Malignant struma ovarii complicated by Trousseau's syndrome and repeated episodes of cerebral ischemic strokes: A case report

Abstract

► Malignant struma ovarii can result in cerebral ischemic stroke and Trousseau's syndrome. ► The combination of anti-neoplastic and anti-coagulant therapy should be undertaken to treat and correct the malignancy-associated coagulopathy.

Keywords: Malignant struma ovarii; Stroke; Thrombosis; Trousseau's syndrome.

Fig. 1

Pre-operative magnetic resonance imaging study of the pelvis revealed a pelvic mass approximately 10 cm in diameter, with cystic (star) and solid (arrows) components.

Fig. 2

(A–C) Perfusion CT scan of the patient after the first episode of ischemic stroke revealed occlusion of the left MCA. (D–F) The large involved territory (arrows) extended to the left temporal and parietal lobes.

Fig. 3

(A) The gross picture of the left ovarian tumor, which was composed of a predominantly cystic lesion with diffuse calcification on the cystic wall. A small, tan-to-brown, gelatinous and solid area (star) was also noted on the cystic wall. (B) Microscopic findings of the solid area revealed an area of malignant neoplastic cells (star) forming fused glands or irregular nests intimately mixed with the adjacent benign thyroid tissue (arrow) (hematoxylin and eosin, original magnification × 200). (C) Microscopic findings of the metastatic cancer cells in the lymph node showed identifiable cancer cells (arrow) in the lymph node (hematoxylin and eosin, original magnification × 400).