Proliferative Highly Differentiated Follicular Carcinoma Of Ovarian Origin (Hdfco) Presenting Long After Bilateral Oophorectomy

• Main Authors: Natalie M. Liu, BS, Neda Moatamed, MD, Racquel S. Bueno, MD, Wendy L. Sacks, MD
• Format: Article
• Language: English
• Published: Elsevier 2017-01-01
• Series: AACE Clinical Case Reports
• Online Access: http://www.sciencedirect.com/science/article/pii/S2376060520301899

ABSTRACT: Objective: The malignant spread of histologically benign struma ovarii was historically referred to as peritoneal strumosis. Recently, highly differentiated follicular carcinoma of ovarian origin (HDFCO) was proposed as a more accurate diagnostic term for this rare disease. We report the unusual case presentation of a woman with HDFCO and the subsequent management of her cancer.Methods: Her interventions included abdominal surgery, postoperative laboratory tests, imaging, thyroidectomy, radioactive iodine-123 (RAI-123) diagnostic screening, and thyroid function studies.Results: A 72-year-old Chinese female was diagnosed with metastatic HDFCO approximately 30 years after hysterectomy and bilateral oophorectomy. While undergoing evaluation for an upper gastrointestinal bleed, a computed tomography scan revealed a 10 cm pelvic mass and multiple other peritoneal tumors. She underwent tumor debulking surgery, and the pathology was interpreted at two institutions; both made the diagnosis of a very well-differentiated follicular carcinoma arising in struma ovarii. Lab tests revealed hyperthyroidism and RAI-123 uptake confirmed tumor production of thyroid hormone. A total thyroidectomy was performed in anticipation of treatment with radioactive iodine-131 (RAI-131). However, the patient remained clinically asymptomatic and, therefore, neither additional tumor debulking nor RAI-131 treatment were performed. No disease progression has been noted for over 3 years.Conclusion: This case highlights the potentially slow-growing nature of HDFCO which, in such cases, may be suited to less aggressive disease management.Abbreviations: CT computed tomography; Hb hemoglobin; HDFCO highly differentiated follicular carcinoma of ovarian origin; RAI-123 radioactive iodine-123; RAI-131 radioactive iodine-131; T3 triiodothyronine; T4 thyroxine; TSH thyroid-stimulating hormone;