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Long-term survival in metastatic malignant struma ovarii treated with oral chemotherapy: A case report.

Ukita M, Nakai H, Kotani Y, Tobiume T, Koike E, Tsuji I, Suzuki A, Mandai M - Oncol Lett (2014)

Bottom Line: Four years subsequent to the initial diagnosis, multiple lung metastases were detected.The patient continues to survive with the disease and 24 years have passed since the initial diagnosis, 20 years following the diagnosis of multiple lung metastates.The present case indicates that the long-term use of oral anticancer agents may facilitate the maintenance of tumor dormancy.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Kinki University Faculty of Medicine, Osakasayama, Osaka 589-8511, Japan.

ABSTRACT
Malignant struma ovarii is a rare type of ovarian tumor. Metastasis from malignant struma ovarii is rare and has only been documented in 5-6% of cases. The natural history and optimal treatment strategy for malignant struma ovarii remains controversial due to its rarity. The current report presents the case of a 45-year-old female who presented with a tumor of the rib bone. Following resection, the postoperative diagnosis was a metastasizing thyroid carcinoma. No abnormality was detected in the thyroid gland, however, computed tomography revealed a tumor in the left ovary. The patient underwent a left salpingo-oophorectomy and a wedge resection of the right ovary. The postoperative diagnosis was determined as a mature cystic teratoma with malignant struma ovarii (thyroid type, follicular carcinoma) of the left ovary and mature cystic teratoma of the right ovary. Four years subsequent to the initial diagnosis, multiple lung metastases were detected. The following chemotherapies were administered sequentially and intermittently: Tegafur-uracil, paclitaxel/carboplatin and oral etoposide. During this period, the metastatic lesions extended into the bone and progressed slowly. The patient continues to survive with the disease and 24 years have passed since the initial diagnosis, 20 years following the diagnosis of multiple lung metastates. The present report describes a rare case of malignant struma ovarii in which surgical resection and pathological examination of a metastatic rib tumor resulted in the identification of the primary ovarian lesion. The clinical behavior of malignant struma ovarii does not necessarily indicate a histological malignancy, therefore, prediction of future metastasis is difficult and the optimal treatment strategy for malignant struma ovarii is controversial. The present case indicates that the long-term use of oral anticancer agents may facilitate the maintenance of tumor dormancy.

No MeSH data available.


Related in: MedlinePlus

Microscopic view of the bone metastasis in a tissue sample taken during the primary surgery. Folicular structures which contain the colloid proliferate invasively via destruction of the trabeculae, indicating a diagnosis of metastatic thyroid carcinoma (hematoxylin and eosin stain; magnification, ×200).
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f1-ol-08-06-2458: Microscopic view of the bone metastasis in a tissue sample taken during the primary surgery. Folicular structures which contain the colloid proliferate invasively via destruction of the trabeculae, indicating a diagnosis of metastatic thyroid carcinoma (hematoxylin and eosin stain; magnification, ×200).

Mentions: In October1989, a 45-year-old premenopausal female (gravida 2; para 2) was referred to the Department of Obstetrics and Gynecology, Kinki University Hospital (Osaka, Japan) for further examination of a metastatic bone tumor. In September 1989, the patient had consulted the local doctor due to back pain and a tumor was identified in the right ninth rib. The patient was admitted to the Department of Orthopedics (Kinki University Hospital) and underwent tumor resection. Pathological diagnosis of the surgical specimen revealed folicular structures which contain the colloid had proliferated invasively via the destruction of the bone trabeculae and metastasis was suspected, which resulted in a diagnosis of a metastasizing thyroid carcinoma (Fig. 1). An ultrasound examination of the thyroid gland and an evaluation of the thyroid hormonal function did not present any unusual findings. Computed tomography (CT) was then performed, which identified an ovarian tumor. The patient was subsequently referred to the Department of Obstetrics and Gynecology (Kinki University Hospital). Abdominal ultrasonography revealed a hypoechoic mass in the left ovary and magnetic resonance imaging revealed a 12×9.5×11-cm solid cystic mass with fatty tissue elements and calcification. In January 1990, a left salpingo-oophorectomy and a wedge resection of the right ovary were performed. Intraoperative examination revealed that the left ovary (diameter, 12 cm) was elastic and comprised of partially multilocular lesions and the right ovary (diameter, 4 cm) contained ovarian cysts. Gross examination of the uterus revealed that it was normal, however, a small volume of ascites was detected.


Long-term survival in metastatic malignant struma ovarii treated with oral chemotherapy: A case report.

Ukita M, Nakai H, Kotani Y, Tobiume T, Koike E, Tsuji I, Suzuki A, Mandai M - Oncol Lett (2014)

Microscopic view of the bone metastasis in a tissue sample taken during the primary surgery. Folicular structures which contain the colloid proliferate invasively via destruction of the trabeculae, indicating a diagnosis of metastatic thyroid carcinoma (hematoxylin and eosin stain; magnification, ×200).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4214513&req=5

f1-ol-08-06-2458: Microscopic view of the bone metastasis in a tissue sample taken during the primary surgery. Folicular structures which contain the colloid proliferate invasively via destruction of the trabeculae, indicating a diagnosis of metastatic thyroid carcinoma (hematoxylin and eosin stain; magnification, ×200).
Mentions: In October1989, a 45-year-old premenopausal female (gravida 2; para 2) was referred to the Department of Obstetrics and Gynecology, Kinki University Hospital (Osaka, Japan) for further examination of a metastatic bone tumor. In September 1989, the patient had consulted the local doctor due to back pain and a tumor was identified in the right ninth rib. The patient was admitted to the Department of Orthopedics (Kinki University Hospital) and underwent tumor resection. Pathological diagnosis of the surgical specimen revealed folicular structures which contain the colloid had proliferated invasively via the destruction of the bone trabeculae and metastasis was suspected, which resulted in a diagnosis of a metastasizing thyroid carcinoma (Fig. 1). An ultrasound examination of the thyroid gland and an evaluation of the thyroid hormonal function did not present any unusual findings. Computed tomography (CT) was then performed, which identified an ovarian tumor. The patient was subsequently referred to the Department of Obstetrics and Gynecology (Kinki University Hospital). Abdominal ultrasonography revealed a hypoechoic mass in the left ovary and magnetic resonance imaging revealed a 12×9.5×11-cm solid cystic mass with fatty tissue elements and calcification. In January 1990, a left salpingo-oophorectomy and a wedge resection of the right ovary were performed. Intraoperative examination revealed that the left ovary (diameter, 12 cm) was elastic and comprised of partially multilocular lesions and the right ovary (diameter, 4 cm) contained ovarian cysts. Gross examination of the uterus revealed that it was normal, however, a small volume of ascites was detected.

Bottom Line: Four years subsequent to the initial diagnosis, multiple lung metastases were detected.The patient continues to survive with the disease and 24 years have passed since the initial diagnosis, 20 years following the diagnosis of multiple lung metastates.The present case indicates that the long-term use of oral anticancer agents may facilitate the maintenance of tumor dormancy.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Kinki University Faculty of Medicine, Osakasayama, Osaka 589-8511, Japan.

ABSTRACT
Malignant struma ovarii is a rare type of ovarian tumor. Metastasis from malignant struma ovarii is rare and has only been documented in 5-6% of cases. The natural history and optimal treatment strategy for malignant struma ovarii remains controversial due to its rarity. The current report presents the case of a 45-year-old female who presented with a tumor of the rib bone. Following resection, the postoperative diagnosis was a metastasizing thyroid carcinoma. No abnormality was detected in the thyroid gland, however, computed tomography revealed a tumor in the left ovary. The patient underwent a left salpingo-oophorectomy and a wedge resection of the right ovary. The postoperative diagnosis was determined as a mature cystic teratoma with malignant struma ovarii (thyroid type, follicular carcinoma) of the left ovary and mature cystic teratoma of the right ovary. Four years subsequent to the initial diagnosis, multiple lung metastases were detected. The following chemotherapies were administered sequentially and intermittently: Tegafur-uracil, paclitaxel/carboplatin and oral etoposide. During this period, the metastatic lesions extended into the bone and progressed slowly. The patient continues to survive with the disease and 24 years have passed since the initial diagnosis, 20 years following the diagnosis of multiple lung metastates. The present report describes a rare case of malignant struma ovarii in which surgical resection and pathological examination of a metastatic rib tumor resulted in the identification of the primary ovarian lesion. The clinical behavior of malignant struma ovarii does not necessarily indicate a histological malignancy, therefore, prediction of future metastasis is difficult and the optimal treatment strategy for malignant struma ovarii is controversial. The present case indicates that the long-term use of oral anticancer agents may facilitate the maintenance of tumor dormancy.

No MeSH data available.


Related in: MedlinePlus