Ciobanu Apostol Delia Gabriela, BuŢureanu Tudor Andrei, Socolov Demetra Gabriela, Scripcaru Daniela Claudia, Rosin Oana LuminiŢa, Lozneanu Ludmila
Department of Obstetrics and Gynecology, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania;
Rom J Morphol Embryol. 2017;58(3):1035-1040.
Strumal carcinoid represents a rare form of ovarian teratoma, consisting of both thyroid tissue and carcinoid structures. The carcinoid component is a well-differentiated neuroendocrine tumor with excellent prognosis. Strumal carcinoid tumors are commonly found in peri-menopausal women who are not usually interested in preserving their fertility and who are thus open to radical surgical treatment. In this report, we present a 24-year-old, nulliparous patient with strumal carcinoid, confirmed by histopathology and a large panel of immunohistochemistry (IHC) markers, who wished to preserve her fertility. In this case, a conservative surgical treatment (salpingo-oophorectomy) served to preserve vital and reproductive prognosis, and correct tumor classification was of extreme importance. The morphological examination of strumal carcinoid showed struma ovarii with a thyroid follicle-like structure [positive for thyroid transcription factor 1 (TTF1), thyroglobulin, CD56, cytokeratin (CK) 19, and negative for Hector Battifora and mesothelioma 1 (HBME1)], and a neuroendocrine cell component with a trabecular arrangement and island growth (positive for synaptophysin, chromogranin, CD56, and CK7 negative), which were interlocked and intimately associated. Papillary thyroid carcinoma of follicular type was ruled out by CD56 positivity and HBME1 negativity. Medullary thyroid carcinoma with strumal component was excluded by calcitonin negative staining. Solid rosette-like structures with negative glial fibrillary acidic protein (GFAP) staining ruled out a neuroectodermal component. A multilocular mucinous cystadenoma was identified without other teratoma components. Strumal carcinoid requires a meticulous examination to rule out other entities with malignant behavior and poor prognosis. In this case, a conservative treatment is sufficient to remove the tumor, preserving vital and reproductive prognosis.
甲状腺类癌是卵巢畸胎瘤的一种罕见形式，由甲状腺组织和类癌结构组成。类癌成分是一种分化良好的神经内分泌肿瘤，预后良好。甲状腺类癌肿瘤常见于围绝经期女性，她们通常对保留生育能力不感兴趣，因此愿意接受根治性手术治疗。在本报告中，我们介绍了一名24岁未生育的甲状腺类癌患者，经组织病理学和大量免疫组化（IHC）标志物证实，她希望保留生育能力。在这种情况下，保守手术治疗（输卵管卵巢切除术）有助于保留重要和生殖预后，正确的肿瘤分类至关重要。甲状腺类癌的形态学检查显示卵巢甲状腺肿具有甲状腺滤泡样结构[甲状腺转录因子1（TTF1）、甲状腺球蛋白、CD56、细胞角蛋白（CK）19阳性，赫克托·巴蒂福拉和间皮瘤1（HBME1）阴性]，以及神经内分泌细胞成分，呈小梁状排列和岛状生长（突触素、嗜铬粒蛋白、CD56阳性，CK7阴性），两者相互交错并紧密相连。滤泡型甲状腺乳头状癌通过CD56阳性和HBME1阴性排除。降钙素阴性染色排除了伴有甲状腺肿成分的甲状腺髓样癌。胶质纤维酸性蛋白（GFAP）染色阴性的实性玫瑰花结样结构排除了神经外胚层成分。确定为多房性黏液性囊腺瘤，无其他畸胎瘤成分。甲状腺类癌需要仔细检查以排除其他具有恶性行为和不良预后的实体。在这种情况下，保守治疗足以切除肿瘤，保留重要和生殖预后。
