Recurrent Struma Ovarii Presented with High Levels of Thyroglobulin.

Struma ovarii are rare ovarian tumors, of monodermal germ cell origin, containing predominantly thyroid tissue. They are typically benign unilateral pelvic masses. Among the rare cases of malignancy, the most common histological type is that of the papillary carcinoma. A definite preoperative diagnosis of these tumors is difficult to achieve since most imaging findings are generally nonspecific. A rare exception is the case of synchronous abnormal thyroid blood tests where an ovarian teratoma should be highly suspected, especially when no pathology of the thyroid gland coexists. Surgical excision is the mainstay of treatment. Taking into account that struma ovarii are mainly encountered in patients of a childbearing age, a conservative surgical approach is a reasonable option. We present the case of a 56-year-old woman who was diagnosed with both a primary and recurrent struma ovarii while investigating the incidental finding of elevated blood laboratory levels of the thyroglobulin (Tg).

VEGF expression in the colorectal adenoma-carcinoma sequence.

Angiogenesis is essential for tumor growth and metastasis. It is controlled by multiple factors, one of the most important being vascular endothelial growth factor (VEGF). VEGF and p53 expression were evaluated in 16 hyperplastic polyps, 35 solitary tubular and tubulovillous adenomas, and 47 cases of sporadic colorectal carcinomas arising on the basis of preexisting adenomas, using immunohistochemistry. In parallel, angiogenesis was assessed by the Chalkley score (CS) method. VEGF positivity was detected in 19/47 carcinoma cases (40%). In the respective adenomatous part of the tumor, VEGF positivity was detected in 11/47 cases (23%). Carcinomas arising from VEGF-positive adenomas were mostly VEGF positive (10/11, 91%), whereas in 28/36 (78%) carcinomas arising from VEGF-negative adenomas VEGF expression was not detected. CS was higher in VEGF-positive compared with VEGF-negative carcinomas (9.1 +/- 1.8 and 7.8 +/- 2.3, respectively, p < 0.05), whereas there was no statistically significant difference between the CS in the VEGF-negative and VEGF-positive adenomatous part of the tumor (3.3 +/- 1.8 and 4.3 +/- 2.3, respectively). Nuclear p53 positivity was detected in 26/47 (55%) cases in the cancerous part and in 14/47 (29%) cases in the adenomatous part of the tissue, and no significant correlation with VEGF expression was observed. We conclude that VEGF associates with angiogenesis in colorectal cancer, and its pattern of expression in adenomas is maintained in the arising carcinomas. Further investigation is warranted to clarify whether these findings could be used as indicators of prognosis in screening programs or in patients with limited stage disease where the usefulness of adjuvant therapies with either cytotoxic drugs or inhibitors of angiogenesis is still unclear.