Malignant Clinical Course of “Proliferative” Ovarian Struma: Diagnostic Challenges and Treatment Pitfalls
Aleksandra Asaturova,
Alina Magnaeva,
Anna Tregubova,
Vlada Kometova,
Yevgeniy Karamurzin,
Sergey Martynov,
Yuliya Lipatenkova,
Leila Adamyan,
Andrea Palicelli
Affiliations
Aleksandra Asaturova
FSBI “National Medical Research Centre for Obstetrics, Gynecology and Perinatology Named after Academician V.I.Kulakov” of the Ministry of Health of the Russian Federation, Bldg 4, Oparina Street, Moscow 117513, Russia
Alina Magnaeva
FSBI “National Medical Research Centre for Obstetrics, Gynecology and Perinatology Named after Academician V.I.Kulakov” of the Ministry of Health of the Russian Federation, Bldg 4, Oparina Street, Moscow 117513, Russia
Anna Tregubova
FSBI “National Medical Research Centre for Obstetrics, Gynecology and Perinatology Named after Academician V.I.Kulakov” of the Ministry of Health of the Russian Federation, Bldg 4, Oparina Street, Moscow 117513, Russia
Vlada Kometova
FSBI “National Medical Research Centre for Obstetrics, Gynecology and Perinatology Named after Academician V.I.Kulakov” of the Ministry of Health of the Russian Federation, Bldg 4, Oparina Street, Moscow 117513, Russia
Yevgeniy Karamurzin
Mediclinic Middle East, Dubai Healthcare City, Bldg 37, Dubai P.O. Box 505004, United Arab Emirates
Sergey Martynov
FSBI “National Medical Research Centre for Obstetrics, Gynecology and Perinatology Named after Academician V.I.Kulakov” of the Ministry of Health of the Russian Federation, Bldg 4, Oparina Street, Moscow 117513, Russia
Yuliya Lipatenkova
FSBI “National Medical Research Centre for Obstetrics, Gynecology and Perinatology Named after Academician V.I.Kulakov” of the Ministry of Health of the Russian Federation, Bldg 4, Oparina Street, Moscow 117513, Russia
Leila Adamyan
FSBI “National Medical Research Centre for Obstetrics, Gynecology and Perinatology Named after Academician V.I.Kulakov” of the Ministry of Health of the Russian Federation, Bldg 4, Oparina Street, Moscow 117513, Russia
Andrea Palicelli
Pathology Unit, Azienda Unità Sanitaria Locale—IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
Struma ovarii (SO) is a monodermal teratoma predominantly composed of thyroid tissue (TT) showing benign, “proliferative”, or malignant histology. By imaging, a 38-year-old patient with lower backache revealed a 6.2-cm vertebral lesion (L5). Core biopsy showed well-differentiated TT without features of papillary carcinoma. A 3.5-cm left ovarian mature teratoma (lacking TT) and peritoneal nodules (showing well-differentiated TT) were also identified and surgically removed. Thyroid ultrasound and cytological examination resulted negative. Four years before, left ovarian cystectomy was performed for a histologically “proliferative” SO. According to the malignant clinical course and WHO classification, this case was overall reassessed as a recurring well-differentiated follicular carcinoma arising in SO (WD-FC-SO), despite lacking malignant histological features in any specimens. Immunophenotype: TTF-1+/PAX-8+/thyroglobulin+/CK7+/chromogranin-/synaptophysin-/inhibin-/calretinin-/HNF1B-; Ki-67 index BRAFV600E mutation. The patient refused further treatments, without recurrence after 17 months. The clinical behavior of SO may be unpredictable. Histologically benign or proliferative strumas extraordinarily metastasize, while SO with malignant features may not recur. The exceptional evidence of peritoneal implants of well-differentiated TT (peritoneal strumosis) in patients with histologically benign SO represents a metastasis of WD-FC-SO (like in our case). A multidisciplinary approach including clinical, laboratory, radiologic, and histopathological data is required.
