METASTATIC RADIOIODINE AVID STRUMA OVARII ASSOCIATED WITH PSEUDO-MEIGS' SYNDROME.

We report a case of 21 years old lady who presented with ascites, left adnexal mass and elevated CA-125. With suspicion of ovarian malignancy, she underwent left salpingo-oophorectomy with omental biopsy. Histopathology revealed: 'follicular variant of papillary thyroid carcinoma arising in struma ovarii' with metastatic papillary thyroid carcinoma in omental and peritoneal nodules. Patient underwent total thyroidectomy followed by radioactive iodine therapy for metastatic omental and peritoneal disease. Post-therapy whole body scan, revealed extensive I-131 avid disease metastatic disease involving the chest, abdomen, pelvis and the musculoskeletal system. Patient was treated with multiple doses of high dose radioactive iodine. She became symptom free on supra-physiologic doses of oral thyroxin however her high thyroglobulin levels and residual radioiodine avid metastatic disease required further treatment. In literature a few cases of struma ovarii have been reported with elevated CA-125 and associated pseudo-Meigs' syndrome. The treatment for this rare disease is still not standardized and poses a therapeutic challenge. Our case emphasizes the need for a multidisciplinary approach for managing struma ovarii.

Vitamin-D status at breast cancer diagnosis: correlation with social and environmental factors and dietary intake.

BACKGROUND: Serum levels of vitamin-D are low in breast cancer patients. Vitamin-D levels have inverse correlations with postmenopausal state, obesity, poor sun exposure and low intake of vitamin-D rich diet. The objective of this study was to quantify levels of vitamin-D in serum to determine the degree of vitamin-D deficiency in breast cancer patients compared with age matched controls and to observe the association between serum 25-OH vitamin-D levels and personal and social parameters, BMI, amount of sun exposure and dietary intake. METHODS: In this cross-sectional analytical study all newly diagnosed breast cancer female patients were recruited into the study over a period of 6 months. Age matched healthy females were also recruited as a control group. Personal and social data was documented on to a pro forma. Sun exposure was determined by mid-day exposure to direct sunlight. Serum 25-OHD levels were studied by ELISA technique on the blood samples. The dietary information was collected by recall over the last 1 year. RESULTS: Vitamin-D deficiency was found in 99% breast cancer females and 90% in healthy females. Mean serum vitamin-D level was 9.6 ± 5 ng/ml and 15.2 ± 10 ng/ml for cases and control group respectively. All breast cancer and 95% healthy females with BMI > 30 were found to be vitamin-D deficient. Menopausal state, parity, parda (veil) observation, area of living and sun exposure did not affect vitamin-D status in either group. Egg, fish and cheese intake revealed correlation with vitamin-D deficiency. Forty percent healthy females were found to have deficient serum vitamin-D levels despite being on supplement. CONCLUSION: Vitamin-D deficiency was highly prevalent among breast cancer females. Serum 25 OHD levels exhibited an inverse correlation with high body mass index and vitamin-D rich diet.