Karim ElSahwi

Bilateral malignant struma ovarii with concurrent thyroid carcinoma

Malignant struma ovarii (MSO) is a rare ovarian tumour. The co-occurrence of MSO and thyroid carcinoma is even rarer. There is no established treatment for these patients. We report a postmenopausal woman in her 60s who presented with left hip pain, increased urinary frequency and fatigue. Imaging showed a left adnexal cystic lesion 8.8 cm in diameter and an incidental 12×8 mm right ovarian cyst. She underwent total laparoscopic hysterectomy and bilateral salpingo-oophorectomy, and findings were significant for bilateral stage IA MSO. The metastatic workup showed concurrent papillary thyroid carcinoma. She underwent total thyroidectomy with neck dissection and radioactive iodine (RAI) adjuvant therapy. While thyroid carcinoma management is more standardised, a literature review yielded a wide range of MSO treatments. Recent literature favours conservative management with unilateral salpingo-oophorectomy. RAI therapy in these cases is controversial. We will discuss the literature findings on the optimal treatment of MSO with concurrent thyroid cancer.

Early-stage serous fallopian tube carcinoma

Primary fallopian tube carcinoma (PFTC) is a rare disease. Its location, close association with epithelial ovarian carcinoma, and lack of specific signs and symptoms make diagnosis challenging especially in its early stages. We report a postmenopausal patient who presented with a 2-month history of abdominopelvic pain with watery vaginal discharge. Imaging findings showed a 7 cm complex left adnexal mass. The patient underwent a robotic-assisted total laparoscopic hysterectomy and bilateral salpingo-oophorectomy and surgical staging. Findings were significant for stage IA serous fallopian tube carcinoma. PFTC is sometimes missed preoperatively and intraoperatively. Available literature review has focused on the clinical and imaging characteristics of PFTC to aid in timely disease diagnosis. Minimally invasive surgery is a viable option in the diagnosis and management of early-stage ovarian cancer due to improved visualisation of pelvic structures, decreased length of hospital stay, decreased estimated blood loss and lower postoperative complication rates compared with laparotomy.

Meigs syndrome presenting with severely elevated CA-125 level

A 64-year-old woman referred to Gynaecological Oncology secondary to the finding of pelvic mass and ascites. Imaging showed multiple pelvic masses, with the largest mass measuring 20 cm in diameter, as well as bilateral pleural effusions and abdominal ascites, suspicious for ovarian carcinoma. Laboratory findings included elevated cancer antigen 125 (CA-125) of 2124 units/mL. The patient underwent an exploratory laparotomy, total abdominal hysterectomy and bilateral salpingo-oophorectomy for pathological evaluation. Postoperatively, the patient had resolution of ascites and pleural effusion. Surgical pathology revealed a 26 cm right ovarian fibroma, confirming the diagnosis of Meigs syndrome. Despite the high suspicion for ovarian carcinoma in patients presenting with elevated CA-125 level, pelvic mass, ascites and pleural effusion, the diagnosis of Meigs syndrome cannot be excluded without pathological evaluation of mass.