Postmenopausal Bleeding with an Accidental Discovery of an Ovarian Strumal Carcinoid Tumor: A Case Report

Abstract

Aim: Ovarian strumal carcinoid is a tumor formed of thyroid tissue and carcinoid elements. It represents less than 2% of all ovarian tumors and less than 5% of mature teratomas. Physicians in many lacations may not be aware about this pathology. Presentation of Case: A multiparous 78-year-old woman presented    by postmenopausal vaginal bleeding. The abdomen& pelvic sonar detected   atrophied endometrium and a right adnexal mass      with mixed echogenicity and increased blood flow, a finding that was confirmed later with a pelvic MRI which revealed a well-defined mass of abnormal signal at the right adnexa showing cystic changes contacting anteriorly the related intestinal loops and the urinary bladder, while contacting posteriorly the recto-sigmoid.  It measured8x6x6cm. Biopsy revealed atypical epithelial proliferation.  CA125 was 90KU/L (normal range,0-35KU/L) while the levels of CEA, CA19-9 and alpha feto protein were normal. After discussion with the family, exploratory hysterectomy and bilateral salpingioophorectomy, along with omentectomy, peritoneal washing and peritoneal sampling were performed. Grossly, the right ovary was    largely occupied by an ovoid mass (9cmx6cmx2 cm). The tumor was staged as IA according to AJCC 2010. Histological examination of the adnexal mass revealed admixture of benign thyroid tissue and tumor tissue formed of trabeculae & nests of monotonous round cells. Such cells showed positivity for thyroglobulin, synaptophysin, chromogranin and low positivity for ki67 and so a diagnosis of   strumal carcinoid tumor was documented. The patient was set to a close follow up. The last follow up was at August 2020 and was satisfactory. Discussion and conclusion: Strumal carcinoids are rare. Pelvic sonar and CA125 are not specific diagnostic tools. They should be considered in the differential diagnosis of any ovarian mass. The disease usually presents at an   early stage.