasize that the histologic malignance does not represent malignant ovarian behavior. Transabdominal hysterectomy+bilateral salpingo-oophorectomy has a better prognosis, and there are different opinions on the management of the mainstream thyroid. Most patients take active thyroid excision followed by chemotherapy and radiotherapy and 131I for postoperative follow-up in accordance with the principle of primary thyroid cancer.
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Objective To investigate the sonographic features and diagnosis values of struma ovarii. Methods The sonographic features of 20 struma ovarii patients diagnosed by pathology from June 2015 to March 2018 were retrospectively analyzed. Results The age of the patients was 29 to 82 (41.5 ± 24.0) years old, and 5 cases were postmenopausal. Ultrasonography showed that ovarian goiter was mainly unilateral and solid-cystic, and most of them were thick partitions. The solid echo was similar to the thyroid gland, and more specific papillary protrusions and honeycomb structures could be found. Some of them could show crystallization speckle echo (high probability of cystic part), and blood flow signal could be seen in most of solid part. The pathological results showed that all cases were ovarian goiter except 1 case of ovarian goiter with local papillary thyroid carcinoma. Conclusions Struma ovarii is characteristic to a certain extent, and ultrasonography is helpful for the diagnosis of the disease.
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El hipertiroidismo se define como la producción excesiva de hormonas tiroideas a partir de tejido tiroideo maduro eutópico o ectópico. La prevalencia general de hipertiroidismo es 1.2%, y la causa más frecuente es la enfermedad de Graves. El estruma ovárico representa el 1% de todos los tumores ováricos y es una causa infrecuente de hipertiroidismo ectópico. Su comportamiento es benigno en más del 90% de los casos; usualmente asintomáticos, sólo el 8% se presentan con tirotoxicosis, y es infrecuente su asociación con enfermedad de Graves. Se comunica el caso de una paciente con esta infrecuente asociación.
Hyperthyroidism is defined as an excessive production of thyroid hormones by eutopic or ectopic mature thyroid tissue. The overall prevalence of hyperthyroidism is 1.2% and the most common cause is Graves' disease. Struma ovarii represents 1% of all ovarian tumors and is an uncommon cause of ectopic hyperthyroidism. It is benign in >90% of the cases; usually asymptomatic, and only 8% are presented with thyrotoxicosis, being rare its association with Graves' disease. We report the case of a patient with this association.
Subject(s)
Humans , Female , Aged , Ovarian Neoplasms/etiology , Struma Ovarii/etiology , Graves Disease/complications , Ovarian Neoplasms/diagnostic imaging , Struma Ovarii/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
El estruma ovárico, neoplasia ovárica infrecuente, constituye un teratoma monodérmico altamente diferenciado hacia tejido tiroideo, cuyo diagnóstico certero lo proporciona la histopatología, siendo su tratamiento definitivo la cirugía. Se presenta el caso de una paciente de 51 años de edad atendida en la 2C Clínica Médica ALOM por dolor abdominal y tumoración de 8 cm en región pélvica derecha, corroborando por ultrasonido una masa anexial de ecogenicidad mixta en dicha región; con marcadores tumorales normales. La conducta quirúrgica consistió en histerectomía total con anexectomía bilateral, evidenciando el diagnóstico anatomopatológico de estruma ovárico del anexo izquierdo y teratoma quístico maduro en el anexo derecho. Por consiguiente, los datos clínicos, los exámenes imagenológicos y anatomopatológicos permiten diagnosticar el estruma ovárico.
The Struma Ovarii, infrequent ovarian neoplasm, it constitutes a highly monodermic teratoma differentiated to the thyroid tissue, whose accurate diagnosis what provides the histopathology being the surgery the definitive treatment. It presents the case of a patient of 51 years old attended in 2C Clínica Médica ALOM by abdominal pain and tumoration of 8 centimeters in right pelvic region, corroborating by ultrasound a right adnexal mass of mixed echogenicity in that region; normal levels of tumor markers. It decided the surgical intervention, it performed total hysterectomy with bilateral adnexectomy, evidencing the anatomopathological diagnosis of Struma Ovarii of the left annex and cystic teratoma mature in the right annex. Therefore, the clinical data, the imaging and anatomopathological examinations allow to diagnose the ovarian struma.
Subject(s)
Ovarian Neoplasms , Teratoma , UterusABSTRACT
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.
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Objective To analyze MRI and CT features of struma ovarii (SO).Methods CT and MRI findings of 14 patients with pathologically confirmed single SO were retrospectively analyzed.The morphology,size,density/signal intensity and enhancement pattern of lesions were analyzed.Results All the tumors appeared as well-defined cystic-solid masses,11 were multilobulated and 3 were round-like.Thirteen lesions were multicystic,and 1 was unilocular.The solid components appeared as thickness septa or wall in 11 and as nodule in 3 lesions.The maximum diameter of the tumors were 3-34 cm,with an average size of (11.34±2.24)cm.MRI showed extremely low signal intensity regions in cyst portion of 7 masses on T2WI without enhancement,while obvious enhancement in solid potion.CT showed high attenuation in cyst portion of 7 masses without enhancement,CT value were 57-90 HU,whereas the solid potion obviously enhanced,and CT values were 145-270 HU.Plaque-like calcification on the walls or nodules were observed in 4 patients.Conclusion CT and MRI findings of SO have certain characteristics,which are helpful for diagnosis and differential diagnosis.
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Objective To investigate the diagnostic value of CT and MRI in struma ovarii (SO).Methods Imaging features of 9 cases with SO confirmed by pathology were analyzed retrospectively.9 patients underwent CT,3 cases underwent both CT and MRI, which were both pre-and post-contrast enhancement.The location,size,shape,margin,density or signal intensity of the lesion,as well as the enhancement patterns of the cystic wall and solid components were observed.Results 7 tumors were located in the right ovary and 2 in the left,with smooth margins and clear boundary.The diameters of the lesions were 5-1 5 cm.The tumors were round in 2 cases,oval round in 2 cases and irregular in 5 cases.9 tumors all appeared cystic-solid type,mainly muti-cystic.The cystic components showed heterogeneous density on CT,mostly low signal intensity on T1WI and high signal intensity on T2WI,few cystic components showed high signal intensity on both T1WI and T2WI.Calcifications were found in 3 cases and fat in 2 cases.The solid components showed slightly high density on plain CT scanning and enhanced markedly either on CT or MRI.6 cases were accompanied with hysteromyomas and 2 cases with ovarian embryoma in the contralateral ovary.Conclusion CT and MRI appearances of SO have a certain characteristic,often manifested as a unilateral adnexal cystic-solid mass and the solid components obviously enhancement,but the boundary is smooth and clear.CT and MRI have different advantages.
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Resumen ANTECEDENTES: el estruma ovárico es un teratoma monodérmico, sumamente complejo, constituido en más de 50% por tejido tiroideo. Una forma infrecuente de manifestación es la estrumosis peritoneal, que consiste en múltiples implantes peritoneales benignos compuestos por estruma ovárico. No existe consenso en relación con el tratamiento; además, la malignidad de la estrumosis peritoneal es tema de controversia. CASO CLÍNICO: paciente nuligesta de 33 años de edad a quien, durante el estudio de esterilidad primaria, se le diagnosticó estruma ovárico derecho. A los tres años postratamiento recurrió en forma de estruma ovárico izquierdo y estrumosis peritoneal (hallazgo intraoperatorio). En ambos casos se efectuó quistectomía laparoscópica, y en la segunda ocasión se practicó, además, la exéresis de los implantes macroscópicos. Después de recibir quimioterapia con 131I (100 mCi) y entrar en remisión completa, se produjo una nueva recidiva cuatro años después; fue necesaria la cirugía citorreductora y un nuevo ciclo de quimioterapia con 131I (100 mCi). En la actualidad la paciente permanece en remisión completa. CONCLUSIONES: ante la escasez de casuística de estrumas ováricos y, sobre todo, de estrumosis peritoneal, resulta imprescindible individualizar el tratamiento en cada paciente, en donde es decisiva la participación de un equipo multidisciplinario. La cirugía citorreductora puede ser una opción terapéutica para favorecer la respuesta al tratamiento ablativo con 131I.
Abstract BACKGROUND: Struma ovarii is a highly specialized monodermic teratoma composed of thyroid tissue in more than 50%. An infrequent form of presentation is peritoneal strumosis, which consists of multiple peritoneal implants of benign mature thyroid tissue. In both situations, there is no consensus about the management of those entities. In addition, malignancy of peritoneal strumosis is controversial. CLINICAL CASE: We report a case of a 33-year-old nulligravid woman that during a sterility study was diagnosed with a right struma ovarii. Three years after treatment, it recurred as a left struma ovarii and a peritoneal strumosis (intraoperative finding). A laparoscopic ovarian cystectomy was performed in both cases, as well as the excision of all macroscopic implants in the second one. She remained in remission after 131I ablative chemotherapy (100 mCi), but a new recurrence took place four years later, requiring a cytoreductive surgery and a second 131I chemotherapy (100 mCi). She is now in complete remission. CONCLUSIONS: Due to the lack of casuistry of struma ovarii and paucity of information, especially in the case of peritoneal strumosis, decisions must be individualized on each patient and must be taken by a multidisciplinary team. Cytoreductive surgery might be an option to improve the response to ablative 131I chemotherapy.
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Objective To investigate sonographic characteristics of struma ovarii with conventional ultrasound and CEUS.Methods Ultrasound images of 65 patients with struma ovarii confirmed by pathology were retrospectively reviewed and analyzed,5 patients were examined with CEUS simultaneously.Results In all 65 patients,lesions in 14 (14/65,21.54 ％) were multocular,49 (49/65,75.34％) were cystic-solid component,2 (2/65,3.08％) were solid.Lesions in 39 (39/65,60.00％) contained dense latticed separation.The abundant blood flow was found in 18 cases (18/65,27.69％) with Doppler examination.Five cases were examined with CEUS,including multilocular lesions of 2 cases and cystic-solid lesions of 3 cases.Regular middle-degree intensity of cyst wall and septa were seen in all 5 cases.Among cystic-solid lesions of 3 cases,lesions of non-enhance pattern was seen in the solid areas of 1 case,irregular middle-high degree intensity pattern were seen in the solid areas of 2 cases,while non-enhance pattern could be seen in part of the solid areas of these 2 cases.All the cystic areas of these 5 cases showed non-enhance pattern.Conclusion The sonographic appearances of struma ovarii are usually multilocular or multilocular with solid component.Because of strum ovarii's special characteristic pathologic components,the imaging features of strum ovarii in conventional ultrasound and CEUS are atypical,thus preoperative diagnosis is quite difficult.
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Objective To investigate sonographic characteristics of struma ovarii with conventional ultrasound and CEUS.Methods Ultrasound images of 65 patients with struma ovarii confirmed by pathology were retrospectively reviewed and analyzed,5 patients were examined with CEUS simultaneously.Results In all 65 patients,lesions in 14 (14/65,21.54 ％) were multocular,49 (49/65,75.34％) were cystic-solid component,2 (2/65,3.08％) were solid.Lesions in 39 (39/65,60.00％) contained dense latticed separation.The abundant blood flow was found in 18 cases (18/65,27.69％) with Doppler examination.Five cases were examined with CEUS,including multilocular lesions of 2 cases and cystic-solid lesions of 3 cases.Regular middle-degree intensity of cyst wall and septa were seen in all 5 cases.Among cystic-solid lesions of 3 cases,lesions of non-enhance pattern was seen in the solid areas of 1 case,irregular middle-high degree intensity pattern were seen in the solid areas of 2 cases,while non-enhance pattern could be seen in part of the solid areas of these 2 cases.All the cystic areas of these 5 cases showed non-enhance pattern.Conclusion The sonographic appearances of struma ovarii are usually multilocular or multilocular with solid component.Because of strum ovarii's special characteristic pathologic components,the imaging features of strum ovarii in conventional ultrasound and CEUS are atypical,thus preoperative diagnosis is quite difficult.
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Objective To explore MRI features of struma ovarii (SO)and analyze the causes of misdiagnosis.Methods The MRI data of 5 patients with SO confirmed by surgery and pathology were analyzed retrospectively.Results The MRI features of SO were summarized as follows:(1)The lesions were often unilateral.(2)The maximal diameter was 3.6-13 cm and the volume was 37.8-854.1 cm3 .(3)The irregular shape was presented in 2 cases,round shape was presented in 2 cases,and superficial lobulated shape was presented in 1 case.(4)The boundary of the lesions was clear,and the adjacent organs were compressed without obvious inva-sion,there was 1 patient showing moderate ascites.(5 )The tumor was cystic or solid-cystic with various size,and capsular space showed homogeneous high,equal or low signal intensity on T1 WI and T2 WI.Irregular solid component and thick separation were be-tween capsular spaces.The wall,solid component,and separation showed significant contrast-enhancement.Conclusion Recognition of the MRI features of SO could improve the diagnostic accuracy and avoid misdiagnosis.
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Objective To evaluate the charateristics of CT and MR imaging of struma ovarii(SO).Methods 10 lesions of 10 pa-tients confirmed by pathology were analyzed retrospectively.6 cases were performed plain and enhanced CT scan and 4 were under-went MR before operation.Imaging features were analyzed retrospectively correlated with histological findings.Results All the SO tumors were appeared as solitary,well-defined,lobulated or oval masses.The largest diameter was less than 10 cm.Ascites were found in 4 cases.Six of SOs were solid-cystic and four were cystic.The cystic portion was low density or high density on CT images. High density cysts were shoewed in 4 cases.On MR images,the cystic portion was hypointenstiy on T1 WI and hypo/hyperintensity on T2 WI.Vacuum phenomenon (hypointenstiy on T1 WI and extremly hypointensity on T2 WI)was observed in 1 case.Solid compo-nent and cystic wall showed remarkable enhancement.Conclusion CT and MR images of SO can reflect its histopathologic charater-istics,which provides important value in the diagnosis and differential diagnosis of SO.
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Post-therapeutic whole body scan (RxWBS) after radioactive iodine (RAI) remnant ablation (RRA) is useful for detect recurrent or metastatic foci of differentiated thyroid carcinoma (DTC) after total thyroidectomy. However, there is rare possibility of false positive iodine uptake in WBS. Here, we report a case of a 72-year-old woman, who underwent RRA after total thyroidectomy due to follicular variant papillary thyroid carcinoma. There is an abnormal iodine uptake in RxWBS in pelvic cavity. Additional single photon emission computed tomography (SPECT)-computed tomography (CT) imaging showed an intensive I-131 avid mass in left ovary. There was a multiple calcified mass in left ovary and enhancing wall thickening in left ureter with hydronephrosis in contrast enhanced CT. She underwent hysterectomy, oophorectomy, left ureterectomy and nephrectomy and diagnosed as mature cystic teratoma with thyroid tissues and ureter cancer. Struma ovarii should be considered if there was abnormal RAI uptake in pelvic cavity. I-131 SPECT-CT is useful for differential diagnosis of abnormal iodine uptakes in WBS.
Subject(s)
Aged , Female , Humans , Diagnosis, Differential , Hydronephrosis , Hysterectomy , Iodine , Nephrectomy , Ovariectomy , Ovary , Struma Ovarii , Teratoma , Thyroid Gland , Thyroid Neoplasms , Thyroidectomy , Tomography, Emission-Computed, Single-Photon , Ureter , Ureteral Neoplasms , Whole Body ImagingABSTRACT
Post-therapeutic whole body scan (RxWBS) after radioactive iodine (RAI) remnant ablation (RRA) is useful for detect recurrent or metastatic foci of differentiated thyroid carcinoma (DTC) after total thyroidectomy. However, there is rare possibility of false positive iodine uptake in WBS. Here, we report a case of a 72-year-old woman, who underwent RRA after total thyroidectomy due to follicular variant papillary thyroid carcinoma. There is an abnormal iodine uptake in RxWBS in pelvic cavity. Additional single photon emission computed tomography (SPECT)-computed tomography (CT) imaging showed an intensive I-131 avid mass in left ovary. There was a multiple calcified mass in left ovary and enhancing wall thickening in left ureter with hydronephrosis in contrast enhanced CT. She underwent hysterectomy, oophorectomy, left ureterectomy and nephrectomy and diagnosed as mature cystic teratoma with thyroid tissues and ureter cancer. Struma ovarii should be considered if there was abnormal RAI uptake in pelvic cavity. I-131 SPECT-CT is useful for differential diagnosis of abnormal iodine uptakes in WBS.
Subject(s)
Aged , Female , Humans , Diagnosis, Differential , Hydronephrosis , Hysterectomy , Iodine , Nephrectomy , Ovariectomy , Ovary , Struma Ovarii , Teratoma , Thyroid Gland , Thyroid Neoplasms , Thyroidectomy , Tomography, Emission-Computed, Single-Photon , Ureter , Ureteral Neoplasms , Whole Body ImagingABSTRACT
OBJECTIVE: The aim of this study was to investigate the preoperative characteristics of benign mature cystic teratoma (MCT) and struma ovarii and their risk factors associated malignancies, and determine the appropriate treatment options for these tumors. METHODS: This was a retrospective study on 248 patients who were pathologically diagnosed with ovarian MCT, struma ovarii, or malignant transformations of these tumors at Inje University Haeundae Paik Hospital from March 2010 to January 2015. Routinely evaluated results of adnexal masses before surgery were compared. RESULTS: A total of six patients (2.4%) were confirmed to have malignant tumors. Of the struma ovarii patients, two out of five patients (40%) were confirmed to have malignancy. The mean age at the diagnosis of patients with malignant transformation of teratomas was 43.0 years (range, 27 to 67 years), which was higher than that of patients with benign teratomas (36.5 years). The mean diameter of the tumor before surgery in the malignant tumor group was 11.4 cm and larger than 6.5 cm of benign group (P=0.003). The mean CA-125 level in the malignant tumor group was higher than that in the benign tumor group (P=0.01). CONCLUSION: Risk factors for malignant transformation of MCT include elevated CA-125 levels, older age, large tumor masses, and postmenopausal status.
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Humans , Diagnosis , Retrospective Studies , Risk Factors , Struma Ovarii , TeratomaABSTRACT
PurposeStruma ovarii (SO) is rare and has no typical symptoms, which is likely to be misdiagnosed before procure. The present study aimed to evaluate multi-sliced CT (MSCT) findings of struma ovarii so as to improve its imaging diagnosis.Materials and Methods The clinical and radiological data of 25 patients with struma ovarii confirmed pathologically patients were retrospectively analyzed and further compared with the pathological results after procure.Results For 25 SO patients, 22 (88%) had unilateral lesions and the rest 3 (12%) had bilateral ones; 11 lesions (44%) were cystic, 8 lesions (32%) were cystic-solid, and 6 lesions (24%) were solid. The CT images of 8 lesions showed high density cystic lumens. Twenty-five tumors had smooth margins, which appeared round, ellipse or irregular. The pathological findings showed that most of the cystic portions were filled with high proteinaceous gelatinous fluid and eosinophiclic colloid, and the solid portions consisted of thyroid tissue and stoma containing abundant blood vessels and fibrous tissue.Conclusion SO has the MSCT features such as cystic solid mass with unilateral and smooth margin, capsular space with high density, calcification, and solid parts with obvious enhancement.
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Objective To study the CT findings of struma ovarii(SO)and improve the understanding of SO imaging features. Methods CT images of 6 cases were retrospectively reviewed.CT plain scan was performed in 6 patients;CT enhancement scan was performed in 2 patients.Results All tumors were unilateral.On non-enhanced CT,the lesions presented as well-defined irregu-lar cystic-solid masses.The cystic portions presented as well-defined,multiple,various size,and there were entire cystic walls with smooth inner wall.Four tumors showed high attenuation lesions in the cyst portion of the mass on precontrast scans.The solid por-tions showed irregular tissue density,and were often distributed in the cysts.The tumors showed stippled calcification in solid por-tions and/or cystic wall in 4 cases.One tumor accompanied a great of ascites liquid.After contrast administration,the cystic por-tions showed no enhancement,and the cystic walls and the solid portions showed mild enhancement.Conclusion CT findings of SO have certain characteristics such as a cystic-solid and well-defined mass with calcification,high attenuation lesion on plain CT,and marked solid part enhancement on contrast CT.
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Struma ovarii is a rare tumor that is defined as an ovarian teratoma with a thyroid tissue component exceeding 50%. Most of these tumors are benign, with malignant struma ovarii occurring in <1% of patients. Here, we describe the case of a 49-year-old female patient with malignant struma ovarii who developed thoracic spine metastasis. She had undergone an oophorectomy and was diagnosed with struma ovarii 10 years previously. She had remained recurrence-free thereafter. At 49 years of age, she developed low back pain and was admitted to our hospital for evaluation of a spinal tumor at the Th7 level. An emergency bone biopsy led to a diagnosis of metastasis from malignant struma ovarii. External beam radiotherapy inhibited further tumor growth and there was no resulting muscle weakness. This is the first report of spinal metastasis occurring 10 years after resection of struma ovarii, indicating the need for long-term follow-up.
Subject(s)
Female , Humans , Middle Aged , Biopsy , Diagnosis , Emergencies , Low Back Pain , Muscle Weakness , Neoplasm Metastasis , Ovariectomy , Radiotherapy , Recurrence , Spinal Neoplasms , Spine , Struma Ovarii , Teratoma , Thyroid GlandABSTRACT
Malignant struma ovarii is extremely rare and difficult to diagnose histologically, particularly in cases of follicular carcinoma. This case study is intended to describe three cases of follicular proliferative lesion arising in struma ovarii that we experienced. The first case was clearly malignant given the clinical picture of multiple recurrences, but there was little histological evidence of malignancy. Our second case featured architectural and cellular atypia and necrosis and was diagnosed as malignant despite the absence of vascular and stromal invasion. Our third case exhibited solid microfollicular proliferation without any definite evidence of malignancy (even the molecular data was negative); however, we could not completely exclude malignant potential after conducting a literature review. In cases such as our third case, it has been previously suggested that a diagnostic term recognizing the low-grade malignant potential, such as "proliferative stromal ovarii" or "follicular proliferative lesion arising in the stromal ovarii" would be appropriate.