EP23 – Challenging management of malignant struma ovarii, follicular thyroid carcinoma and Graves’ disease

     

    Goldstein, Horia1; Dobrescu, Ruxandra2; Coles, Diana2; Goldstein, Daniela2; Gherlan, Iulian1,2; Chiriac, Iulia Andreea2; Badiu, Corin1,2; Ioachim, Dumitru2; Terzea, Dana2; Voicu, Gabriela2; Goldstein, Andrei2
    1 “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
    2 “C.I.Parhon” National institute of Endocrinology, Bucharest, Romania


    Background/Purpose: 
    An uncommon type of ovarian teratoma, struma ovarii is seldom associated with malignancy.

    Objectives: We present a rare association of malignant struma ovarii (MSO), follicular thyroid carcinoma (FTC) and Graves’ disease.

    Methods: A 50-year-old woman presented with persistent thyrotoxicosis post-thyroidectomy for a benign thyroid nodule in the context of hyperthyroidism of Graves’ disease. Abdominal ultrasonography revealed a 6 cm tumor on the right ovary suggesting struma ovarii, and the patient was advised to undergo ovariectomy, but postponed. A year later she presented with lower limb neurological deficits, and CT and MRI scans revealed multiple pulmonary, vertebral and liver metastases.

    Results: Orthopedic resection of a large T11 vertebral tumor was performed, and pathology indicated metastasis of follicular thyroid carcinoma (FTC). Review of the original thyroid pathology revealed well differentiated FTC. 131I whole body scan (WBS) showed intense iodine uptake in the lungs, right pelvis, axial skeleton, skull. Right ovariectomy confirmed malignant struma ovarii. Additional parietal and vertebral tumor resection (T2) and stabilisation were done, followed by chemoembolisation of two hepatic lesions and radioiodine ablation – total dose 878 mCi 131I. At the last admission WBS revealed numerous bone metastases and high stimulated thyroglobulin (STg=5070ng/ml), but in regression, proving efficient management of a challenging case.

    Discussion & Conclusion:  The association of MSO with FTC and Graves’ disease makes this case unique in the reported literature. Genetic testing will determine whether the MSO and FTC might represent multifocal expression of the same tumor.

     

     

    References:

    1. Metastatic struma ovarii treated with total thyroidectomy and radioiodine ablation. McGill JF, Sturgeon C, Angelos P. Endocrine Practice. March2009;15(2):167-73.
    2. Poorly Differentiated Thyroid Carcinoma Arising in Struma Ovarii. Surapan Khunamornpong,1 Jongkolnee Settakorn,1 Kornkanok Sukpan,1, Prapaporn Suprasert,2 and Sumalee Siriaunkgul1
    3. Struma ovarii: CT findings. Sung Il Jung,1 Young Jun Kim,1 Min Woo Lee,1 Hae Jeong Jeon,1 Jong-Sun Choi,2 Min Hoan Moon3
      Papillary thyroid microcarcinoma in struma ovarii. Domenico Meringolo • Davide Bianchi •Carmelo Capula • Giuseppe Costante
    4. Struma ovarii: role of imaging? Martine I. Dujardin & Priti Sekhri & Lindsay W. Turnbull
    5. Pathology of Struma Ovarii: A Report of 96 Cases. Shuanzeng Wei1 & Zubair W. Baloch1 & Virginia A. LiVolsi1
    6. The enigma of struma ovarii. LAWRENCE M. ROTH* AND ALEKSANDER TALERMAN
      A Hormonally Active Malignant Struma Ovarii. Carolina Lara,1 Dalia Cuenca,1 Latife Salame,2 Rafael Padilla-Longoria,3 and Moisés Mercado1,2
    7. Giant struma ovarii. Olivia Laura Friedrich • Hans-Peter Sinn •Christof Sohn • Michael Eichbaum

 

Leave a Reply

  • Upcoming Events

     

    World Congress on Thyroid Cancer 3.5
    June 20 – 22, 2019
    Rome, Italy

    World Congress on Thyroid Cancer 4.0
    July 29 – August 1, 2021
    Boston, Massachusetts

     

  • WCTC3.5 Steering Committee:

     

    Rocco Bellatone, Co-Chair
    Celestino Lombardi, Co-Chair
    Gregory W. Randolph, MD
    Bryan McIver, MD
    Jeremy Freeman, MD
    Ian J. Witterick, MD
    Ashok R. Shaha, MD
    Jatin P. Shah, MD