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2011, Volume 27, Number 3, Page(s) 261-261
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DOI: 10.5146/tjpath.2011.01086 |
Hashimoto's Disease in a Bilateral Benign Cystic Ovarian Teratoma: A Case Report |
Rupinderjeet KAUR, Jasbir SINGH, Anureet KAUR, Rimpi BANSAL, Satish SHARMA |
Department of Pathology, Giansagar Medical College and Hospital, Banur, Dist Patiala, PUNJAB, INDIA |
Keywords: Hashimoto thyroiditis, Teratoma, Mature, Dermoid, Ovary |
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A wide array of tissues derived from all the three germinal layers is
seen in ovarian teratomas. Among these, thyroid tissue is present in
10% cases of all mature cystic teratomas.
We report this case of Hashimoto's thyroiditis in a clinically euthyroid
patient who tested positive for antithyroid peroxidase antibodies in
spite of normal thyroid hormone profile.
While the histological features of several disorders of thyroid tissue
may be discovered, Hashimoto's thyroiditis is extremely rare finding
in ovarian teratomas. |
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Mature teratomas, mostly cystic (dermoid cyst), account
for approximately 30% of benign ovarian tumors, and are
unilateral in 88%. Microscopically, tissues derived from all
the three germinal layers may be found, the most common
being epidermis, skin appendages and neural tissue.
Thyroid tissue is present in 10% of cases 1.
Thyroid tissue in ovarian teratoma may exhibit histological
features of several disorders, like diffuse and nodular
hyperplasia, chronic thyroiditis and carcinoma. The finding
of Hashimoto's disease in a bilateral mature cystic teratoma
is a very rare phenomenon, with few cases reported in
literature till date2,3. We report this case for its rarity. |
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Abstract
Introduction
Case Presentation
Disscussion
References
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A woman, aged 42 years, complained of severe acute
abdominal pain and vomiting. Radiological diagnosis
revealed bilateral ovarian masses, for which an emergency
laparotomy was performed and hysterectomy with bilateral oopherectomy was done. The specimen was sent for
histopathological examination.
Grossly, the uterus and cervix measured 10x7.5x6 cm.
The left ovary measured 9x6x3.5 cm, which on cut section
showed multiloculated cysts containing sebaceous material,
tufts of hair and some solid areas. The right ovary measured
7x5x4cm. It was predominantly cystic containing sebum. A
Rokitansky protuberance, having a tooth like structure was
also seen.
Serial sections from both ovaries showed a lining of
keratinizing squamous epithelium with skin appendages.
Neural tissue, respiratory epithelium, gastric epithelium,
bone and smooth muscle were also present.
One section from left ovary contained predominantly
thyroid tissue, consisting of colloid filled follicles showing
prominent Hurthle cell change. The peri-acinar tissues
contained mature lymphocytes, lymphoid follicles with
enlarged reactive centres. The appearances were consistent with the chronic lymphocytic thyroiditis of Hashimoto's
disease. Lymphocytic infiltration was not seen in association
with any of the other teratomatous elements.
The thyroid hormone profile of the patient was normal.
Antithyroid peroxidase antibodies were positive postoperatively. |
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Abstract
Introduction
Case Presentation
Disscussion
References
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Various tissues from all the three germinal layers are found
in mature teratoma. Benign and malignant transformation
can occur in any of these tissues. Thyroid tissue is present in
10% of cases which is usually normal looking or may show
benign changes like hyperplasia or thyroiditis. Some cases
of carcinoma and malignant lymphoma are also reported 4.
In ovarian teratoma, thyroiditis is an occasional finding
and Hashimoto's thyroiditis is rare5. Caruso et al (1971)
reviewed 305 teratomas of the ovary and discovered that
thyroid tissue was present in only 20 cases (7%) and
struma ovarii in two cases (0.7%). There is no mention of
Hashimoto's disease in any of their cases2. In another
study of 315 tertomas conducted by Watson, thyroid tissue
was present in 17 cases and among these cases Hashimoto's
disease was encountered only in one case, in which an
immunological test for antithyroid antibodies was negative3. In our case, the patient's clinical and thyroid hormone
profile was normal. Ultrasonographic examination was
unremarkable. However our patient tested positive for
antithyroid peroxidase antibodies. Hashimoto's disease
has been reported in papillary carcinoma of the thyroid originating in a teratoma of the ovary6. Etiopathogenesis
of such change in ectopic thyroid tissue is unclear. Watson
attributes internal gynaecological manipulation and the
possibility that some trauma, could initiate the formation
of the ovarian Hashimoto's disease3. In our case no such
history could be elicited.
This paper reports a rare case of a patient with Hashimoto's
thyroiditis in thyroid tissue in a bilateral mature cystic
teratoma associated with positive specific antithyroid
antibodies in the absence of symptoms and signs, due to
thyroid disease. |
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Abstract
Introduction
Case Presentation
Discussion
References
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1) Pantoja E, Noy MA, Axtmayer RW, Colon FE, Pelegrina I:
Ovarian dermoids and their complications: comprehensive
historical review. Obstet Gynecol Surv 1975, 30:1-20 [ PubMed ]
2) Caruso PA, Marsh MR, Minkowitz S, Karten G: An intense
clinicopathologic study of 305 teratomas of the ovary. Cancer
1971, 27:343-348 [ PubMed ]
3) Watson AA: Histological Hashimoto's disease in a benign cystic
ovarian teratoma. J Clin Path 1972, 25:240-242 [ PubMed ]
4) Hasleton PS, Kelehan P, Wittaker JS, Burslem RW, Turner L:
Benign and malignant struma ovarii . Arch Pathol Lab Med 1978,
102:180-184 [ PubMed ]
5) Bonadio AG: Hashimoto's thyroiditis in “struma ovarii”. Case
report and review of the literature. Minerva Endocrinol 2002,
27:49-52 [ PubMed ]
6) Doldi N, Taccagni GL, Bassan M, Frigerio L, Mangili G, Jansen
AM, Ferrari A: Hashimoto's disease in a papillary carcinoma of
the thyroid originating in a teratoma of the ovary (malignant
struma ovarii). Gynecol Endocrinol 1998, 12:41-42 [ PubMed ] |
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Abstract
Introduction
Case Presentation
Discussion
References
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