Ovarian metastasis from thyroid carcinoma: a case report and literature review
© Corrado et al.; licensee BioMed Central Ltd. 2014
Received: 29 July 2014
Accepted: 23 September 2014
Published: 30 October 2014
Papillary thyroid carcinoma is rarely associated with metastatic disease. The most common sites of metastasis are the lungs and bones, while only few cases of ovarian metastasis are described in literature.
We report the case of a 51 years old woman, treated 9 years before for papillary thyroid carcinoma, presenting to our Institute with a pelvic ovarian mass revealed by ultrasound imaging. After bilateral salpingo-oophorectomy, the histologic examination detected a left ovarian metastasis from papillary thyroid carcinoma.
Even if the diagnosis of ovarian metastasis from thyroid carcinoma is often controversial, it should be considered when a woman with an ovarian lesion of unknown origin, has a personal history of malignant thyroid disease.
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Papillary thyroid carcinoma is the most common histotype of thyroid carcinoma and it is associated to a good prognosis and to a loco regional spread. The presence of distant metastasis is an important prognostic factor, although it is a rare event. Distant metastasis from papillary thyroid carcinoma often occurs decades after the primary tumor and the 70% of patients who die for papillary thyroid carcinoma are disease free after the primary treatment. Moreover, the 30 years mortality rates increase to 43% as a result of a distant recurrence ,. The most common metastatic sites are lung  and, following, bone. Instead, rare metastatic sites are brain, parotid, breast, liver, kidney, adrenal glands, ovaries, muscle and skin .
Ovaries are the most common metastatic sites from both genital and extragenital primaries, mostly originating in the gastrointestinal tract, and ovarian metastasis represent about 5% to 30% of all ovarian tumors ,.
We report a rare case of ovarian metastasis from thyroid carcinoma after 9 years from the diagnosis.
In December 2013 a 51 years old woman presented to our Gynecologic Oncology Unit, for the presence of a pelvic mass originating from the left ovary, occasionally detected in the ultrasound imaging during a routine check. She was 1 gravida, 1 para, with no previous gynecological pathology in her history. She referred that in 2004, following diagnosis of thyroid carcinoma, she underwent a total thyroidectomy in another hospital. The histological examination revealed a papillary thyroid carcinoma, follicular variant, involving the left thyroid lobe. She received a radio-iodine metabolic adjuvant treatment by administration of 120 mCi 131I.
This neoplasm was suggestive for a metastasis because there was no evidence of benign struma ovary and the others teratomatous component.
Papillary thyroid carcinoma is associated with a good prognosis and with a low metastatic power. A distant metastasis from papillary thyroid carcinoma is a rare event, above all when the recurrence occurs in less common sites. For this reason, rare metastasis is often not considered during the clinical setting.
When an ovarian mass is found to contain cells with features of thyroid carcinoma, a differential diagnoses should have to be considered between thyroid cancer arising from a struma ovarii and ovarian metastasis originating from a primary thyroid carcinoma, since the prognosis and clinical management are different. Thyroid carcinoma originating from a struma ovarii, presenting a papillary histotype in 70% of all cases, is reported to occur much more commonly than an ovarian metastasis from the thyroid. As a matter of fact, struma ovarii are the 5% of ovarian teratomas, 5-10% results in malignant teratomas and metastatic diseases doesn't reach the 23% of cases. However, when no teratomatous elements and no normal thyroid epithelial tissue are detected in the ovarian lesion, the diagnosis of metastasis with a thyroid origin is suggestive . In our patient, the ovarian parenchyma was completely occupied by thyroid-type neoplasm, there was no evidence of benign struma ovary or others teratomatous component and cells were positive to TTF-1 and Thyroglobulin antibodies.
Literature review of ovarian metastasis from thyroid carcinoma
Site of metastasis
Surgery of metastasis
Young RH 
Logani S 
Total thyroidectomy with lymphadenectomy
Brogioni S 
Total thyroidectomy, with lymphadenectomy
Thymus, lungs, ovaries, brain
Pirvu A 
Total thyroidectomy with lymphadenectomy
Laparoscopic bilateral oophorectomy
In conclusion, the ovarian involvement by a primary thyroid cancer is a rare event, but it should be considered, since it seems to be a negative prognostic factor worsening the oncological outcome. The histopathologic evaluation, including immunohistochemical stain and the investigation of patient's history are crucial steps in the diagnosis and clinical management of ovarian metastasis from thyroid cancer.
Written informed consent was obtained by patient for publication of this report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
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