Malignant Clinical Course of "Proliferative" Ovarian Struma: Diagnostic Challenges and Treatment Pitfalls

Malignant Clinical Course of "Proliferative" Ovarian Struma: Diagnostic Challenges and Treatment Pitfalls

Struma ovarii (SO) is a monodermal teratoma predominantly composed of thyroid tissue (TT) showing benign, “proliferative”, or malignant histology. By imaging, a 38-year-old patient with lower backache revealed a 6.2-cm vertebral lesion (L5). Core biopsy showed well-differentiated TT without features...

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Bibliographic Details
Published in:Diagnostics (Basel) Vol. 12; no. 6; p. 1411
Main Authors: Asaturova, Aleksandra, Magnaeva, Alina, Tregubova, Anna, Kometova, Vlada, Karamurzin, Yevgeniy, Martynov, Sergey, Lipatenkova, Yuliya, Adamyan, Leila, Palicelli, Andrea
Format: Journal Article
Language:English
Published: Switzerland MDPI AG 07-06-2022
MDPI
Subjects:
Back pain
Biopsy
Cartilage
Case Report
Cellular biology
Fractures
Hyperthyroidism
Laparoscopy
Metastasis
Morphology
Mutation
Ovaries
peritoneal strumosis
struma ovarii
Thyroid cancer
Thyroidectomy
Tomography
Tumors
Ultrasonic imaging
well differentiated follicular carcinoma arising in struma ovarii
United States > US
well differentiated follicular carcinoma arising in struma ovarii
struma ovarii
peritoneal strumosis
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Summary:Struma ovarii (SO) is a monodermal teratoma predominantly composed of thyroid tissue (TT) showing benign, “proliferative”, or malignant histology. By imaging, a 38-year-old patient with lower backache revealed a 6.2-cm vertebral lesion (L5). Core biopsy showed well-differentiated TT without features of papillary carcinoma. A 3.5-cm left ovarian mature teratoma (lacking TT) and peritoneal nodules (showing well-differentiated TT) were also identified and surgically removed. Thyroid ultrasound and cytological examination resulted negative. Four years before, left ovarian cystectomy was performed for a histologically “proliferative” SO. According to the malignant clinical course and WHO classification, this case was overall reassessed as a recurring well-differentiated follicular carcinoma arising in SO (WD-FC-SO), despite lacking malignant histological features in any specimens. Immunophenotype: TTF-1+/PAX-8+/thyroglobulin+/CK7+/chromogranin-/synaptophysin-/inhibin-/calretinin-/HNF1B-; Ki-67 index < 5%. Polymerase chain reaction analysis resulted negative for BRAFV600E mutation. The patient refused further treatments, without recurrence after 17 months. The clinical behavior of SO may be unpredictable. Histologically benign or proliferative strumas extraordinarily metastasize, while SO with malignant features may not recur. The exceptional evidence of peritoneal implants of well-differentiated TT (peritoneal strumosis) in patients with histologically benign SO represents a metastasis of WD-FC-SO (like in our case). A multidisciplinary approach including clinical, laboratory, radiologic, and histopathological data is required.
ISSN:2075-4418
2075-4418
DOI:10.3390/diagnostics12061411