Introduction: Struma ovarii (SO) is a rare ovarian teratoma characterized by the presence of thyroid tissue in more than 50% of the tumor. Malignant transformation is rare and the most common associated malignancy is papillary thyroid carcinoma (PTC). Pregnancy may represent a stimulus to differentiated thyroid cancer (DTC) growth in patients with known structural or biochemical evidence of disease, but data about malignant SO evolution during pregnancy are rare. We present the first reported case of a pregnant patient with malignant SO and biochemical evidence of disease. Case Presentation: A previously healthy 35-year-old female diagnosed with a suspicious left pelvic mass on routine ultrasound was submitted to laparoscopic oophorectomy which revealed a malignant SO with areas of PTC. A 15-mm thyroid nodule (Bethesda V in the fine-needle aspiration cytology) was detected by palpation and total thyroidectomy was performed. Histology revealed a 15 mm follicular variant of PTC (T1bNxMx). Subsequently, she received 100 mCi of radioactive iodine therapy (RAIT) with the whole-body scan showing only moderate neck uptake. Her suppressed thyroglobulin (Tg) before RAI was 1.1 ng/mL. She maintained biochemical evidence of disease, with serum Tg levels of 7.6 ng/mL. She got pregnant 14 months after RAIT, and during pregnancy, Tg increased to 21.5 ng/mL. After delivery, Tg decreased to 14 ng/mL but, 6 months later, rose again and reached 31.9 ng/mL on the last follow-up visit. TSH was always suppressed during follow-up. At the time of SO diagnosis, a chest computed tomography scan showed 4 bilateral lung micronodules in the upper lobes which were nonspecific, and 9 months after diagnosis, a pelvic MRI revealed a suspicious cystic nodule located on the oophorectomy bed. These lung and pelvic nodules remained stable during follow-up. Neck ultrasonography, abdominal MRI, and fluorodeoxyglucose-positron emission tomography showed no suspicious lesions. Discussion/Conclusion: As for DTC, pregnancy seems to represent a stimulus to malignant SO growth. This can be caused by the high levels of estrogen during pregnancy that may bind to receptors in malignant cells and/or by the high levels of hCG which is known to stimulate TSH receptors.
Eur Thyroid J

中文翻译：

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恶性卵巢间质瘤合并甲状腺癌：妊娠期间和之后的结果

简介：卵巢瘤（SO）是一种罕见的卵巢畸胎瘤，其特征是50%以上的肿瘤中存在甲状腺组织。恶性转化很少见，最常见的相关恶性肿瘤是甲状腺乳头状癌（PTC）。在具有已知疾病结构或生化证据的患者中，妊娠可能是分化型甲状腺癌 (DTC) 生长的刺激因素，但有关妊娠期间恶性 SO 演变的数据很少。我们介绍了首例报告的患有恶性 SO 和疾病生化证据的妊娠患者的病例。案例介绍：一名先前健康的 35 岁女性在常规超声诊断为可疑左侧盆腔肿块，接受腹腔镜卵巢切除术，结果显示有 PTC 区域的恶性 SO。触诊发现一个 15 毫米的甲状腺结节（细针抽吸细胞学中的 Bethesda V）并进行了全甲状腺切除术。组织学显示 15 mm 滤泡型 PTC (T1bNxMx)。随后，她接受了 100 mCi 的放射性碘治疗 (RAIT)，全身扫描显示只有中度的颈部摄取。在 RAI 之前，她的抑制甲状腺球蛋白 (Tg) 为 1.1 ng/mL。她保持疾病的生化证据，血清 Tg 水平为 7.6 ng/mL。她在 RAIT 后 14 个月怀孕，在怀孕期间，Tg 增加到 21.5 ng/mL。分娩后，Tg 降至 14 ng/mL，但 6 个月后再次上升，达到 31。最后一次随访时为 9 ng/mL。随访期间 TSH 始终受到抑制。SO 诊断时，胸部 CT 扫描显示上叶有 4 个双侧肺微结节，非特异性，诊断 9 个月后，盆腔 MRI 显示位于卵巢切除床上的可疑囊性结节。这些肺和盆腔结节在随访期间保持稳定。颈部超声检查、腹部 MRI 和氟脱氧葡萄糖正电子发射断层扫描显示没有可疑病变。这些肺和盆腔结节在随访期间保持稳定。颈部超声检查、腹部 MRI 和氟脱氧葡萄糖正电子发射断层扫描显示没有可疑病变。这些肺和盆腔结节在随访期间保持稳定。颈部超声检查、腹部 MRI 和氟脱氧葡萄糖正电子发射断层扫描显示没有可疑病变。讨论/结论：对于 DTC，妊娠似乎代表了对恶性 SO 生长的刺激。这可能是由于怀孕期间可能与恶性细胞中的受体结合的高水平雌激素和/或已知刺激 TSH 受体的高水平 hCG 引起的。
欧洲甲状腺杂志