Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Struma ovarii is an ovarian germ cell tumor consisting mainly of thyroid tissue. Five percent of struma ovarii are malignant, and of these only five percent metastasize. The rarity of this disease has resulted in difficulty in agreeing on treatment regimes and in limited imaging experience. The authors report two cases and highlight the imaging and monitoring difficulties encountered in their management. The authors conclude that I-131 has a role to play both therapeutically and in monitoring these patients, but that biochemical testing is a more reliable indicator of disease status.
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PMID:Metastatic malignant struma ovarii. Two case reports. 163 39

Struma ovarii are specialized teratomas consisting of thyroid tissue. They may demonstrate all pathologic features seen in the thyroid gland. Malignant transformation of thyroid tissue in struma ovarii is uncommon and is rarely recurrent or metastatic. We report the diagnosis and treatment of a recurrent struma ovarii with malignant transformation, and intraperitoneal, retroperitoneal, and hepatic metastases.
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PMID:Diagnosis and treatment of disseminated struma ovarii with malignant transformation. 906 67

Struma ovarii consists of thyroid tissue derived from germ cells in a mature teratoma. Malignant transformation is very rare, with clinically evident metastatic disease reported in approximately 20 cases. The rarity of this disease renders evaluation of treatment modalities difficult. There is evidence that these tumors behave like their thyroid counterparts, and cytoreductive surgery followed by ablation with radioactive iodine has been advocated. We report the diagnosis and treatment of 2 patients with metastatic malignant struma ovarii treated with a combination of surgery and radiation therapy.
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PMID:Malignant struma ovarii: two case reports and a review of the literature. 1036 77

Struma ovarii (SO) is usually asymptomatic and only in a few cases it is associated with thyrotoxicosis. The presurgical diagnosis is very uncommon. In the majority of cases a pelvic mass is discovered at physical examination or by abdominal ultrasound. Only the hystopathologic examination is able to reveal the characteristic features of SO, with thyroid cells organized in follicles as the main tumoral tissue constituent. The histologic recognition of malignancy is not easy and usually requires an exhaustive sampling of the lesion to evaluate the extracapsular invasion. We report the case of a 59-year-old woman who came to our observation for the fortuitous finding of elevated serum thyroglobulin (Tg) levels (600-800 ng/mL). Because the thyroid function was normal and the ultrasound showed only a subcentrimetric nodule, the clinical suspicious of a SO was considered. Ultrasound examination of the abdomen showed a solid mass of 2 cm in the left ovary. A (131)I uptake was observed at scintiscan in the site of the solid mass. Three months after the resection of the left ovary serum Tg levels were markedly reduced (106 ng/mL), and its values continued to decrease down to 34 ng/mL at last control. The histology showed that the ovarian mass was mainly constituted of thyroid tissue (98%), with no malignant features. The molecular analysis of several thyroid differentiation gene mRNAs in the SO tissue showed an abundant expression of all genes but pendrin (PDS). A reduced PDS mRNA expression might explain the defective thyroxine (T(4)) production. Despite the absence of malignant features, the expression of RET/PTC3 rearrangement was found, raising the possibility of a potential malignant nature of the tumor. A cancer-free period of 3-4 years, as in our patient, is not long enough to definitively exclude a late onset metastatic disease but, unfortunately, the patient died of nonmedical reasons. In conclusion, we report a case of SO that, to our knowledge, is the first in which the clinical suspicion arose from the inappropriately elevated presurgical serum levels of Tg. A quite exhaustive molecular analysis of thyroid specific genes and oncogenes provided two interesting findings: the low PDS mRNA expression, which may explain the low hormonal production and the absence of thyrotoxicosis and the presence of a RET/PTC3 rearrangement, which prompts the possibility of a late malignant evolution.
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PMID:RET/PTC3 rearrangement and thyroid differentiation gene analysis in a struma ovarii fortuitously revealed by elevated serum thyroglobulin concentration. 1640 8

Struma ovarii is an ovarian teratoma mainly composed of thyroid tissue, which can become malignant with possible peritoneal dissemination or even distant metastases. Therapeutic management follows protocols used for thyroid cancer. We report the first use of (18)F-fluorodeoxyglucose positron emission tomography (PET) in the follow-up of malignant struma ovarii with persistently elevated serum thyroglobulin level and negative diagnostic iodine 131 whole body scan after thyroidectomy and four courses of 131 iodine. Hilar and mediastinal lymph node uptake was detected but histological verification concluded that there was a false-positive localization corresponding to sarcoidosis lesions without malignant aspect.
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PMID:[Malignant struma ovarii: false positive PET image for suspected metastasis due to sarcoidosis]. 1731 36

Struma ovarii has elicited considerable interest because of its many unique features since Ludwig Pick first elucidated its relationship to teratoma in the early part of the 20th century. The most common thyroid-type malignancies to arise in struma ovarii are papillary and follicular carcinomas. In this article, we describe a newly recognized neoplasm originating from struma ovarii that we interpret as follicular carcinoma with a high degree of differentiation. By definition, all of these cases have an innocuous appearance resembling that of nonneoplastic thyroid tissue in both the ovary and sites of dissemination. Including our own, 14 cases in the literature spread to the peritoneum, and 4 metastasized to more distant sites. The peritoneal involvement more often was diagnosed at the same time as the ovarian struma; however, the systemic dissemination occurred subsequent to oophorectomy. Our index patient with highly differentiated follicular carcinoma (HDFCO) developed peritoneal dissemination and para-aortic lymph node metastases 26 years after excision of ovarian struma. Vascular invasion was not identified in any of the cases; however, the primary neoplasm extended to the surface of the ovary in 2 cases with peritoneal involvement. Because of its harmless histological appearance, this form of follicular carcinoma characteristically cannot be diagnosed until the neoplasm spreads beyond the ovary, thus, showing evidence of aggressive behavior. The corollary of this observation is that cases having the histological appearance of ordinary struma ovarii can rarely behave in a malignant fashion. Although cases of typical thyroid-type carcinoma with extraovarian dissemination are relatively easy to diagnose, those with an innocuous histological appearance present nosological and diagnostic difficulties. The differential diagnosis of peritoneal dissemination of struma includes HDFCO, the typical types of thyroid cancer, and so-called strumosis. We have studied the relationship of HDFCO to cases reported as peritoneal strumosis or similar terms and doubt the existence of the latter as a distinct clinicopathologic entity. The treatment of choice for patients with HDFCO is local resection of the extraovarian tumor with subsequent thyroidectomy followed by radioactive iodine ablation.
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PMID:Highly differentiated follicular carcinoma arising from struma ovarii: a report of 3 cases, a review of the literature, and a reassessment of so-called peritoneal strumosis. 1831 21

Struma ovarii is a rare monodermal ovarian teratoma composed predominantly of mature thyroid tissue. We describe herein the case of a 22-year-old woman who underwent a right salpingo-oophorectomy for struma ovarii at the age of 12 years, who was admitted 8 years later with signs and symptoms of a left pelvic tumor. Laparoscopy detected a left ovarian endometriotic cyst and multiple nodules on the pelvic peritoneum, right lateral abdominal wall, diaphragm, vesical plica and liver. The diagnosis was abdominal and pelvic widespread dissemination of recurrent struma ovarii, with features consistent with the follicular variant of papillary thyroid carcinoma. The patient was treated with a combination of conservative surgery and two 131I administrations (cumulative activity of 350 mCi after dosimetric evaluation). Because of the high degree of hormonogenesis shown by the metastases, the first administration was performed following use of recombinant human (rh) thyroid-stimulating hormone (TSH) to reach adequate TSH levels. To avoid the 'stunning effect' and to obtain high-quality scintigraphy, a whole-body scan was performed with 123I after rh-TSH and before the 131I therapy. We also discuss the potential role and the possible benefit of using gonadotropin-releasing hormone analogs and ovarian tissue cryopreservation to preserve fertility in women treated with 131I for pelvic metastases from malignant struma ovarii.
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PMID:A case of metastatic struma ovarii treated with 131I therapy: focus on preservation of fertility and selected review of the literature. 1858 10

Struma ovarii has elicited considerable interest because of its many unique features since Ludwig Pick first elucidated its relationship to teratoma in the early part of the 20th century. In this article, we report 3 cases of papillary and 1 of follicular thyroid carcinoma; 2 of these cases were associated with mature cystic teratoma. Metastases occurred in 2 patients, and 1 died of neoplasm. In regard to the occurrence of thyroid-type carcinoma in struma ovarii, precise terminology should be used, and the expression malignant struma ovarii was avoided as a diagnostic term. Upon review of the literature, papillary carcinoma and follicular carcinoma are the most frequent types of malignancy to occur in ovarian struma; other forms of thyroid carcinoma occur only rarely. The diagnostic criteria for cases of papillary carcinoma are similar to those described in the cervical thyroid gland and are based primarily on nuclear and architectural features. In reference to follicular carcinoma, invasion into the surrounding ovarian tissue, vascular invasion, or metastasis is evidence of malignancy. Histological malignancy in a struma does not necessarily equate with biological malignancy, and the majority of thyroid-type carcinomas do not spread beyond the ovary. Occasionally, metastases of ovarian struma have an innocuous histological appearance, and such cases are referred to as highly differentiated follicular carcinoma of ovarian origin (HDFCO). Because its histological appearance resembles that of nonneoplastic thyroid, HDFCO characteristically cannot be diagnosed until the neoplasm spreads beyond the ovary. In this article, we apply the term typical thyroid carcinoma to those forms of thyroid malignancy arising in ovarian struma that closely resemble the types described in the cervical thyroid gland to distinguish them from HDFCO. Typical follicular carcinoma is more aggressive than the somewhat more common papillary carcinoma, and HDFCO is the least aggressive of these tumor types. Cases of thyroid-type carcinoma arising in the ovary sometimes lack evidence of preexisting struma. The more aggressive thyroid-type neoplasms can arise in thyroid tissue within a mature cystic teratoma, or they may overgrow and replace the struma. Primary thyroid-type carcinoma must be distinguished from rare instances of ovarian metastases that originate in the cervical thyroid gland and the less differentiated forms from other ovarian neoplasms such as clear cell adenocarcinoma and tumors with an oxyphilic appearance. In the differential diagnosis with other ovarian neoplasms, cases of thyroid-type carcinoma associated with strumal carcinoid should not be diagnosed as malignant strumal carcinoid because the latter diagnosis might lead to suboptimal therapy.
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PMID:Typical thyroid-type carcinoma arising in struma ovarii: a report of 4 cases and review of the literature. 1875 73

We report the case of a 42-year-old woman who presented with multiple pulmonary nodules. Surgical resection of 3 nodules revealed differentiated thyroid carcinoma. Thyroid and neck ultrasound was normal. A review of her history revealed that this patient underwent an ovarian cyst resection 15 years ago. Reexamination of pathology samples, with the help of immunohistochemical markers, concluded to a struma ovarii. Pelvic ultrasound was normal; F-18 FDG PET scan was negative. She had total thyroidectomy, with negative histology, followed by first I-131 therapy (3.9 GBq). Thyroglobuline (Tg) was elevated (3230 microg/L in hypothyroidism). The whole-body scan showed multiple foci of pulmonary I-131 uptake, a bone metastasis of third rib, and I-131 uptake in an abdominal para-aortic lymph node. At second I-131 therapy (3.8 GBq), Tg level had decreased to 14 microg/L and there was a decrease in the number of pulmonary nodular I-131 uptake, and resolution of the bone and para-aortic lymph node metastasis. At third I-131 therapy (4.9 GBq), thyroglobuline was undetectable and the whole-body scan showed no I-131 uptake. Struma ovarii is a rare ovarian tumor mostly benign. Metastasis of malignant struma ovarii are rare. Most frequent localizations are liver and peritoneum. Treatment of the malignant struma ovarii implies ovarian surgical resection, total thyroidectomy, and I-131 therapy.
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PMID:Pulmonary metastasis of struma ovarii: a case report. 2070 43

We present a case of a postmenopausal woman diagnosed with an ovarian mass containing thyroid follicles and foci of papillary thyroid carcinoma during pathological examination. This patient referred having had a metachronous thyroid malignancy 10 years before. The differential diagnosis between a thyroid malignancy arising from a struma ovarii and a metastatic ovarian tumor originating from thyroid-cancer is challenging. Struma ovarii should be considered when thyroid components are the predominant element or when thyroid malignant tissue is identified within an ovarian lesion. Thyroid carcinoma arising from a struma ovarii is reported to occur in a minority of cases. Of these, papillary carcinoma is the most frequent subtype encountered. Regarding primary thyroid carcinomas, papillary carcinomas have a lower metastatic potential when compared to follicular carcinomas, and most of the metastases occur in the cervical lymph nodes. Ovarian metastases are exceedingly rare and generally associated with widespread disease. However, they must be considered in the presence of previous history of malignant thyroid carcinoma. The authors review the main clinical, imaging and therapeutic aspects of both these entities and present the most likely diagnosis.
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PMID:Papillary carcinoma arising in struma ovarii versus ovarian metastasis from primary thyroid carcinoma: a case report and review of the literature. 2442 20


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