Estruma ovárico asociado con enfermedad de graves / Struma ovarii associated with Graves' disease

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.

[Struma ovarii associated with Graves' disease]. / Estruma ovárico asociado con enfermedad de Graves.

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.

Follicular variant papillary thyroid carcinoma arising in struma ovarii.

Struma ovarii is a rare monodermal ovarian teratoma in which thyroid tissue is the predominant or exclusive element. Malignant transformation is known to occur, usually as classical papillary thyroid carcinoma (PTC). However, the recognition of follicular variant PTC raises the possibility of similar malignancy arising in struma ovarii. We examined 13 cases of struma ovarii to determine if these lesions can exhibit histological, immunohistochemical, and/or molecular features of follicular variant PTC. Ten of these had atypical histology, cytologic features of PTC, and all ten showed diffuse positivity for CK19; eight of these were also positive for HMBE-1. Mutational analysis for BRAF identified no V600E mutations. However, seven of the ten cases with features of follicular variant PTC exhibited a rearranged in transformation (RET)/PTC rearrangement by reverse transcriptase polymerase chain reaction (RT-PCR). The three cases considered to be benign based on histologic and cytologic criteria were negative for CK19 and HBME-1 by immunohistochemistry, and had no evidence of BRAF mutation or ret/PTC-1 and ret/PTC-3 rearrangements. These results indicate that follicular variant PTC can occur in struma ovarii and that such lesions exhibit the same morphologic and immunohistochemical profile as follicular variant PTC in thyroid. The application of molecular testing to verify the diagnosis can be valuable, as these lesions may harbor ret/PTC gene rearrangements.

Coexistence of Graves' disease and benign struma ovarii in a patient with marked ascites and elevated CA-125 levels.

BACKGROUND: Struma ovarii is the most common monodermal ovarian teratoma and consists mainly of thyroid tissue. Only 5% of patients with this tumor have features of hyperthyroidism. The pathophysiology of hyperthyroidism in struma ovarii is not clear. CASE: We describe a case of benign struma ovarii, presenting with the clinical features of an ovarian cancer: large complex pelvic mass, large amount of ascites and markedly elevated CA-125 serum levels. The patient was initially treated for Graves' disease, on the basis of ultrasonographic, laboratoristic and scintigraphic evidence. The resistance to the medical treatment led to thyroidectomy. After surgery the hyperthyroidism persisted and, suddenly, the patient presented ascites. A large pelvic mass was then diagnosed which, at the pathologic examination, was diagnosed as a struma ovarii. CONCLUSION: The struma ovarii always has to be considered when a pelvic mass is associated with features of hyperthyroidism.

[Struma ovarii. A case report]. / Goitre ovarien. A propos d'un cas.

Struma ovarii is a rare ovarian tumor composed entirely or in part of thyroid tissue. Pathogenesis is unclear. Diagnosis rests on the histologic study. A case is reported. Specific features of struma ovarii are discussed based on a review of the literature. The treatment is surgical and the outcome generally favorable.

Paraplejia secundaria a metástasis de un carcinoma folicular de Strumma ovarii / Secundary paraplegia a to metastasis of follicular carcinoma of ovarian struma

Se presenta el caso clínico de una paciente de 47 años de edad a la que dos años antes se les practicó histerectomía con salpingo-oforectomía bilateral por tumor ovárico reportado como un tumor de la granulosa. Acude nuevamente con cuadro de paraplejía secundaria a comprensión medular por fractura patológica de vértebra dorsal (T7-8). Se le practica laminectomía de la lesión vertebral osteolítica, la que se reporta como correspondiente a un carcinoma folicular de tiroides metastásico. Posteriormente es sometida a una tiroidectomía total, la pieza de esta ocasión se reportó como "glándula tiroidea normal". En busca de la lesión primaria se reexamina la pieza y laminillas de histerectomía, diagnosticándose un carcinoma folicular y struma ovarii. Es tratada con Iodo 131, recupera la motilidad y cinco años después se encuentra en perfectas condiciones, haciendo vida normal. Se hacen comentarios sobre dicha entidad

Immunocytochemical localization of calcitonin-producing cells in a strumal carcinoid with amyloid stroma.

A nonfunctioning strumal carcinoid arising in a 49-year-old woman was studied by histochemical and immunocytochemical techniques. All tumor cells, irrespective of their architectural arrangement, showed properties of neuroendocrine-programmed cells, without any evidence of thyroid follicular cell differentiation. Foci of calcitonin-producing C-cells were demonstrable by immunocytochemical technique and were closely associated with areas of amyloid stroma of the tumor. Efforts at localization of insulin and gastrin within the tumor cells gave negative results. While the results in the present case offer additional support for an APUD cell origin of strumal carcinoids, the presence of the calcitonin-producing C-cells within the tumor raises interesting histogenetic possibilities as to whether these lesions are derived from C-cells or represent an ovarian carcinoid with foci of C-cell differentiation.