First case report of papillary thyroid carcinoma arising within a functional teratoma in Graves’ disease patient

Abstract

Aim

Mature cystic teratoma is the most common kind of ovarian germ tumor. However, malignant transformation is uncommon, differentiated thyroid carcinoma is even rare. Hyperthyroidism due to coexistence of Graves’ disease (GD) and struma ovarii has been reported. Functional teratoma with papillary thyroid carcinoma (PTC) in GD case has never been reported in literature.

Material and method

A 48-year-old woman with GD for 4 years, who visited our hospital with complaints of severe abdominal pain for 1 day. Computed tomography of the abdominal revealed a large fat-containing lesion with dense calcification, measured 8.6 × 7.2 cm in size. Laparotomy right total oophorectomy was performed, and a huge gangrenous right ovary was noted during exploration. The final pathological diagnosis was teratoma with PTC change at right ovary. We performed thyroglobulin, TTF-1 and CK19 staining in the teratoma, the results were positive, suggesting the thyroid-hormone secretion in the PTC tissue.

Result

After resection of the ovarian lesion, euthyroidism was achieved. Adjuvant thyroidectomy is not performed for no evidence of thyroid lesion or distant metastases. No GD recurrence in the 2 years after operation. The patient also does not manifest any gynecological disease symptoms, whereas the other ovary, in the follow-up ultrasound examinations, shows normal size and echo structure.

Conclusion

PTC can arise within ovarian teratoma and may have thyroid hormone production. Surgeries of unilateral oophorectomy or cystectomy are a reasonable treatment, and follow-up of thyroid image and data is necessary.

Graves病患者有分泌功能畸胎瘤内出现甲状腺乳头状癌的首次病例报告 摘要

目的：成熟囊性畸胎瘤是最常见的卵巢生殖细胞肿瘤。然而, 恶性转化并不常见, 分化型甲状腺癌更为罕见。据报道, Graves病（GD）和卵巢甲状腺瘤并存导致甲状腺功能亢进。目前从未在GD病例中发现有分泌功能性畸胎瘤伴甲状腺乳头状癌（PTC）相关文献被报道过。

材料和方法：一名 48 岁女性, 患有Graves病4 年, 主诉剧烈腹痛1天来我院就诊。腹部计算机断层扫描提示一个大小8.6*7.2 cm, 内含脂肪伴致密钙化的病灶。进行经腹右侧卵巢切除术, 术中探查发现右侧卵巢有一个巨大的病灶。最终病理诊断为右侧卵巢畸胎瘤伴甲状腺乳头状癌改变。我们对畸胎瘤组织进行甲状腺球蛋白、TTF-1和CK19染色, 结果为阳性, 提示PTC组织有甲状腺激素分泌。

结果：切除卵巢病变后, 甲状腺功能恢复正常。如果没有甲状腺病变或远处转移的证据, 则不进行辅助性甲状腺切除术。术后2年无GD复发。患者也没有任何妇科疾病症状, 后续超声检查提示, 另一侧卵巢大小及回声结构正常。

结论：PTC可发生于卵巢畸胎瘤内, 可能与甲状腺激素的生成有关。单侧卵巢切除术或囊肿剔除术是一种合理的治疗方法, 有必要对甲状腺进行影像学和实验室行随访。

Keywords:

• Cystic teratoma
• primary papillary thyroid carcinoma
• Graves’ disease

Disclosure statement

No potential conflict of interest was reported by the author(s).