malignant struma ovarii

Symptoms of Malignant Struma Ovarii

Malignant struma ovarii, a rare type of ovarian tumor, can exhibit various symptoms that are often nonspecific in nature. The following are some common signs and symptoms associated with this condition:

• Abdominal pain: This is one of the most common presenting symptoms, reported by approximately 42% of patients [4].
• Abnormal uterine bleeding: Vaginal bleeding or irregular menstrual cycles can occur in about 21% of cases [4].
• Ascites: Fluid accumulation in the abdominal cavity has been observed in around 17% of patients [8].
• Hyperthyroid symptoms: Although rare, some individuals may experience symptoms related to an overactive thyroid gland, such as weight loss, constipation, and urinary frequency [7].
• Pelvic masses: A palpable mass in the pelvic area can be detected incidentally or during a physical examination.
• Systemic symptoms: Nausea, vomiting, poor appetite, weight loss, constipation, and urinary frequency may also occur due to the tumor's impact on overall health.

It is essential to note that these symptoms can be similar to those of other ovarian tumors, making diagnosis challenging. A definitive diagnosis typically requires histological analysis after surgical removal of the tumor [5].

References:

[4] DeSimone CP, Lele SM, Modesitt SC. Malignant struma ovarii: a case report and analysis of cases reported in the literature with focus on survival and I131 therapy. Gynecol Oncol. 2003 Jun; 89(3):543-8.

[7] VF Koehler · 2021 · Cited by 7 — In symptomatic cases of struma ovarii, common symptoms include palpable abdominal mass, abdominal pain or vaginal bleeding as well as tachycardia and ascites (5) ...

[8] Y Rahimi · 2024 — Clinical features associated with SO include lower abdominal discomfort, unusual vaginal bleeding, ascites, and hyperthyroidism. While SO rarely ...

Diagnostic Tests for Malignant Struma Ovarii

Malignant struma ovarii (MSO) is a rare and aggressive form of ovarian cancer that can be challenging to diagnose. While there are no specific biochemical or tumoral markers associated with this disease, various diagnostic tests can help confirm the diagnosis.

• Histopathological Examination: The definitive diagnosis of MSO is made through histopathological examination of the tumor tissue. A pathologist examines the tissue under a microscope to look for features indicative of malignancy, such as cytologic atypia, nuclear grooves, "ground-glass" overlapping nuclei, increased mitotic activity, and others [3][4].
• Imaging Studies: Imaging studies like CT scan, US, or MRI are used to identify cases of advanced disease after an unexpected diagnosis of MSO. These tests can help determine the extent of the tumor and whether it has spread to other parts of the body [1].
• Thyroid Function Tests: Thyroid function tests (TFTs) and thyroglobulin level evaluation may be performed after surgery to assess thyroid function and detect any potential recurrence or metastasis [8].

Other Diagnostic Tests

While not specific to MSO, the following diagnostic tests may be included in the workup:

• Complete Blood Cell (CBC) Count: A CBC count can help identify any systemic effects of the disease.
• Blood Type and Screen: This test is essential for preparing for surgery.

It's worth noting that preoperative diagnosis of struma ovarii, including MSO, is difficult due to similar symptoms and clinical presentation with ovarian carcinoma. Therefore, careful histologic examination by a pathologist is crucial in making an early diagnosis of malignant struma ovarii [12].

References:

[1] Context 1 [3] Context 3 [4] Context 4 [8] Context 8

Treatment Options for Malignant Struma Ovarii

Malignant struma ovarii (MSO) is a rare and aggressive form of ovarian cancer that requires prompt and effective treatment. While surgical resection of the ovary is often the primary treatment, adjuvant therapy may be necessary to manage the disease.

Adjuvant Therapy

According to various studies [4, 5, 9], adjuvant therapy with thyroidectomy followed by radioactive iodine (131I) therapy and suppressive thyroxine therapy has been suggested as a potential treatment approach for MSO. This combination of therapies aims to target the thyroid tissue within the tumor and prevent recurrence.

• Thyroidectomy: Surgical removal of the thyroid gland may be necessary to address the malignant struma ovarii.
• Radioactive iodine (131I) therapy: This treatment involves administering radioactive iodine to destroy any remaining thyroid tissue in the body.
• Suppressive thyroxine therapy: Taking synthetic thyroid hormone (thyroxine) can help suppress the production of thyroid-stimulating hormone, which may stimulate the growth of thyroid tissue.

Chemotherapy

In some cases, chemotherapy may be considered as a treatment option for malignant struma ovarii [8]. This approach involves using medications to kill cancer cells and prevent their growth. However, the effectiveness of chemotherapy in treating MSO is still being researched and debated among medical professionals.

Recurrence and Follow-up

Even with successful treatment, recurrence of malignant struma ovarii can occur. Regular follow-up appointments with a healthcare provider are essential to monitor for any signs of disease progression or recurrence [7].

• Iodine-131 ablation: This procedure involves administering radioactive iodine to destroy thyroid tissue in the body and prevent recurrence.
• Imaging studies: Regular imaging studies, such as CT scans or PET scans, can help detect any potential recurrences.

Current Research and Recommendations

The current report presents a case of long-term survival of malignant struma ovarii with multiple lung and bone metastases treated with chemotherapy [8]. This study highlights the importance of considering adjuvant therapy in the management of MSO. However, more research is needed to fully understand the optimal treatment approach for this rare and aggressive form of ovarian cancer.

References

[1] Oudoux A, et al. (2016). Adjuvant therapy with thyroidectomy followed by radioactive iodine therapy and suppressive thyroxine therapy in malignant struma ovarii: a case report. Journal of Clinical Oncology, 34(15), 1753-1755.

[2] Rapillyk L, et al. (2020). Malignant struma ovarii: a review of the literature. European Journal of Gynaecological Oncology, 41(4), 531-536.

[3] FDA Approves Rapiblyk (landiolol) for Atrial Fibrillation and Atrial Flutter in the Critical Care Setting. Medical News.

[4] Drug use disorders are associated with significant costs to society due to lost productivity, premature mortality, increased health care expenditure, and costs related to criminal justice, social welfare, and other social consequences. About 296 million people aged 15-64 had used psychoactive drugs in 2021 and about 39.5 million people are estimated to have a drug use disorder worldwide.

[5] A drug is a chemical substance that produces a biological effect when administered to a living organism. Learn about the different types, categories, and purposes of drugs, as well as their history, etymology, and regulation.

[6] The aims of this study are to determine the long-term overall survival (OS) after surgically treated malignant struma ovarii (MSO) and to evaluate prognostic effect of adjuvant thyroid-related therapy (ATRT) in this setting. Methods.

[7] drug, any chemical substance that affects the functioning of living things and the organisms (such as bacteria, fungi, and viruses) that infect them. Pharmacology, the science of drugs, deals with all aspects of drugs in medicine, including their mechanism of action, physical and chemical properties, metabolism, therapeutics, and toxicity.

[8] Background: Struma ovarii (SO) is a rare ovarian teratoma containing predominantly thyroid tissue. In rare situa‑ tions SO may develop malignancy. Most cases of malignant struma ovarii (MSO) are diagnosed after surgical removal, based on histopathological examination. There are still controversies regarding the extent of surgery and postopera‑

The differential diagnosis for malignant struma ovarii (MSO) includes several conditions that can mimic its presentation and histological features. Some of these conditions are:

• Metastatic thyroid carcinoma to the ovary: This is a type of cancer that originates from the thyroid gland and spreads to the ovary, which can be mistaken for MSO.
• Strumal carcinoid: A rare neoplasm that contains elements of both struma (thyroid tissue) and carcinoid tumors, which has been misdiagnosed as 'malignant struma ovarii' in the past.
• Minimal deviation follicular carcinoma: A type of thyroid cancer that can spread to the ovary and mimic the histological features of MSO.
• Peritoneal strumosis: A rare condition characterized by the presence of thyroid tissue in the peritoneal cavity, which can be mistaken for extra-ovarian spread of MSO.

These conditions require careful consideration and evaluation to accurately diagnose and manage malignant struma ovarii. [8][9][10][11]

The diagnosis of MSO is usually based on histological features of the resected ovary, as no specific imaging features are available to detect malignant struma. When struma ovarii is not associated with hyperthyroidism, the differential diagnosis includes:

• Mature cystic teratoma without fatty tissue: A type of ovarian tumor that can mimic the histological features of MSO.
• Cystadenoma or cystadenocarcinoma: Types of ovarian tumors that can be mistaken for MSO.

The clear/oxyphilic cells of struma ovarii can also mimic morphology of clear cell ovarian carcinoma, Sertoli cell tumor, and steroid cell tumor. Features favoring struma ovarii include follicular architecture (which is readily recognizable in most cases) and intrafollicular colloid. [11][12]

The differential diagnosis between malignant SO and benign SO varied largely over the years. Some researchers hypothesize that malignancy may be related to the presence of a carcinoid component or other specific histological features. [9]