Ovarian strumal carcinoid presenting as severe progressive constipation

Area of Science:

• Gynecologic Oncology
• Endocrinology
• Gastroenterology

Background:

• Strumal carcinoid tumors are rare germ cell tumors with mixed thyroid and carcinoid components.
• Unlike typical carcinoid tumors, strumal carcinoids rarely cause carcinoid syndrome, but can present with gastrointestinal issues like constipation.
• The pathophysiology of constipation in strumal carcinoid tumors is not fully understood, with both mechanical and hormonal mechanisms proposed.

Purpose of the Study:

• To report a case of a 60-year-old female with severe constipation due to an ovarian strumal carcinoid tumor.
• To investigate the potential mechanism behind the constipation, differentiating between mechanical compression and hormonal effects.

Main Methods:

• Clinical presentation of a patient with severe progressive constipation and painful defecation.
• Diagnostic imaging including CT scan to identify an ovarian mass.
• Surgical removal of the ovarian tumor.
• Histopathological confirmation of strumal carcinoid tumor.
• Post-operative assessment of symptom resolution.

Main Results:

• A large, solid-cystic right adnexal mass was identified, initially suspected as a monomorphic teratoma.
• Histopathology confirmed the mass as a strumal carcinoid tumor.
• The patient's severe constipation completely resolved after surgical resection of the tumor.

Conclusions:

• Ovarian strumal carcinoid tumors can present with severe constipation, potentially mediated by the tumor's production of substances like peptide YY, which inhibit intestinal motility.
• This case suggests a hormonal mechanism for constipation in strumal carcinoid tumors, distinct from mechanical obstruction.
• Surgical management is effective in resolving constipation associated with these rare tumors.