Elshafie Omayma, Hussein Samir, Al Kalbani Moza, Al Hamadani Aisha, Bou Khalil Abir, Woodhouse Nicholas
Department of Endocrinology, Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Sultanate of Oman.
Department of Radiology, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman.
Endocrinol Diabetes Metab Case Rep. 2022 Oct 1;2022. doi: 10.1530/EDM-21-0169.
A 33-year-old female presented in 2013 with left flank pain. Ultrasound and MRI pelvis showed a complex mass 9 × 7 cm arising from the left ovary suggestive of ovarian torsion. She underwent a laparoscopic cystectomy, but the patient was lost to follow-up. Three years later, she presented with abdominal distension. Ultrasound and CT scan revealed a solid left ovarian mass with ascites and multiple peritoneal metastasis. Investigations showed elevated CA 125, CA 19-9. Ovarian malignancy was suspected. She underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy on November 2016. The histopathology confirmed a well-differentiated thyroid cancer of ovarian origin with features of a papillary follicular variant without evidence of ovarian cancer and the thyroglobulin (Tg) level was elevated, more than 400 consistent with the diagnosis of malignant struma ovarii. The follow-up post-surgery showed normalization of CA 125, CA 19-9 and Tg. The patient underwent total thyroidectomy on January 2017. The histology was benign excluding thyroid cancer metastases to the ovary. She was started on thyroxine suppression, following which she received two ablation doses 131iodine (131I) each 5.3 GBq. The Tg remains slightly elevated at less than 10. 131I WBS showed no residual neck uptake and no distant avid metastasis. She was planned for molecular analysis which may indicate disease severity. We describe a case of malignant struma ovarii with widespread metastatic dissemination and a good response to surgery and 131I treatment without recurrence after 5 years of follow-up. The Tg remains slightly elevated indicating minimal stable residual disease.
Malignant struma ovarii is a rare disease; diagnosis is difficult and management is not well defined. Presentation may mimic advanced carcinoma of the ovary. Predominant sites of metastasis are adjacent pelvic structures. Thyroidectomy and 131iodine therapy should be considered. The management should be similar to that of metastatic thyroid cancer.
一名33岁女性于2013年出现左侧腰痛。盆腔超声和磁共振成像显示左卵巢有一个9×7cm的复杂肿块，提示卵巢扭转。她接受了腹腔镜囊肿切除术，但患者失访。三年后，她出现腹胀。超声和CT扫描显示左卵巢实性肿块伴腹水和多处腹膜转移。检查显示CA 125、CA 19-9升高。怀疑为卵巢恶性肿瘤。她于2016年11月接受了全腹子宫切除术和双侧输卵管卵巢切除术。组织病理学证实为起源于卵巢的高分化甲状腺癌，具有乳头状滤泡变体特征，无卵巢癌证据，甲状腺球蛋白（Tg）水平升高，超过400，符合恶性卵巢甲状腺肿的诊断。术后随访显示CA 125、CA 19-9和Tg恢复正常。患者于2017年1月接受了全甲状腺切除术。组织学为良性，排除甲状腺癌转移至卵巢。她开始接受甲状腺素抑制治疗，之后接受了两次消融剂量的131碘（131I），每次5.3GBq。Tg仍略有升高，低于10。131I全身显像显示颈部无残留摄取，无远处放射性转移。计划对她进行分子分析，这可能表明疾病的严重程度。我们描述了一例恶性卵巢甲状腺肿伴广泛转移扩散的病例，该病例对手术和131I治疗反应良好，随访5年无复发。Tg仍略有升高，表明残留疾病稳定且极少。
恶性卵巢甲状腺肿是一种罕见疾病；诊断困难，治疗方法尚不明确。临床表现可能类似晚期卵巢癌。转移的主要部位是邻近的盆腔结构。应考虑行甲状腺切除术和131碘治疗。治疗应与转移性甲状腺癌相似。
