Sinai Oncology Conference

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Sinai Oncology Conference
January 24, 2006
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Case Presentation
Vitals Afebrile HR 78 BP 236/124
PE Incarcerated umbilical hernia ()
guarding Remainder of exam unremarkable
Labs Normal electrolytes, WCC 7.8K EKG NSR, no
ischemic changes CXR Normal
AXR No evidence obstruction colon full of stool
Taken to PACU for BP control prior to proceeding
to OR for repair of incarcerated hernia
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Operative Findings
Upon induction, palpation of abdomen revealed two
peri-umbilical hernias and underlying abdominal
mass
Exploration revealed two hernia sacs with viable
omentum
Proceeded to formal laparotomy that demonstrated
massive right ovarian mass
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Pathology
Weight 3100 grams Size 22cm x 17cm x 13 cm
Grossly 90 multiloculated cyst with areas of
hair and normal ovarian parenchyma. Distinct
4.8cm area of yellow-tan tissue sectioned
separately revealing thyroid follicles.
Mature cystic teratoma with strumal carcinoid,
trabecular pattern
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Struma Ovarii
Germ cell tumors comprise 15-20 of ovarian
tumors majority of them are mature cystic
teratomas
10 teratomas contain foci of thyroid tissue
Struma ovarii when thyroid tissue is
predominant component Hyperthyroidism seen in
5-8 of patients
Malignant transformation of thyroid tissue is
rare (0.1) Almost exclusively papillary thyroid
carcinoma (ltlt follicular) Rx for malignancy
TAH/BSO and must evaluate thyroid (??Role of
pelvic lymph node dissection and omentectomy)
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Strumal Carcinoid of the Ovary
Strumal carcinoid even rarer subcategory of
mature teratomas characterized by mixture of
thyroid and carcinoid tissues
Can be immunoreactive for somatostatin,
chromagranin, synaptophysin, serotonin,
glucagon, insulin, gastrin and calcitonin