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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 primary ovarian lesion. (A) Thyroid follicles of various size are densely proliferated. The follicular cells exhibit enlarged nuclei, chromatin condensation and nuclear stratification (hematoxylin and eosin [H&E] stain; magnification, ×200). (B) Vascular invasion is also apparent (H&E stain; magnification, ×100). The subsequent pathological diagnosis was malignant struma ovarii (thyroid type, follicular carcinoma).
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f2-ol-08-06-2458: Microscopic view of the primary ovarian lesion. (A) Thyroid follicles of various size are densely proliferated. The follicular cells exhibit enlarged nuclei, chromatin condensation and nuclear stratification (hematoxylin and eosin [H&E] stain; magnification, ×200). (B) Vascular invasion is also apparent (H&E stain; magnification, ×100). The subsequent pathological diagnosis was malignant struma ovarii (thyroid type, follicular carcinoma).

Mentions: 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. Microscopic analysis aided in the classification of the tumor as a follicular adenocarcinoma. The tumor cells formed tightly packed small and large follicles filled with pink colloid-like material, and exhibited round nuclei, increased chromatin (Fig. 2A), as well as mitoses and vascular invasion (Fig. 2B). Furthermore, 123I scintigraphy revealed no abnormal uptake in the thyroid or other organs. The patient was finally diagnosed with stage IV malignant struma ovarii with rib metastasis, according to the International Federation of Gynecology and Obstetrics ovarian cancer staging system, 1988 (7).


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 primary ovarian lesion. (A) Thyroid follicles of various size are densely proliferated. The follicular cells exhibit enlarged nuclei, chromatin condensation and nuclear stratification (hematoxylin and eosin [H&E] stain; magnification, ×200). (B) Vascular invasion is also apparent (H&E stain; magnification, ×100). The subsequent pathological diagnosis was malignant struma ovarii (thyroid type, follicular carcinoma).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f2-ol-08-06-2458: Microscopic view of the primary ovarian lesion. (A) Thyroid follicles of various size are densely proliferated. The follicular cells exhibit enlarged nuclei, chromatin condensation and nuclear stratification (hematoxylin and eosin [H&E] stain; magnification, ×200). (B) Vascular invasion is also apparent (H&E stain; magnification, ×100). The subsequent pathological diagnosis was malignant struma ovarii (thyroid type, follicular carcinoma).
Mentions: 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. Microscopic analysis aided in the classification of the tumor as a follicular adenocarcinoma. The tumor cells formed tightly packed small and large follicles filled with pink colloid-like material, and exhibited round nuclei, increased chromatin (Fig. 2A), as well as mitoses and vascular invasion (Fig. 2B). Furthermore, 123I scintigraphy revealed no abnormal uptake in the thyroid or other organs. The patient was finally diagnosed with stage IV malignant struma ovarii with rib metastasis, according to the International Federation of Gynecology and Obstetrics ovarian cancer staging system, 1988 (7).

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