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Tall-Cell Variant Papillary Thyroid Carcinoma Arising from Struma Ovarll
Institution:1. Department of General Surgery, Cleveland Clinic Foundation;2. Department of Anatomic Pathology, Cleveland Clinic Foundation;3. Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic Foundation, Cleveland, Ohio;4. Department of Endocrine Surgery, Cleveland Clinic Foundation.;1. Department of Endocrinology and Metabolism;2. Department of Dieteticse;3. Department of Internal Medicine, Fortis Hospitals and Research Institute and Fortis healthcare, Opp IIM-B,154/9, Bannerughatta High Road, Bangalore, 560076, Karnataka, India;4. Department of Biostatistics, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore-560029, Karnataka, India.
Abstract:ObjectiveTo present a case of tall-cell variant (TCV) papillary thyroid carcinoma (PTC) arising from Struma ovarii (SO) and to discuss special considerations in the management of this patient.MethodsThe clinical presentation and relevant pathologic features of a patient with PTC-TCV developing from SO are described, and a concise review of literature regarding this topic is also presented.ResultsA 36-year-old woman with a history of stable right ovarian dermoid cyst presented with amenorrhea and was found to have a significantly enlarged right ovary with multiple cysts. Following laparoscopic cystectomy, pathology revealed mature cystic teratoma (SO) with associated PTC-TCV. Based on this finding, she underwent right salpingo-oophorectomy, right pelvic lymph node dissection, and partial omentectomy. Pathology was negative for extra-ovarian disease, and her tumor was staged as pT1pN0M0. Total thyroidectomy was performed in preparation for radioactive iodine (RAI) therapy. A diagnostic iodine-131 (I-131) scan showed residual uptake in the neck with faint uptake in the lower left quadrant of the abdomen and was followed by therapy with 90 mCi of I-131. The patient had an unremarkable course with no clinical or biochemical evidence of disease recurrence to date.ConclusionsThis is to our knowledge the first reported case of TCV-PTC arising from SO. The presence of this aggressive variant of PTC factored into our decision to proceed with thyroidectomy and I-131 ablation, despite the lack of conclusive evidence in the literature. Recent discoveries on the natural history of thyroid-derived TCV-PTC were critical in choosing the appropriate management for this patient’s disease. (Endocr Pract. 2014;20:e24-e27)
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