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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

Computed tomography images of the (A) middle and (B) lower lung fields, prior to commencing paclitaxel/carboplatin therapy, indicating multiple metastases of the bilateral lung.
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f3-ol-08-06-2458: Computed tomography images of the (A) middle and (B) lower lung fields, prior to commencing paclitaxel/carboplatin therapy, indicating multiple metastases of the bilateral lung.

Mentions: Tegafur-uracil (UFT) was administered (600 mg/day) as an adjuvant chemotherapy for two years. Follow-up included measurements of thyroid function (via thyroglobulin levels) and regular chest X-rays every two months. In November 1993, three years after commencing UFT therapy, a chest X-ray revealed multiple lung metastases. Although systemic chemotherapy was recommended, the patient refused and recommenced treatment with UFT at an increased dosage of 3,000 mg/day. Following two further years of treatment, the patient refused to continue UFT administration, preferring to undergo observation. During this period, the lung nodules progressed slowly, however, no thyroid dysfunction or other symptoms were observed. In 1999, the patient identified a painless mass under the right scapula but did not recieve medical treatment. In 2001, the patient returned to Kinki University Hospital presenting with pain in the pubic region and a CT scan revealed metastasis to the left acetabulum. Paclitaxel (60 mg/m2) and carboplatin (area under the curve, 2) were administered weekly for six months resulting in stabilization of the lung nodules and the mass under the right scapula, however, the bone metastases in the acetabulum continued to progress. Following six months of paclitaxel/carboplatin therapy (Fig. 3), the patient refused any aggressive intervention and oral etoposide (25 mg/day) was administered intermittently for eleven years. After eleven years, due to the risk of secondary leukemia, oral etoposide was replaced with cyclophosphamide hydrate and continued until the present. During this period, the metastatic lesions progressed slowly (Fig. 4). Leg pain that is associated with the bone metastases is currently controlled by a non-steroidal anti-inflammatory medicine. Consequently, the patient has survived with the disease for 24 years since the initial diagnosis of stage IV malignant struma ovarii and for 20 years since the cancer recurred.


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)

Computed tomography images of the (A) middle and (B) lower lung fields, prior to commencing paclitaxel/carboplatin therapy, indicating multiple metastases of the bilateral lung.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f3-ol-08-06-2458: Computed tomography images of the (A) middle and (B) lower lung fields, prior to commencing paclitaxel/carboplatin therapy, indicating multiple metastases of the bilateral lung.
Mentions: Tegafur-uracil (UFT) was administered (600 mg/day) as an adjuvant chemotherapy for two years. Follow-up included measurements of thyroid function (via thyroglobulin levels) and regular chest X-rays every two months. In November 1993, three years after commencing UFT therapy, a chest X-ray revealed multiple lung metastases. Although systemic chemotherapy was recommended, the patient refused and recommenced treatment with UFT at an increased dosage of 3,000 mg/day. Following two further years of treatment, the patient refused to continue UFT administration, preferring to undergo observation. During this period, the lung nodules progressed slowly, however, no thyroid dysfunction or other symptoms were observed. In 1999, the patient identified a painless mass under the right scapula but did not recieve medical treatment. In 2001, the patient returned to Kinki University Hospital presenting with pain in the pubic region and a CT scan revealed metastasis to the left acetabulum. Paclitaxel (60 mg/m2) and carboplatin (area under the curve, 2) were administered weekly for six months resulting in stabilization of the lung nodules and the mass under the right scapula, however, the bone metastases in the acetabulum continued to progress. Following six months of paclitaxel/carboplatin therapy (Fig. 3), the patient refused any aggressive intervention and oral etoposide (25 mg/day) was administered intermittently for eleven years. After eleven years, due to the risk of secondary leukemia, oral etoposide was replaced with cyclophosphamide hydrate and continued until the present. During this period, the metastatic lesions progressed slowly (Fig. 4). Leg pain that is associated with the bone metastases is currently controlled by a non-steroidal anti-inflammatory medicine. Consequently, the patient has survived with the disease for 24 years since the initial diagnosis of stage IV malignant struma ovarii and for 20 years since the cancer recurred.

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