Umezaki Yasushi, Uriu Yasue, Okugawa Kaoru, Hashiguchi Mariko, Yokoyama Masatoshi
Department of Obstetrics and Gynecology, Faculty of Medicine, Saga University, Saga, Japan.
Department of Pathology, Faculty of Medicine, Saga University, Saga, Japan.
Medicine (Baltimore). 2025 Aug 29;104(35):e44240. doi: 10.1097/MD.0000000000044240.
Struma ovarii is a rare form of mature cystic teratoma, with malignant transformation reported in approximately 5% to 10% of cases. Transformation into follicular thyroid carcinoma (FTC) is extremely uncommon; as a result, no standardized guidelines exist for treatment or prognosis for such cases.
A 54-year-old woman with cholelithiasis presented with upper abdominal discomfort. A lower abdominal mass was incidentally detected during evaluation.
Transvaginal ultrasonography revealed a 12-cm multilocular cystic tumor in the right ovary. Magnetic resonance imaging and computed tomography findings suggested a mature cystic teratoma with potential for malignant transformation. Exploratory laparotomy was performed, and intraoperative frozen section analysis confirmed malignant transformation.
The patient subsequently underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic lymphadenectomy, para-aortic lymph node biopsy, and omentectomy. Histopathological examination revealed tumor cells demonstrating cribriform proliferation, accompanied by eosinophilic structures, extensive necrosis, and venous invasion. These findings supported the diagnosis of FTC arising within struma ovarii.
Postoperatively, the patient underwent routine follow-up, including serum thyroglobulin tests and imaging studies every 3 months. At 1 year, the patient showed no signs of tumor recurrence and remained in good clinical condition.
Malignant transformation of struma ovarii into FTC is an extremely rare condition and necessitates thorough histopathological evaluation for accurate diagnosis. This case highlights the diagnostic and therapeutic challenges associated with such tumors.
卵巢甲状腺肿是成熟囊性畸胎瘤的一种罕见形式，据报道约5%至10%的病例会发生恶性转化。转化为滤泡状甲状腺癌（FTC）极为罕见；因此，对于此类病例，不存在标准化的治疗或预后指南。
一名54岁患有胆结石的女性因上腹部不适就诊。在评估过程中偶然发现下腹部有肿块。
经阴道超声检查发现右侧卵巢有一个12厘米的多房性囊性肿瘤。磁共振成像和计算机断层扫描结果提示为具有恶性转化潜能的成熟囊性畸胎瘤。进行了剖腹探查术，术中冰冻切片分析证实发生了恶性转化。
患者随后接受了全腹子宫切除术、双侧输卵管卵巢切除术、盆腔淋巴结清扫术、腹主动脉旁淋巴结活检和大网膜切除术。组织病理学检查显示肿瘤细胞呈筛状增生，伴有嗜酸性结构、广泛坏死和静脉侵犯。这些发现支持卵巢甲状腺肿内发生FTC的诊断。
术后，患者接受常规随访，包括每3个月进行血清甲状腺球蛋白检测和影像学检查。1年后，患者无肿瘤复发迹象，临床状况良好。
卵巢甲状腺肿恶性转化为FTC是一种极其罕见的情况，需要进行全面的组织病理学评估以准确诊断。该病例突出了与此类肿瘤相关的诊断和治疗挑战。
