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Dual malignancy in adolescence: A rare case report of metachronous papillary carcinoma of thyroid following dysgerminoma of ovary

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ABSTRACT

Dual malignancy is rare in adolescents. Dual malignancy with the second malignancy of thyroid is rare. No association has been reported between dysgerminoma of ovary and carcinoma thyroid in medical literature. Despite a thorough PubMed search (key words — Papillary carcinoma of thyroid, metachronous, dysgerminoma ovary), we were unable to find a previous reported case of metachronous papillary carcinoma of thyroid (PTC) following dysgerminoma of the ovary. After surgery, the patient is being regularly followed up for recurrence/development of new primary. We report this unusual and rare case in a 17-year-old female patient.

No MeSH data available.


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(a) MRI of the neck showing postoperative changes in the neck with irregular nodular soft tissue in the region of the right lobe of thyroid with subcentimeter lymph node in bilateral deep upper cervical region and (b) MRI of the pelvis showing normal-appearing left ovary with absent right ovary and uterus
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Figure 3: (a) MRI of the neck showing postoperative changes in the neck with irregular nodular soft tissue in the region of the right lobe of thyroid with subcentimeter lymph node in bilateral deep upper cervical region and (b) MRI of the pelvis showing normal-appearing left ovary with absent right ovary and uterus

Mentions: A 17-year-old female, following right lobectomy of the thyroid gland, with a histopathological report of PTC was referred to the Department of Surgical Oncology at Sri Aurobindo Medical College and Post Graduate Institute in Indore, Madhya Pradesh in India for further management in 2014. Examination of the neck revealed a scar from a previous surgery, with no palpable neck nodes. Indirect laryngoscopy (IDL) revealed bilateral mobile vocal cords. Blood investigations revealed serum T3 1.19 ng/mL (0.8-2 ng/mL), serum T4 of 5.88 ug/dL (5.1-14.1 ug/dL), serum TSH of 6.04 Uiu/mL (0.27-4.20 Uiu/mL), serum level of lactate dehydrogenase (LDH) 157 Iu/L (140-280 Iu/L). Previous history revealed hysterectomy with right salpingo-oophorectomy performed 3 years back during evaluation of primary amenorrhea with right ovarian mass [Figure 1]. Diagnostic laparoscopy revealed rudimentary double uterus with a huge right ovarian mass. Gross examination revealed 1300g right ovarian mass with fallopian tube with didelphys of rudimentary uterus. Microscopy confirmed the diagnosis of dysgerminoma of the right ovary Stage I a [Figure 2a]. The patient had taken chemotherapy bleomycin, etoposide, and cisplatinum (BEP) regime, i.e., bleomycin IV per week X9; dose at 20 U/m2, etoposide 100 mg/m2 days 1-5 q3wk X3, cisplatin 20 mg/m2 days 1-5 q3wk X3 at a 4 week interval in the adjuvant setting. Magnetic resonance imaging (MRI) of the neck and the pelvis was performed before completion; thyroidectomy revealed postoperative changes with irregular nodular soft tissue in the region of the right lobe of thyroid with subcentimeter lymph node in bilateral deep upper cervical region [Figure 3a] and left ovary was normal in appearance, measuring 2.9 cm × 4.7 cm [Figure 3b]. Completion thyroidectomy with bilateral central neck node dissection was performed that was negative for residual malignant disease. Radioactive iodine scan (I131) performed 1 year after completion thyroidectomy did not reveal any residual disease.


Dual malignancy in adolescence: A rare case report of metachronous papillary carcinoma of thyroid following dysgerminoma of ovary
(a) MRI of the neck showing postoperative changes in the neck with irregular nodular soft tissue in the region of the right lobe of thyroid with subcentimeter lymph node in bilateral deep upper cervical region and (b) MRI of the pelvis showing normal-appearing left ovary with absent right ovary and uterus
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5121993&req=5

Figure 3: (a) MRI of the neck showing postoperative changes in the neck with irregular nodular soft tissue in the region of the right lobe of thyroid with subcentimeter lymph node in bilateral deep upper cervical region and (b) MRI of the pelvis showing normal-appearing left ovary with absent right ovary and uterus
Mentions: A 17-year-old female, following right lobectomy of the thyroid gland, with a histopathological report of PTC was referred to the Department of Surgical Oncology at Sri Aurobindo Medical College and Post Graduate Institute in Indore, Madhya Pradesh in India for further management in 2014. Examination of the neck revealed a scar from a previous surgery, with no palpable neck nodes. Indirect laryngoscopy (IDL) revealed bilateral mobile vocal cords. Blood investigations revealed serum T3 1.19 ng/mL (0.8-2 ng/mL), serum T4 of 5.88 ug/dL (5.1-14.1 ug/dL), serum TSH of 6.04 Uiu/mL (0.27-4.20 Uiu/mL), serum level of lactate dehydrogenase (LDH) 157 Iu/L (140-280 Iu/L). Previous history revealed hysterectomy with right salpingo-oophorectomy performed 3 years back during evaluation of primary amenorrhea with right ovarian mass [Figure 1]. Diagnostic laparoscopy revealed rudimentary double uterus with a huge right ovarian mass. Gross examination revealed 1300g right ovarian mass with fallopian tube with didelphys of rudimentary uterus. Microscopy confirmed the diagnosis of dysgerminoma of the right ovary Stage I a [Figure 2a]. The patient had taken chemotherapy bleomycin, etoposide, and cisplatinum (BEP) regime, i.e., bleomycin IV per week X9; dose at 20 U/m2, etoposide 100 mg/m2 days 1-5 q3wk X3, cisplatin 20 mg/m2 days 1-5 q3wk X3 at a 4 week interval in the adjuvant setting. Magnetic resonance imaging (MRI) of the neck and the pelvis was performed before completion; thyroidectomy revealed postoperative changes with irregular nodular soft tissue in the region of the right lobe of thyroid with subcentimeter lymph node in bilateral deep upper cervical region [Figure 3a] and left ovary was normal in appearance, measuring 2.9 cm × 4.7 cm [Figure 3b]. Completion thyroidectomy with bilateral central neck node dissection was performed that was negative for residual malignant disease. Radioactive iodine scan (I131) performed 1 year after completion thyroidectomy did not reveal any residual disease.

View Article: PubMed Central - PubMed

ABSTRACT

Dual malignancy is rare in adolescents. Dual malignancy with the second malignancy of thyroid is rare. No association has been reported between dysgerminoma of ovary and carcinoma thyroid in medical literature. Despite a thorough PubMed search (key words — Papillary carcinoma of thyroid, metachronous, dysgerminoma ovary), we were unable to find a previous reported case of metachronous papillary carcinoma of thyroid (PTC) following dysgerminoma of the ovary. After surgery, the patient is being regularly followed up for recurrence/development of new primary. We report this unusual and rare case in a 17-year-old female patient.

No MeSH data available.


Related in: MedlinePlus