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Vol 57, No 1 (2019)
Case report
Submitted: 2018-12-04
Accepted: 2019-03-25
Published online: 2019-03-28
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The role of immunohistochemical examination in diagnosis of papillary thyroid cancer in struma ovarii

Ewelina Szczepanek-Parulska1, Anna Pioch1, Ewa Cyranska-Chyrek1, Kosma Wolinski1, Donata Jarmołowska-Jurczyszyn2, Malgorzata Janicka-Jedynska2, Przemyslaw Majewski2, Maciej Zabel345, Marek Ruchala1
DOI: 10.5603/FHC.a2019.0004
·
Pubmed: 30924920
·
Folia Histochem Cytobiol 2019;57(1):35-42.
Affiliations
  1. Department of Endocrinology, Metabolism, and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
  2. Department of Clinical Pathology Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355 Poznan, Poland
  3. Department of Anatomy and Histology, University of Zielona Góra, Poland, ul. Zyty 28, 65-046 Zielona Góra, Poland
  4. Department of Histology and Embryology, ul. Chałubińskiego 6a, 50-368 Wrocław, Poland
  5. Department of Human Morphology and Embryology, Wroclaw Medical University, ul. Chałubińskiego 6a, 50-368 Wrocław, Poland

open access

Vol 57, No 1 (2019)
CASE REPORT
Submitted: 2018-12-04
Accepted: 2019-03-25
Published online: 2019-03-28

Abstract

Introduction. Struma ovarii (SO) is a monodermal teratoma in which thyroid tissue comprises more than 50% of the tumour. Papillary thyroid cancer (PTC) in SO is a rare finding, as only 5% of SO cases undergo malignant transformation. Malignant SO is usually asymptomatic and infrequently diagnosed preoperatively. Because of its rarity, there is no consensus about diagnosis and management, while treatment and follow-up procedures are not clearly established.


Material and methods. Herewith, we report two cases of PTC in SO. The first patient was a 25-year-old woman diagnosed with bilateral ovarian tumours. The second patient, 19-year-old woman, presented with unilateral ovarian mass. Both patients were qualified for surgical excision of the tumours. Histopathological specimens underwent both conventional histopathological assessment and immunohistochemical staining.


Results. In the first patient histopathology revealed SO with two foci of PTC. Immunohistochemically a positive expression of CK7, CK19, p63 and thyroglobulin (Tg) confirmed the diagnosis. She underwent total thyroidectomy in 2016 in order to enable ablative radioiodine therapy and facilitate further thyroglobulin monitoring. Unfortunately, the patient was lost from follow-up. In the second patient, histopathological diagnosis was follicular variant of PTC in SO. Postoperatively, a pelvic CT revealed osteolytic lesion 6 cm in size, being a metastatic change. The patient underwent unilateral ovariectomy, total thyroidectomy and multiple cycles of radioiodine therapy. Currently, 9 years following the diagnosis, the patient achieved disease remission.


Conclusions. PTC in SO still remains a diagnostic and therapeutic challenge. Immunostaining for CK7, CK19, p63 and Tg might be helpful in histopathological diagnosis. The decision on the need of total thyroidectomy and radioiodine therapy should be made individually. However, thyroid remnant ablation increases the sensitivity and specificity of follow-up testing using serum Tg level as a tumour marker.

Abstract

Introduction. Struma ovarii (SO) is a monodermal teratoma in which thyroid tissue comprises more than 50% of the tumour. Papillary thyroid cancer (PTC) in SO is a rare finding, as only 5% of SO cases undergo malignant transformation. Malignant SO is usually asymptomatic and infrequently diagnosed preoperatively. Because of its rarity, there is no consensus about diagnosis and management, while treatment and follow-up procedures are not clearly established.


Material and methods. Herewith, we report two cases of PTC in SO. The first patient was a 25-year-old woman diagnosed with bilateral ovarian tumours. The second patient, 19-year-old woman, presented with unilateral ovarian mass. Both patients were qualified for surgical excision of the tumours. Histopathological specimens underwent both conventional histopathological assessment and immunohistochemical staining.


Results. In the first patient histopathology revealed SO with two foci of PTC. Immunohistochemically a positive expression of CK7, CK19, p63 and thyroglobulin (Tg) confirmed the diagnosis. She underwent total thyroidectomy in 2016 in order to enable ablative radioiodine therapy and facilitate further thyroglobulin monitoring. Unfortunately, the patient was lost from follow-up. In the second patient, histopathological diagnosis was follicular variant of PTC in SO. Postoperatively, a pelvic CT revealed osteolytic lesion 6 cm in size, being a metastatic change. The patient underwent unilateral ovariectomy, total thyroidectomy and multiple cycles of radioiodine therapy. Currently, 9 years following the diagnosis, the patient achieved disease remission.


Conclusions. PTC in SO still remains a diagnostic and therapeutic challenge. Immunostaining for CK7, CK19, p63 and Tg might be helpful in histopathological diagnosis. The decision on the need of total thyroidectomy and radioiodine therapy should be made individually. However, thyroid remnant ablation increases the sensitivity and specificity of follow-up testing using serum Tg level as a tumour marker.

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Keywords

struma ovarii; papillary thyroid cancer; teratoma; CK7; CK19; p63; thyroglobulin; IHC

About this article
Title

The role of immunohistochemical examination in diagnosis of papillary thyroid cancer in struma ovarii

Journal

Folia Histochemica et Cytobiologica

Issue

Vol 57, No 1 (2019)

Article type

Case report

Pages

35-42

Published online

2019-03-28

Page views

4102

Article views/downloads

1822

DOI

10.5603/FHC.a2019.0004

Pubmed

30924920

Bibliographic record

Folia Histochem Cytobiol 2019;57(1):35-42.

Keywords

struma ovarii
papillary thyroid cancer
teratoma
CK7
CK19
p63
thyroglobulin
IHC

Authors

Ewelina Szczepanek-Parulska
Anna Pioch
Ewa Cyranska-Chyrek
Kosma Wolinski
Donata Jarmołowska-Jurczyszyn
Malgorzata Janicka-Jedynska
Przemyslaw Majewski
Maciej Zabel
Marek Ruchala

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