Abstract
Strumal carcinoid is an unusual rare ovarian teratoma characterized by the presence of thyroid tissue with a carcinoid tumor. We report a case of a 60-year-old nulliparous woman, who presented with complaints of a decrease in appetite, urinary frequency, and left lower extremity edema. By ultrasound of the abdomen, a large multiloculated cystic lesion occupying almost the entire pelvis and measuring 24 x 14 x 20 cm with internal debris concerning either uterine or ovarian cystic carcinoma was seen. By MRI, it was confirmed to be an ovarian lesion. Labs revealed elevated cancer antigen 125 (CA125) of 105 U/ml and carcinoembryonic antigen (CEA) of 6.4 ng/ml. The patient underwent surgery and the intraoperative consultation confirmed teratoma with a neuroendocrine component. Grossly, it was a multicystic ovarian mass and on sectioning, it had partial solid and cystic areas with clear to mucoid fluid. Histopathology showed foci of ectopic thyroid tissue admixed with foci of well-differentiated neuroendocrine tumor, grade 1 (carcinoid) displaying insular and trabecular patterns consistent with the diagnosis of strumal carcinoid (monodermal teratoma). Thyroid transcription factor-1 (TTF-1) and thyroglobulin immunostains highlighted ectopic thyroid tissue and synaptophysin highlighted neuroendocrine component. Strumal carcinoids are almost invariably benign and pathologic staging is not warranted. Treatment of strumal carcinoid is salpingo-oophorectomy.
Highlights
Strumal carcinoid is an ovarian teratoma accounting for 3% of all ovarian teratomas and is characterized by the presence of thyroid tissue with a carcinoid tumor
3% of teratomas account for strumal carcinoid type which is an admixture of benign thyroid tissue and carcinoid
There is a theory about hybrid cells differentiating into thyroid follicular cells and hindgut neuroendocrine cells [9,10], and the carcinoid arises from neuroendocrine cells of the genital tract [3]
Summary
Strumal carcinoid is an ovarian teratoma accounting for 3% of all ovarian teratomas and is characterized by the presence of thyroid tissue with a carcinoid tumor. The occurrence of papillary thyroid carcinoma in the strumal carcinoid is a growing concern, patients should be diligently managed [1,2]. Magnetic resonance imaging (MRI) demonstrated a large complex cystic mass measuring approximately 29 x 14 x 21 cm with a solid enhancing internal component consistent with ovarian tumor (the imaging was done at an outside facility and only notes were available for the case report). Histopathological examination of the left ovary showed foci of ectopic thyroid tissue with colloid-filled follicles admixed with foci of well-differentiated neuroendocrine tumor, grade 1 (carcinoid) consistent with. How to cite this article Mohammed S, Anelo O, Khan F (December 17, 2021) Strumal Carcinoid Presenting as Large Pelvic Mass: A Rare Case and Review of Literature. The patient recovered well after surgery and was discharged thereafter
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