An Unusual Case of Malignant Struma Ovarii Causing Thyrotoxicosis.

BACKGROUND: Struma ovarii (SO) is a specialized monodermal teratoma predominantly composed of mature thyroid tissue, accounting for approximately 5% of all ovarian teratomas. Thyrotoxicosis is seen in about 8% of patients with SO. Most SO cases are benign with only 5-10% being malignant, and malignant SO causing thyrotoxicosis is very uncommon. CASE: A 64-year-old woman had been diagnosed with thyrotoxicosis 2 years previously. The thyroid gland was palpable with a micronodular texture, and the patient was euthyroid under carbimazole. She presented with abdominal pain and progressive enlargement of the abdomen over a 2-month period. An abdominal ultrasonography revealed a pelvic mass and a large fluid collection. Additional imaging confirmed the presence of a complex right ovarian mass measuring 13 cm. The patient underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy, omentectomy and appendectomy. The histological examination revealed the presence of 'follicular thyroid-type carcinoma arising in an SO of the right ovary, with metastatic infiltration in the tissue fragments from the pouch of Douglas'. Antithyroid treatment was discontinued 1 month after surgery in light of the pathology result. During the 4-year follow-up, the patient remained euthyroid. CONCLUSION: There has been controversy about the management of malignant SO, which is a rare entity. Malignant SO causing thyrotoxicosis is even more uncommon. As clinical signs are nonspecific, other causes of thyrotoxicosis must be considered for a differential diagnosis. Our case is one of the very few cases ever reported.

Breast tuberculosis: Diagnosis, management and treatment.

INTRODUCTION: Mammary (breast) tuberculosis is a rare manifestation of extra-pulmonary localization of the disease which accounts for less than 0.1% of breast conditions in developed countries, but reaches 3-4% in regions where the disease presents with high incidence (India, Africa). It appears mostly in women of reproductive age, multiparous, lactating. It has been scarcely reported to infect male patients, mainly before puberty, as well as women of older age. The most common presentation is that of a tumor in the middle or upper-outer quadrant of the breast, with multifocal involvement being rarely documented. The differential diagnosis includes breast cancer and abscess formation. PRESENTATION OF CASE: We report a case of breast tuberculosis that was treated in the Breast Unit of our hospital. Differential diagnosis, imaging methods, operative diagnostic approach and surgical treatment, histological verification of the disease and further therapeutic management are described. DISCUSSION: High risk population is identified, primary and secondary disease is described and clinical presentations are analyzed. Evaluation of diagnostic workup and limitations are reported. CONCLUSION: In accordance with the present worldwide revival of the disease, mainly because of massive numbers of migrating population, this subject is reviewed, reminding us of a rather uncommon clinical entity.

Excessive hirsutism in pregnancy because of Krukenberg tumor.

Krukenberg tumor is an ovarian metastatic tumor which may rarely develop during pregnancy. The diagnosis of this tumor is often overlooked by the signs and symptoms of pregnancy and therefore delayed. The prognosis is universally poor and most patients die within one year of diagnosis.We present a case of a pregnant woman who was admitted for threatened premature birth and diagnosed with Krukenberg tumor. Virilization symptoms initiated clinical and laboratory investigation and eventually the diagnosis of Krukenberg tumor was confirmed. The woman delivered a healthy infant and after that she received palliative treatment.

Partial molar pregnancy with a chromosomically and phenotypically normal embryo: presentation of an extremely rare case and review of literature.

We present an extremely rare case of partial molar pregnancy with a chromosomically and phenotypically normal embryo and review of the literature. A 31-year-old nulliparous was referred to us at 30 weeks of gestation due to absence of fetal movements and subsequent ultrasound examination revealed intrauterine demise. Prenatal amniocentesis due to raised maternal serum α-fetoprotein had shown a karyotypically normal female embryo and second trimester ultrasound demonstrated no anatomic abnormalities. Upon induction of labor with misoprostol, a phenotypically normal embryo was delivered and the placenta showed intermixed areas of marked hydatidiform villous change and normal parenchyma. Pathologic examination of the placenta confirmed the molar change of placenta. Two are the main theories discussed herein that explain the placental molar changes in singleton pregnancies: confined placental mosaicism (one case reported to date) and placental mesenchymal dysplasia (70 cases reported). Differential diagnosis is based on histopathologic features and genetic analysis of placenta.

Prenatal diagnosis of prune-belly syndrome at 13 weeks of gestation: case report and review of literature.

We present a case report of a foetus with Prune-Belly syndrome (PBS) which was diagnosed sonographically during the 13th week of gestation and review of the literature. Sonographic diagnosis was based on abnormally distended urinary bladder and abdomen and absence of 'keyhole sign'. Termination was performed on parental request and post-mortem examination revealed absence of abdominal wall musculature and the distended urinary bladder in a male foetus. Prenatal diagnosis of PBS is based on ultrasound and is usually diagnosed in the second trimester. In the first trimester there are very few reports to date. Prognosis and possible treatment options are herein discussed as well as the underlying mechanisms that may explain the clinical presentation of the syndrome.

A pre-tailored panel of antibodies in the study of cervical mesonephric remnants.

AIMS: To investigate the immunohistochemical profile of cervical mesonephric remnants. METHODS AND RESULTS: Cases of mesonephric remnants, microglandular hyperplasia, tunnel clusters, tuboendometrioid metaplasia and cervical adenocarcinomas were immunohistochemically stained with Ki-67, CD10, bcl2 and p16. All 26 cases of mesonephric remnants were strongly positive for bcl2 and weakly to moderately positive for p16. CD10 was positive in 19 cases. Seven cases were negative and 19 weakly positive for Ki-67. All 10 cases of tuboendometrioid metaplasia showed high positivity for bcl2. Two cases were negative for p16; seven cases presented low and one case moderate positivity. Five cases were negative for CD10, while in five the staining was low. Six cases of tuboendometrioid metaplasia were negative for Ki-67, while four showed low staining. Tunnel clusters were negative for all antibodies, except one, which showed focal positivity for Ki-67 and p16. All cases of microglandular hyperplasia were negative for bcl2, p16 and CD10 and only 5/12 showed focal positivity for Ki-67. All adenocarcinomas were negative for bcl2 and CD10, and highly positive for p16 and Ki-67. CONCLUSIONS: bcl2 is more constantly and strongly expressed in mesonephric remnants than CD10. p16 is weakly to moderately positive, while Ki-67 is negative to weakly positive.