Incidental Detection of Struma Ovarii on the Whole Body Scan in a Differentiated Thyroid Cancer Patient

Hye-Seon Oh; Eyun Song; Dong Eun Song; Won Bae Kim

doi:10.11106/ijt.2016.9.2.180

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Oh, Song, Song, and Kim: Incidental Detection of Struma Ovarii on the Whole Body Scan in a Differentiated Thyroid Cancer Patient

Case Report

Int J Thyroidol 2016;9(2):180-184.

Published online: 20 November 2016

DOI: https://doi.org/10.11106/ijt.2016.9.2.180

Incidental Detection of Struma Ovarii on the Whole Body Scan in a Differentiated Thyroid Cancer Patient

Hye-Seon Oh¹, Eyun Song¹, Dong Eun Song², Won Bae Kim^1,

¹Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

²Department of and Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Correspondence: Won Bae Kim, MD, PhD, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: 82-2-3010-3913, Fax: 82-2-3010-6962, E-mail: kimwb@amc.seoul.kr

Received 19 April 2016 Revised 14 June 2016 Accepted 20 June 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Post-therapeutic whole body scan (RxWBS) after radioactive iodine (RAI) remnant ablation (RRA) is useful for detect recurrent or metastatic foci of differentiated thyroid carcinoma (DTC) after total thyroidectomy. However, there is rare possibility of false positive iodine uptake in WBS. Here, we report a case of a 72-year-old woman, who underwent RRA after total thyroidectomy due to follicular variant papillary thyroid carcinoma. There is an abnormal iodine uptake in RxWBS in pelvic cavity. Additional single photon emission computed tomography (SPECT)-computed tomography (CT) imaging showed an intensive I-131 avid mass in left ovary. There was a multiple calcified mass in left ovary and enhancing wall thickening in left ureter with hydronephrosis in contrast enhanced CT. She underwent hysterectomy, oophorectomy, left ureterectomy and nephrectomy and diagnosed as mature cystic teratoma with thyroid tissues and ureter cancer. Struma ovarii should be considered if there was abnormal RAI uptake in pelvic cavity. I-131 SPECT-CT is useful for differential diagnosis of abnormal iodine uptakes in WBS.

Keywords: Differentiated thyroid cancer, Iodine uptake, Teratoma, Struma ovarii

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Fig. 1.

Representative radiologic and pathologic images of the thyroid cancer. Thyroid ultrasonograhy (US) images (A, B) thyroid US reveals 5.5-cm-sized hypoechoic nodule with smooth margin at the lower pole of right thyroid lobe (A) and another isoechoic 0.7-cm-sized nodule with irregular margin at the mid pole of left thyroid lobe (B). (C) Core needle biopsy for the right thyroid nodule revealed histological features of suspicious for follicular neoplasm with thin tumor capsule and microfollicular proliferation (H&E staining, magnification x200). (D) Large well-demarcated ovoid mass (5.5x4.2x3.7 cm) on lower pole of right lobe and several ovoid nodules were in surgical specimen after total thyroidectomy showed. (E) Tumor on right lobe revealed encapsulated invasive follicular variant of papillary carcinoma (FV-PTC) with capsular invasion (H&E staining, magnification x200). (F) Tumor cells of encapsulate invasive FV-PTC revealed mild nuclear atypia including enlarged nuclei, pale chromatin, irregular nuclear membrane and oval nuclear shape, supporting the diagnosis of FV-PTC (H&E staining, magnification x400).

Fig. 2.

Representative radiologic and pathologic images of the mature cystic teratoma. (A) Posttherapeutic whole body scan at 7 days after the administration 2.96 GBq I-131 showed multifocal thyroid bed uptake due to remnants of normal thyroid and intensive uptake on pelvic area. (B) Additional single photon emission computed tomography (SPECT)-computed tomography (CT) image at 21 days after I-131 remnant ablation showed 8.5-cm-sized intensive radioiodine-avid mass in left ovary or uterine fundus. (C) Abdominopelvic CT showed multiple calcified mass (hollow arrow) with contrast enhancement in left ovary and enhancing wall thickening in left distal ureter (read arrow) with hydronephrosis (arrowhead). (D) Mature cystic teratoma was found on left ovary with struma ovarii component composed of hyperplastic thyroid follicles (H&E staining, magnification x40). (E) Focal adenomatous hyperplasia was identified in the areas of struma ovarii (H&E staining, magnification x200).

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