Journal List > Korean J Hepatobiliary Pancreat Surg > v.16(3) > 1040551

TOOLS
Lee, Yi, Kim, Choi, Park, Hong, Choi, Chung, Lee, Park, Min, Chung, and Suh: Metastatic follicular struma ovarii complicating pregnancy: a case report and review of the literature
Case Report
Korean Journal of Hepato-Biliary-Pancreatic Surgery

Korean Journal of Hepato-Biliary-Pancreatic Surgery 2012; 16(3): 123-127.

Published online: 31 August 2012

DOI: https://doi.org/10.0000/kjhbps.2012.16.3.123

Metastatic follicular struma ovarii complicating pregnancy: a case report and review of the literature

Woohyung Lee1, Nam-Joon Yi1, Hyeyoung Kim1, Youngrok Choi1, Minsu Park1, Geun Hong1, June Young Choi1, Hyun Hoon Chung2, Kwang-Woong Lee1, Do-Joon Park3, Hye Sook Min4, June-key Chung5, Kyung-Suk Suh1

1Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.

2Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.

3Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.

4Department of Pathology, Seoul National University College of Medicine, Seoul, Korea.

5Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea.

Corresponding author: Nam-Joon Yi. Department of Surgery, Seoul National University College of Medicine, 101, Daehak-ro, Chongno-gu, Seoul 110-744, Korea. Tel: +82-2-2072-2990, Fax: +82-2-766-3975, gsleenj@hanmail.net

Received 24 July 2012       Revised 28 July 2012       Accepted 1 August 2012

Copyright © 2012 Korean Association of HBP Surgery

Abstract

A 35-year-old woman was determined to have an ovarian cyst and underwent a right ovarian cystectomy at 10 weeks of gestation. A histopathological examination revealed follicular carcinoma arising in a teratoma. No evidence of metastasis was found after delivery. She underwent a total thyroidectomy, followed by radioactive iodine (RAI) therapy. However, her serum thyroglobulin level increased to 1,437 ng/ml (normal range: 0-52 ng/ml) after 10 months. Radioiodine scintigraphy and abdominal computed tomography revealed liver metastasis and peritoneal seeding. She underwent debulking surgery of the liver, right salpinx, and peritoneal seeding nodules. A pathological examination showed metastatic follicular carcinoma with focal poorly differentiated features. Adjuvant RAI therapy was restarted, and her serum thyroglobulin levels returned to normal. In conclusion, metastatic lesions were successfully treated with a combination of debulking surgery and RAI therapy. Close medical follow-up monitoring serum thyroglobulin levels is mandatory in such patients.

Keywords: Struma ovarii, Metastatic follicular carcinoma, Liver metastasis, Radioactive iodine therapy

Figures and Tables

Fig. 1
Imaging studies of the metastatic struma ovarii. (A) An iodine-131 scan after radioactive iodine therapy. This test revealed several nodules in the right upper quadrant of the abdomen (liver, arrow), peritoneum (arrow), and pelvic cavity (arrow). (B) Computed tomography scans showing an enhanced conglomerate nodular mass (arrow) in segment 6 of the liver with several daughter nodules and multiple seeding nodules (arrow). (C) The fluorodeoxyglucose-positron emission tomography (18-FDG-PET) scans showing increased uptake in the exophytic liver mass (arrow) and lymph nodes in neck level II.
kjhps-16-123-g001
Fig. 2
Pathological examination of the metastatic follicular struma ovarii. (A) A metastatic follicular carcinoma in the liver at the bottom. (B) High-power magnification of the metastatic lesion in the liver shows many follicular masses. (C, D) Mulifocal necrosis (C) and positive P53 staining (D) represent the possibility of malignant transformation.
kjhps-16-123-g002
Table 1
Literature review of malignant follicular struma ovarii cases
kjhps-16-123-i001

TAH/BSO, total abdominal hysterectomy/bilateral salpingo-oophorectomy; RTx, radiotherapy; NED, no evidence of disease; USO, unilateral salpingo-oophorectomy; NI, not indicated; CTx, chemotherapy; DOD, died of disease

References

1. Marcy PY, Thariat J, Benisvy D, et al. Lethal, malignant, metastatic struma ovarii. Thyroid. 2010. 20:1037–1040.
2. Ruel IF, Fierrard H, Vercellino L, et al. Pulmonary metastasis of struma ovarii: a case report. Clin Nucl Med. 2010. 35:692–694.
3. Garg K, Soslow RA, Rivera M, et al. Histologically bland "extremely well differentiated" thyroid carcinomas arising in struma ovarii can recur and metastasize. Int J Gynecol Pathol. 2009. 28:222–230.
4. Zhang X, Axiotis C. Thyroid-type carcinoma of struma ovarii. Arch Pathol Lab Med. 2010. 134:786–791.
5. Yücesoy G, Cakiroglu Y, Muezzinoglu B, et al. Malignant struma ovarii: a case report. J Korean Med Sci. 2010. 25:327–329.
6. Janszen EW, van Doorn HC, Ewing PC, et al. Malignant struma ovarii: good response after thyroidectomy and I ablation therapy. Clin Med Oncol. 2008. 2:147–152.
7. Salvatori M, Dambra DP, D'Angelo G, et al. A case of metastatic struma ovarii treated with 131I therapy: focus on preservation of fertility and selected review of the literature. Gynecol Endocrinol. 2008. 24:312–319.
8. Roth LM, Miller AW 3rd, Talerman A. Typical thyroid-type carcinoma arising in struma ovarii: a report of 4 cases and review of the literature. Int J Gynecol Pathol. 2008. 27:496–506.
9. Shaco-Levy R, Bean SM, Bentley RC, et al. Natural history of biologically malignant struma ovarii: analysis of 27 cases with extraovarian spread. Int J Gynecol Pathol. 2010. 29:212–227.
10. Dardik RB, Dardik M, Westra W, et al. Malignant struma ovarii: two case reports and a review of the literature. Gynecol Oncol. 1999. 73:447–451.
11. Bolat F, Erkanli S, Kayaselcuk F, et al. Malignant struma ovarii: a case report. Pathol Res Pract. 2005. 201:409–412.
12. Cherng SC, Wang YF, Fan YM, et al. Malignant struma ovarii with peritoneal implants and pelvic structures and liver metastases demonstrated by I-131 SPECT and low-dose CT. Clin Nucl Med. 2005. 30:797–798.
13. Makni SK, Bahri I, Ellouze S, et al. Malignant struma ovarii: a case report. J Gynecol Obstet Biol Reprod (Paris). 2005. 34:815–818.
14. Kwon TH, Ji EK, Hong HS, et al. Ultrasonographic findings of struma ovarii. Korean J Obstet Gynecol. 2002. 45:1966–1969.
15. Yücesoy G, Cakiroglu Y, Muezzinoglu B, et al. Malignant struma ovarii: a case report. J Korean Med Sci. 2010. 25:327–329.
16. Kim SM, Choi BK, Kang JH, et al. A case of bilateral struma ovarii combined with subclinical hyperthyroidism. Endocrinol Metab. 2012. 27:72–76.
17. Baek CK, Lee CJ, Kim WG. A case of primary malignant struma ovarii tumor of the ovary. Korean J Gynecol Oncol Colposc. 2004. 15:64–67.
TOOLS
Similar articles