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Follicular proliferative lesion arising in struma ovarii.

Park MJ, Kim MA, Shin MK, Min HS - J Pathol Transl Med (2015)

Bottom Line: Malignant struma ovarii is extremely rare and difficult to diagnose histologically, particularly in cases of follicular carcinoma.Our second case featured architectural and cellular atypia and necrosis and was diagnosed as malignant despite the absence of vascular and stromal invasion.In cases such as our third case, it has been previously suggested that a diagnostic term recognizing the low-grade malignant potential, such as "proliferative stromal ovarii" or "follicular proliferative lesion arising in the stromal ovarii" would be appropriate.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Seoul National University College of Medicine, Seoul, Korea.

ABSTRACT
Malignant struma ovarii is extremely rare and difficult to diagnose histologically, particularly in cases of follicular carcinoma. This case study is intended to describe three cases of follicular proliferative lesion arising in struma ovarii that we experienced. The first case was clearly malignant given the clinical picture of multiple recurrences, but there was little histological evidence of malignancy. Our second case featured architectural and cellular atypia and necrosis and was diagnosed as malignant despite the absence of vascular and stromal invasion. Our third case exhibited solid microfollicular proliferation without any definite evidence of malignancy (even the molecular data was negative); however, we could not completely exclude malignant potential after conducting a literature review. In cases such as our third case, it has been previously suggested that a diagnostic term recognizing the low-grade malignant potential, such as "proliferative stromal ovarii" or "follicular proliferative lesion arising in the stromal ovarii" would be appropriate.

No MeSH data available.


Related in: MedlinePlus

Peritoneal nodules found intraoperatively (A) and the microscopic findings (B, C). HBME1 positivity of microfollicles of the first case (D) is observed and the initial ovarian lesion of the first case (E) shows vascular invasion (E, inset). The gross features of the second case (F) and the histological findings (G, H) are suggestive of malignancy, and HBME1 status is positive only in the cytoplasm (I). In the third case, the solid regions are tiny and scattered (J). Microscopically, microfollicles are predominant (K), and cyclin D1 expression is increased (L).
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f1-jptm-49-3-262: Peritoneal nodules found intraoperatively (A) and the microscopic findings (B, C). HBME1 positivity of microfollicles of the first case (D) is observed and the initial ovarian lesion of the first case (E) shows vascular invasion (E, inset). The gross features of the second case (F) and the histological findings (G, H) are suggestive of malignancy, and HBME1 status is positive only in the cytoplasm (I). In the third case, the solid regions are tiny and scattered (J). Microscopically, microfollicles are predominant (K), and cyclin D1 expression is increased (L).

Mentions: A 35-year-old female visited the hospital complaining of abdominal discomfort, and pelvic magnetic resonance imaging (MRI) scan revealed multiple nodules in the peritoneum and omentum with a large volume of ascitic fluid. She had a history of surgery to treat struma ovarii in the left ovary 9 years ago. The mass was removed under the suspicion of struma ovarii recurrence. Three months later, multiple enhanced nodules in the adnexa, omentum, perihepatic space, and peritoneum (Fig. 1A) were evident on follow-up imaging, and the patient underwent re-surgery, total thyroidectomy, and radioactive iodine (RAI) therapy. The histological features of nodules from the second and third surgeries were similar. The nodules exhibited mixed micro- and macro-follicular proliferation, with scattered lymphocytic infiltration, and were covered with thin fibrous capsules (Fig. 1B). The tumor cell nuclei were round, uniform, and normochromatic; neither mitosis nor necrosis was evident (Fig. 1C). Immunohistochemically, galectin-3, cyclin D1, and HBME1 were focally positive, and HBME1 expression was limited principally to regions of microfollicular proliferation (Fig. 1D). The Ki-67 positivity level was enhanced by up to 10%, in the microfollicles. The cervical thyroid showed features of chronic lymphocytic thyroiditis but there was no evidence of malignancy. We reviewed all slides of the struma ovarii initially operated on to compare later lesions with the initial ovarian mass. The original mass had both solid and cystic components, and was fibrotically encapsulated (Fig. 1E). Follicles of variable size and papillary structure were observed, and one microscopic focus of vascular invasion was observed after meticulous examination (Fig. 1E, inset). No mutation in any of BRAF (V600E) or RAS (HRAS codon 61, NRAS codon 61, and KRAS codon 12/13), and no PPARy rearrangement (explored using fluorescence in situ hybridization), was evident in the recurring nodules. The lesion was diagnosed as follicular carcinoma arising in the struma ovarii, based on the clinical and pathological findings, and the patient underwent RAI therapy (200 mCi). There has not been local recurrence or distant metastasis in the 25 months of follow-up to date.


Follicular proliferative lesion arising in struma ovarii.

Park MJ, Kim MA, Shin MK, Min HS - J Pathol Transl Med (2015)

Peritoneal nodules found intraoperatively (A) and the microscopic findings (B, C). HBME1 positivity of microfollicles of the first case (D) is observed and the initial ovarian lesion of the first case (E) shows vascular invasion (E, inset). The gross features of the second case (F) and the histological findings (G, H) are suggestive of malignancy, and HBME1 status is positive only in the cytoplasm (I). In the third case, the solid regions are tiny and scattered (J). Microscopically, microfollicles are predominant (K), and cyclin D1 expression is increased (L).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4440939&req=5

f1-jptm-49-3-262: Peritoneal nodules found intraoperatively (A) and the microscopic findings (B, C). HBME1 positivity of microfollicles of the first case (D) is observed and the initial ovarian lesion of the first case (E) shows vascular invasion (E, inset). The gross features of the second case (F) and the histological findings (G, H) are suggestive of malignancy, and HBME1 status is positive only in the cytoplasm (I). In the third case, the solid regions are tiny and scattered (J). Microscopically, microfollicles are predominant (K), and cyclin D1 expression is increased (L).
Mentions: A 35-year-old female visited the hospital complaining of abdominal discomfort, and pelvic magnetic resonance imaging (MRI) scan revealed multiple nodules in the peritoneum and omentum with a large volume of ascitic fluid. She had a history of surgery to treat struma ovarii in the left ovary 9 years ago. The mass was removed under the suspicion of struma ovarii recurrence. Three months later, multiple enhanced nodules in the adnexa, omentum, perihepatic space, and peritoneum (Fig. 1A) were evident on follow-up imaging, and the patient underwent re-surgery, total thyroidectomy, and radioactive iodine (RAI) therapy. The histological features of nodules from the second and third surgeries were similar. The nodules exhibited mixed micro- and macro-follicular proliferation, with scattered lymphocytic infiltration, and were covered with thin fibrous capsules (Fig. 1B). The tumor cell nuclei were round, uniform, and normochromatic; neither mitosis nor necrosis was evident (Fig. 1C). Immunohistochemically, galectin-3, cyclin D1, and HBME1 were focally positive, and HBME1 expression was limited principally to regions of microfollicular proliferation (Fig. 1D). The Ki-67 positivity level was enhanced by up to 10%, in the microfollicles. The cervical thyroid showed features of chronic lymphocytic thyroiditis but there was no evidence of malignancy. We reviewed all slides of the struma ovarii initially operated on to compare later lesions with the initial ovarian mass. The original mass had both solid and cystic components, and was fibrotically encapsulated (Fig. 1E). Follicles of variable size and papillary structure were observed, and one microscopic focus of vascular invasion was observed after meticulous examination (Fig. 1E, inset). No mutation in any of BRAF (V600E) or RAS (HRAS codon 61, NRAS codon 61, and KRAS codon 12/13), and no PPARy rearrangement (explored using fluorescence in situ hybridization), was evident in the recurring nodules. The lesion was diagnosed as follicular carcinoma arising in the struma ovarii, based on the clinical and pathological findings, and the patient underwent RAI therapy (200 mCi). There has not been local recurrence or distant metastasis in the 25 months of follow-up to date.

Bottom Line: Malignant struma ovarii is extremely rare and difficult to diagnose histologically, particularly in cases of follicular carcinoma.Our second case featured architectural and cellular atypia and necrosis and was diagnosed as malignant despite the absence of vascular and stromal invasion.In cases such as our third case, it has been previously suggested that a diagnostic term recognizing the low-grade malignant potential, such as "proliferative stromal ovarii" or "follicular proliferative lesion arising in the stromal ovarii" would be appropriate.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Seoul National University College of Medicine, Seoul, Korea.

ABSTRACT
Malignant struma ovarii is extremely rare and difficult to diagnose histologically, particularly in cases of follicular carcinoma. This case study is intended to describe three cases of follicular proliferative lesion arising in struma ovarii that we experienced. The first case was clearly malignant given the clinical picture of multiple recurrences, but there was little histological evidence of malignancy. Our second case featured architectural and cellular atypia and necrosis and was diagnosed as malignant despite the absence of vascular and stromal invasion. Our third case exhibited solid microfollicular proliferation without any definite evidence of malignancy (even the molecular data was negative); however, we could not completely exclude malignant potential after conducting a literature review. In cases such as our third case, it has been previously suggested that a diagnostic term recognizing the low-grade malignant potential, such as "proliferative stromal ovarii" or "follicular proliferative lesion arising in the stromal ovarii" would be appropriate.

No MeSH data available.


Related in: MedlinePlus