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Case Reports
. 2024 Jul 1:16:1187-1198.
doi: 10.2147/IJWH.S454119. eCollection 2024.

Follicular Thyroid Carcinoma Arising from the Struma Ovarii Coexisting with Papillary Thyroid Carcinoma, Hashimoto's Thyroiditis and Polycystic Ovarian Syndrome-a Case Report and Literature Review

Zhaoting Wu  1   2 , Lihua Tang  1 , Yaozhen Lai  1 , Muyuan Liu  3 , Li Zhou  1
Affiliations
Case Reports

Follicular Thyroid Carcinoma Arising from the Struma Ovarii Coexisting with Papillary Thyroid Carcinoma, Hashimoto's Thyroiditis and Polycystic Ovarian Syndrome-a Case Report and Literature Review

Zhaoting Wu et al. Int J Womens Health. .

Abstract

Purpose: Struma ovarii is a highly specialized teratoma consisting primarily of mature thyroid tissue. However, malignant struma ovarii coexisting with thyroid carcinoma, not to mention autoimmune disease, is uncommon. Malignant struma ovarii complicated with papillary thyroid carcinoma, Hashimoto's thyroiditis and polycystic ovarian syndrome has never been reported in literature.

Patients and methods: A 32-year-old female was admitted to our hospital due to a history of abdominal distension and menolipsis over the past half a year. Physical examination touched a 6 × 6 cm mass with a clear boundary, normal movement, and no pressing pain in the right adnexal area, Imaging revealed a cystic solid mass of 6 × 7 cm in the right ovary and the level of tumor markers including CA125, CA199, CA153, CEA, AFP were normal, but with low TSH and increased TPOAb, TGAb, TRAb. Laparoscopic right ovary tumor resection was performed, followed by comprehensive staging surgery, as well as thyroidectomy after pathologic diagnosis. The patient was diagnosed with a combination of follicular thyroid cancer from struma ovarii, papillary thyroid carcinoma and Hashimoto's thyroiditis, along with polycystic ovarian syndrome. Immunohistochemical staining showed positivity for Ag, CK-pan, CK7, PAX8 and TTF-1 in the right ovarian mass, and the left thyroid was positive for the BRAF V600E mutation.

Results: The patient underwent thyroxine suppression therapy and radioactive iodine 131I therapy after operation. Serum thyroglobulin was undetectable, and no signs of recurrence or metastasis were detected in the imaging examination at the 2-year follow-up.

Conclusion: Malignant struma ovarii coexisting with thyroid carcinoma is rare. No report has been identified in literature review on the rare malignant struma ovarii coexisting with thyroid carcinoma, Hashimoto's thyroiditis and polycystic ovarian syndrome. Our case can offer experience of diagnosis and treatment to some extent for such rare case. Therefore, it is essential to consider the association between ovarian tumors and the endocrine system. This case is valuable in understanding the diagnosis and management of such an unusual complicated disease.

Keywords: case report; follicular thyroid carcinoma; gynaecological tumor; struma ovarii.

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Conflict of interest statement

The authors declare that there is no conflict of interest that could impair the impartiality of the paper.

Figures

Figure 1
Figure 1
Abdominal ultrasound indicating a mixed echogenic mass in the right enlarged ovary without clear boundary. The dotted line surrounds blood flow signals detected in the interior and surrounding tissue.
Figure 2
Figure 2
(a–c) Papillary structures are visible, with ground-glass nuclei, nuclear groove, and overlapping nuclei, including pseudo-inclusion bodies; (d-f) Malignant area of struma ovarii. Cellular nuclei show atypia and the tumor has infiltrated into ovarian tissues, which form hyperplastic follicles similar to follicular thyroid cancer, without nuclear grooves, nuclear pseudo-inclusion bodies or nuclear overlap and ground glass nuclei.
Figure 3
Figure 3
Specific nuclear positivity for TTF-1 in thyroid follicles.
See this image and copyright information in PMC

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