Case report: Malignant struma ovarii.

Struma ovarii are specialized teratomas consisting of thyroid tissue with various microscopic features, ranging from benign to malignant. We report a rare form of malignant struma ovarii, composed exclusively of a follicular variant of papillary thyroid carcinoma with capsular invasion, which occurred in a 65-yr-old woman.

Ultrastructural characteristics of the endometrial stroma of athymic nude rats in the proestrus and metestrus phases of the estrous cycle

En el presente estudio se observa la ultraestructura del estroma endometrial de ratas congenitamente atímicas (rnu/rnu), homozigotas para el gen nude recesivo y de sus camadas eutímicas (+/rnu), heterozigotas para el mismo gen, ambas de la línea Rowet, con el propósito de detectar posibles alteraciones en las ratas rnu/rnu. Estudios morfológicos del aparato reproductor de éstas, usando microscopio de luz, no muestran diferencias de las ratas +/rnu. Estudios ultraestructurales referentes a este asunto no fueron encontrados en la literatura consultada. La ultraestructura del estroma endometrial de rnu/rnu y +/rnu mostraron fibroblastos con una GER más dilatada en el proestro que el metaestro y una menor frecuencia de eosinófilos y macrófagos en las ratas rnu/rnu que en las +/rnu en proestro. La frecuencia de monocitos fue mas alta en el proestro mientras que la de los neutrófilos fue mas baja en el proestro y metaestro, en ambos grupos de ratas. Los resultados ultraestructurales sugieren que la menor frecuencia de eosinófilos y macrófagos encontrados en la ratas rnu/rnu en fase de proestro pueden estar relacionados con atmia congénita y/o alteraciones en los niveles de hormonas esteroidales encontradas en esas ratas

Ovarian strumal carcinoid in association with multiple endocrine neoplasia, type IIA.

Strumal carcinoid is an unusual form of monodermal ovarian teratoma with thyroid-like follicles admixed with typical carcinoid tumor patterns. We encountered a case of this neoplasm in a patient with multiple endocrine neoplasia, type IIA (Sipple's syndrome), including a medullary thyroid carcinoma diagnosed 24 years previously. During evaluation of bilateral adrenal pheochromocytomas, a unilateral left ovarian strumal carcinoid was discovered. Subsequently, the patient had a parathyroid adenoma excised. The ovarian tumor was immunohistochemically reactive for neuron-specific enolase, chromogranin, synaptophysin, and serotonin, but did not stain for calcitonin. The follicular structures stained for thyroglobulin. This unusual case shows that ovarian strumal carcinoid, like carcinoid tumors at other sites, may arise in association with multiple endocrine neoplasia.

Immunochemical and ultrastructural studies of an ovarian strumal carcinoid.

An ovarian strumal carcinoid which synthesized peptide hormones, but did not induce the carcinoid syndrome, was analysed histochemically, immunohistochemically and ultrastructurally. Dot-immunobinding assays were performed in order to determine the endocrine gene expression. The amylase resistant colloid was found to be PAS-positive in the follicular portions of the tumour. Carcinoid cells showed Grimelius positive argyophilic granules in the subnuclear position. The Fontana-Masson argentaffin reaction was negative. Immunohistochemistry for adrenocorticotropic hormone (ACTH) revealed strong reactivity in the follicular areas of the carcinoid. The immunoreactivity for somatotropic release inhibiting factor (SRIF) was found positive in the trabecular portion of the carcinoid tumour, thyroglobulin in the follicles. Neuron-specific enolase, protein S-100 A/B, synaptophysin and chromogranin A evoked weak cytoplasmic immunostaining of the tumor cells. Dot-immunobinding assays substantiated these immunohistochemical results, except for the thermolabile protein S-100 A/B. Electron microscopy of tumor cells showed numerous electron-dense cytoplasmic granules, 250 to 350 nm in diameter, both in follicular and trabecular areas of the tumor. Plasma levels of tumor-associated ACTH, SRIF and thyroglobulin were measured by radioimmunoassay and were found to be within the normal range.

[Strumal carcinoid tumor of the ovary--histologic and electron microscopy characteristics of the tumor]. / "Strumal carcinoid" tumor jajnika--histoloske i elektronskomikroskopske karakteristike tumora.

Strumal carcinoid tumor is a very rare primary tumor of the ovary in which carcinoid is admixed with tissue resembling thyroid follicles. We report a 44-year-old women with benign strumal carcinoid tumor of the ovary and without any clinical symptoms. Histochemical and electron microscopical examinations of the tumor showed intracytoplasmic dense core secretory granules, indicating that this neoplasm is a pure carcinoid tumor with acinar differentiation resembling thyroid tissue.

Strumal carcinoids of the ovary. An immunohistologic and ultrastructural study.

A series of six ovarian strumal carcinoids was examined. The presence of thyroid follicular epithelium was conclusively proved by the presence of follicular cells immunohistochemically positive for thyroglobulin, and by the ultrastructural identification of non-neuroendocrine cells with features of thyroid epithelium lining the follicles. Progressive replacement of thyroid epithelial cells by carcinoid cells accounts for the predominance of neuroendocrine granule-containing cells and the scarcity of thyroid epithelial cells lining many of the follicles. A variety of neuroendocrine hormones and other immunoreactive substances was demonstrated within carcinoid cells, including somatostatin (five cases), chromogranin (five cases), serotonin (five cases), glucagon (four cases), insulin (two cases), and gastrin (one case). Only one case contained calcitonin-positive cells. None were carcinoembryonic antigen-positive or had amyloid deposits. The carcinoid element in five cases stained positively for prostatic acid phosphatase. While strumal carcinoid shares some features with medullary carcinoma of the thyroid gland, it has sufficient differences to warrant a separate designation.

[Structural and histochemical characterization of a struma ovarii]. / Caracterización estructural e histoquímica de un estruma ovárico.

We have studied the thyroid tissue present in a cystic ovarian teratoma with the purpose of characterizing its structural and histochemical components. The methods of hematoxilyn and eosin, PAS, PAS/sialidase, Alcian blue at pH 2.5 and 1.0, were used, as well as, blocking reactions, Cason's thrichromic, and toluidine blue at pH 3.8. In the tissue we observed zones with follicles of normal appearance that varied considerably in size. The epithelium was constituted by cuboid cells surrounding a colloid substance of uniform aspect, that was strongly acidophilic, PAS positive and with variable reactivity with toluidine blue and weakly alcianophilic. With the thrichrome method, the different follicles stained in different tones. Parafollicular clear cells, bigger and less basophilic than follicular ones, with a nucleus having a lax chromatin, were identified. Cystic follicles were observed in whose cavities were conspicuous histyocytes surrounding rests of colloid substance, with metachromatic and PAS positive granules in their cytoplasm. Some groups of follicles were rudimentary, scarcely differentiated, and mostly without colloid. Others, with a greater degree of differentiation, showed diminutes follicles with intensely basophilic and PAS positive colloid. Beasides, follicular groups with excessive content of colloid appeared very distended and lined by a flat epithelium. According to the characteristics analyzed it may be concluded that: 1) it is a highly differentiated monoblastic teratoma, in which it appears non-encapsulated thyroid tissue; 2) the tumor resembles in different areas, either normal thyroid tissue, thyroid adenoma of the macrofollicular type, fetal or microfollicular and solid or embryonary adenoma, and follicles with the pattern of "thyroiditis".

Caracterización estructural e histoquimica de un estruma ovarico / Structural and histochemical caracterization of an ovarian struma

Hemos estudiado el tejido tiroideo presente en un teratoma quístico de ovario con el objeto de caracterizar sus componentes estructurales y citoquímicos. Se utilizaron los métodos de hematoxilina y eosina. PAS. PAS/sialidasa, blue a pH 2,5 y 1,0, reacciones de bloqueo, tricrómico de Cason, azul de toluidina a pH 3,8 y metenamina/plata. En el mismo hemos observado zonas con folículos de apariencia normal que variaban considerablemente de tamaño. El epitelio estaba constituido por células cuboideas que rodeaban a una sustancia coloide de aspecto uniforme, francamente acidófila, con variable reactividad al azul de toluidina y débilmente alcionofilica. Con el método tricrómico, los diferentes folículos se tiñeron de distintas tonalidades. Se identificaron células claras parafoliculares más grandes y menos basófilas que las foliculares. Se observaron folículos quísticos en cuyas cavidades se destacaban histiocitos rodeando a restos de sustancia coloide, los que tenían granulaciones metacromáticas y PAS positivas en sucitoplasma. algunos grupos de folículos eran rudimentarios, escasamente diferenciados y por lo general sin coloide. Otros, con un grado mayor de diferenciación, mostraban folículos en miniatrura con coloide intensamente basófilo y PAS positivo. Además, aparecían grupos foliculares distendidos, con excesivo contenido coloide y tapizados por un epitelio plano. Según las características analizadas podemos podemos concluir que: 1) se trata de un teratoma monoblástico altamente diferenciado en el que aparece tejido tiroideo no encapsulado; 2) dicho tumor se semeja en diferentes áreas al tejido tiroideo normal, al adenoma tiroideo tipo macrofolicular, microfolicular o fetal, sólido o embrionario, y a folículos con patrón de "tiroiditis" (AU)

Caracterización estructural e histoquimica de un estruma ovarico / Structural and histochemical caracterization of an ovarian struma

Hemos estudiado el tejido tiroideo presente en un teratoma quístico de ovario con el objeto de caracterizar sus componentes estructurales y citoquímicos. Se utilizaron los métodos de hematoxilina y eosina. PAS. PAS/sialidasa, blue a pH 2,5 y 1,0, reacciones de bloqueo, tricrómico de Cason, azul de toluidina a pH 3,8 y metenamina/plata. En el mismo hemos observado zonas con folículos de apariencia normal que variaban considerablemente de tamaño. El epitelio estaba constituido por células cuboideas que rodeaban a una sustancia coloide de aspecto uniforme, francamente acidófila, con variable reactividad al azul de toluidina y débilmente alcionofilica. Con el método tricrómico, los diferentes folículos se tiñeron de distintas tonalidades. Se identificaron células claras parafoliculares más grandes y menos basófilas que las foliculares. Se observaron folículos quísticos en cuyas cavidades se destacaban histiocitos rodeando a restos de sustancia coloide, los que tenían granulaciones metacromáticas y PAS positivas en sucitoplasma. algunos grupos de folículos eran rudimentarios, escasamente diferenciados y por lo general sin coloide. Otros, con un grado mayor de diferenciación, mostraban folículos en miniatrura con coloide intensamente basófilo y PAS positivo. Además, aparecían grupos foliculares distendidos, con excesivo contenido coloide y tapizados por un epitelio plano. Según las características analizadas podemos podemos concluir que: 1) se trata de un teratoma monoblástico altamente diferenciado en el que aparece tejido tiroideo no encapsulado; 2) dicho tumor se semeja en diferentes áreas al tejido tiroideo normal, al adenoma tiroideo tipo macrofolicular, microfolicular o fetal, sólido o embrionario, y a folículos con patrón de "tiroiditis"

Strumal carcinoid of the ovary. Ultrastructural and immunohistochemical study.

Strumal carcinoid of the ovary with mucinous cystadenoma of borderline malignancy is reported. A colloid-like material in the follicular structure contained thyroglobulin which was immunohistochemically demonstrated to confirm the thyroid element, whereas the carcinoid component, which showed argyrophilia and displayed neurosecretory granules, revealed an insular or trabecular structure. This confirmed the presence of colloid filled thyroid epithelium intimately admixed with the carcinoid. Electron microscopy revealed carcinoid cells expanding toward the inner layer of the follicles but thyroid epithelium almost always stretched its thin cytoplasmic processes to cover the colloidal lumen. No calcitonin was demonstrated but CEA was seen in some cells of the carcinoid. No amyloid was detected.

Strumal carcinoid of the ovary. A case report.

The case of a 58-year-old Japanese female with strumal carcinoid of the ovary is described. Ultrastructural examinations revealed numerous neurosecretory-type granules in the cytoplasm of both thyroid and carcinoid components. Immunohistochemical studies showed immunoreactivities for thyroxin and thyroglobulin in the thyroid component. Several mucous glands were also observed in the tumor tissue. These morphological findings suggested that the follicles in the thyroid component were lined with thyroid follicular, carcinoid and mucous cells, and also supported the theory that this tumor may be derived from multidirectional differentiations of endodermal origin.

Ovarian strumal carcinoid: immunohistochemical, ultrastructural, and clinicopathologic observations.

A review of 13 ovarian strumal carcinoids in the files of the Armed Forces Institute of Pathology has established further evidence that these tumors have both endocrine and neuroendocrine differentiation. The two functional routes of differentiation occur even within individual tumor cells. Immunohistochemical reaction for thyroglobulin was positive in the strumal regions of all 12 cases tested. This positivity was also present in transitional zones where the thyroid follicles merged with nests of carcinoid cells. Electron microscopy performed in six cases showed cells with neuroendocrine granules in the thyroid follicles; these cells resemble the C-cells of the normal thyroid gland. An immunoperoxidase reaction for calcitonin, however, revealed no positivity in any of the cells corresponding to the neuroendocrine cells within the follicles or those in the carcinoid component. Variable positivity for serotonin was observed, however. It is proposed that cells within the struma that have morphologic similarities to the C-cells of the thyroid give rise to the carcinoid component. These cells appear capable of producing thyroglobulin as well as neuroendocrine granules.

Carcinoid tumors of the ovary.

Carcinoid tumors of the ovary are uncommon, but 150 cases of primary ovarian carcinoids and 40 cases of carcinoid tumors metastatic to the ovary have been reported. Primary carcinoid tumors of the ovary are divided into insular, trabecular, strumal and mucinous types. The insular type is most common, followed by the strumal type. The majority of primary ovarian carcinoids occur in association with mature cystic teratoma, but a considerable number present in pure form. Only the insular type is associated with the carcinoid syndrome. The age incidence of patients with ovarian carcinoids shows a wide range but most patients are postmenopausal. Primary carcinoids of the ovary are invariably unilateral. They form a solid nodule within a cystic teratoma, or when pure a solid yellow-grey mass, and vary from microscopical to large tumors measuring in excess of 20 cm in the longest diameter. The metastatic carcinoids are nearly always bilateral and scattered tumor deposits are present throughout both ovaries. Primary ovarian carcinoids metastasize only occasionally, and should be treated as ovarian tumors of low malignant potential.

Histology, ultrastructure, and immunohistochemistry of strumal carcinoid: a case report.

A case of ovarian strumal carcinoid was studied by histochemistry, electron microscopy, and immunocytochemistry. The thyroid component of the tumor was micro-macrofollicular, whereas the carcinoid areas had a trabecular growth pattern. Carcinoid cells contained argyrophilic, dense-core secretory granules and were immunopositive for serotonin but not for calcitonin, somatostatin, or thyroglobulin. Follicular thyroid cells were positive for thyroglobulin, and were negative for calcitonin and somatostatin. Thyroglobulin and serotonin-containing cells were present in microfollicles adjacent to areas of trabecular carcinoid and struma ovarii. The data suggest that strumal carcinoids develop in close association with struma ovarii and represent a subset of ovarian teratomas. Current hypotheses on the cell of origin of strumal carcinoids are reviewed.

Strumal carcinoid of the ovary: an immunohistochemical and electron microscopic study.

A case of strumal carcinoid of the ovary is reported. The follicles contained T4-immunoreactive substance, whereas the carcinoid component of the tumor had a trabecular structure and showed argyrophilic elements. Pancreatic-polypeptide and enteroglucagon were localized in these cells by an immunocytochemical method. The same cells displayed small electron-dense endocrine-like granules. A common precursor for the thyroid and carcinoid components is postulated.

Malignant struma ovarii. Light and electron microscopic study.

Malignant struma ovarii is a very rare tumor, consisting of a struma ovarii with malignant change. Only 17 examples with metastases have previously been reported. We present a case which involved both ovaries and produced multiple metastases. Microscopy and ultrastructure were identical to a mixed papillary and follicular carcinoma of the thyroid gland. Characteristic ultrastructural features of malignant struma ovarii are: microvilli on the surface and in the cytoplasmatic vacuoles; oncocytic transformation of cytoplasm of some cells; and presence of electron dense, granular and crystalline material (colloid) in the follicles and vacuoles. The patient's thyroid was normal. We conclude that malignant struma ovarii can only be diagnosed wheb a carcinoma arising in the thyroid gland can be excluded. Ultrastructure examination may provide useful diagnostic features separating malignant struma ovarii from strumal carcinoid and serous adenocarcinoma.

Ovarian strumal carcinoid. An immunocytochemical and ultrastructural study of two cases.

Examination by immunoperoxidase methods showed that two strumal carcinoids contained thyroxine in the follicular epithelium and colloid. Ultrastructure showed features of thyroid epithelia. Granule-containing cells replaced some follicular epithelial cells at the colloid interface. The morphology of the granules of these cells resembled those of C-cells and foregut-hindgut carcinoids. Transition between thyroid and carcinoid occurred by proliferation of interfollicular cells which subtly formed trabecular structures. Immunoperoxidase for calcitonin was positive both in the interfollicular cells of one tumor and in cells near the transition from thyroid to carcinoid pattern of the other. We conclude that thyroid tissue is a proven component of strumal carcinoid but that follicular epithelial cells may be replaced by granule-containing parafollicular cells. We suggest that the transition from thyroid to carcinoid is accomplished through an intermediate stage of calcitonin-positive cell proliferation. We emphasize, however, that these neoplasms are types of teratomas which may show several forms of differentiation. The tumor of one patient had mid-gut carcinoid elements and represents the first described strumal carcinoid with the carcinoid syndrome.

Calcitonin secreting struma-carcinoid tumor of the ovary.

The ultrastructure of strumal carcinoid tumors at times may reveal a far more complex structure than can be ascertained from light microscopy. It may at times be indistinguishable from medullary carcinoma of the thyroid gland. Both tumors appear to be capable of producing 5-hydroxyindolacetic acid and calcitonin. The common shared biologic and ultrastructural features suggest a common origin, from neuroectodermal cells.