Struma ovarii is a rare ovarian tumour that has been reported to represent 0. When there is struma ovarii larger than normal thyroid, the patient rarely has hyperthyroidism. The malignant struma ovarii was first described by wetteland in 1956. Concomitant struma ovarii with serous cystadenoma in a. We report a case of pure struma ovarii tumor diagnosed by cytology during laparoscopic surgery. Constantine axiotis, md n struma ovarii is a monodermal variant of ovarian teratoma. Struma ovarii is defined as ovarian goiter which comprises either entirely or predominantly thyroid tissue 50 %. We here report a case of struma ovarii, which mimicked as malignant ovarian tumour. Malignancy in struma ovarii is a rare form of ovarian germ cell tumour. Struma ovarii accompanied by mature cystic teratoma of the. Postoperative tests of thyroid antibody activity were negative. Struma ovarii is diagnosed when thyroid tissue comprises more than 50 % of the teratoma 4, 5. Struma ovarii with follicular, fetal and embryonic forms of thyroid tissue he x10 figure 2.
Up to 510% of all cases of struma ovarii are reported to be malignant. May 30, 2017 struma ovarii is a rare monodermal germ cell tumor where the ovary is comprised of at least half thyroid tissue. Struma ovarii, as a monodermal variant of ovarian teratoma, constitutes 50 %. This case is important, not only being rare, but it also highlights the importance of careful and extensive histopathological examination even in a seemingly simple cystic lesion of the ovary to avoid missing concomitant focal pathologies. Struma ovarii is defined as histologically by the presence of thyroidcharacterized like.
Thyroid tissue can be observed in 515% of dermoid tumors but to designate the tumor as struma ovarii, it must. This case is a unique contribution to the narrow body of literature on the coexistence of malignant struma ovarii and cervical thyroid carcinoma and its management. These tumors may have a malignant potential either because of its histological characteristics or its dissemination outside the ovary 2. The gross appearance was of bilateral dermoid cysts. Most cases of struma ovarii were asymptomatic, as is the present case 3. At evacuation of the uterus a laparotomy was performed and bilateral ovarian cysts were seen. Struma ovarii is a specialized or monodermal teratoma predominantly composed of mature thyroid tissue 1. Thyroidtype carcinoma of struma ovarii xuchen zhang, md, phd. This phenomenon may indicate an embryological origin. Thyroidtype carcinoma arising in struma ovarii is rare. Coexistence of malignant struma ovarii and cervical papillary. The morphological spectrum of the thyroid tissue ranges from that of normal thyroid to proliferative adenomalike lesions and thyroidtype carcinomas malignant transformation. Residual ovarian tissue was present on the left but no residual ovary was seen on the right. Preoperative diagnosis of struma ovarii is difficult as the symptoms, clinical presentation and image on ultrasound are often similar to that of ovarian carcinoma.
Struma ovarii differential diagnoses medscape reference. This website is intended for pathologists and laboratory personnel, who understand that medical information is imperfect and must be interpreted using reasonable medical judgment. It is a rare tumor which comprises 1% of all ovarian tumors and 2. A rare ovarian teratoma article introduction struma ovarii is a unique variant of the monodermal teratomas of the ovary, which is entirely composed of thyroid tissue. It is a rare tumor which comprises 14% of all benign ovarian tumors1. Struma ovarii is an uncommon condition, in which thyroid tissue is the predominant or exclusive element in an ovarian teratoma. This also includes cases of mature teratoma with less than 50 % thyroid tissue but harboring thyroidassociated malignancy. All structured data from the file and property namespaces is available under the creative commons cc0 license. Although the typical presentation is that of a pelvic mass, unusual clinical manifestations such as hyperthyroidism, ascites, and meigs syndrome have been recognised. The prognosis with patients with a malignant struma ovarii is difficult to make because of inadequate followup of the reported cases and long clinical courses. Imaging following an intravenous contrast agent is known to demonstrate marked enhancement of the thick septations and locally thickened wall seen in struma ovarii 25.
The largest reported papillary thyroid carcinoma arising. Struma ovarii is a variant of mature cystic teratoma, with predominant thyroid element. Struma ovarii is a rare entity consisting of thyroid components that are part of a teratoma or dermoid in the ovary. Thyroidtype carcinoma of struma ovarii archives of. Best treatment for benign struma is laparoscopic operation. Struma ovarii is a rare ovarian tumor defined by the presence of thyroid tissue comprising more than 50% of the overall mass. Coexistence of malignant struma ovarii and cervical. Missed initial diagnosis of malignant struma ovarii containi. A 42year old primiparous woman presented with abdominal pain and midline pelvic palpable firm mass. Struma ovarii or monodermal teratoma is a specialized ovarian neoplasm which mainly constitutes mature thyroid tissue. Struma ovarii accounts for approximately 5 percent of all ovarian teratomas 24.
A 38yrold woman with struma ovarii that was initially diagnosed as benign presented with pulmonary metastasis and coughing 17 yr later. In strumal carcinoid, the carcinoid tissue is present in the struma. The histopathological report was benign struma ovarii of the left ovary. Struma ovarii is an uncommon type of ovarian mature teratoma with a predominant thyroid component. In such cases, the tumor mimics malignant ovarian tumor. She underwent laparoscopy, and the content of the left ovarian cystic. Malignant struma ovarii with peritoneal dissemination. May 27, 2009 struma ovarii is a monodermal variant of ovarian teratoma. A case of struma ovarii diagnosed by cytology during. Struma ovarii accounts for approximately 5 percent of all ovarian teratomas.
Struma ovarii coincident with hashimotos thyroiditis. Struma ovarii so is difficult to diagnose on clinical basis or imaging and is mostly discovered incidentally, with few published cases in the literature. Struma ovarii is a teratoma of the ovaries that contains a large amount of thyroid tissue. The excised ovarian mass showed evidence of strumaderived papillary thyroid carcinoma. Malignant struma ovarii is a very rare tumor, with considerable disagreement concerning the necessary histologic features for malignancy. Struma ovarii with papillary thyroid carcinoma journal of. Struma ovarii so is a monodermal teratoma in which thyroid tissue comprises more than 50% of the tumour. The current study reports an unusual case of struma ovarii occurring in a 49 year. Struma ovarii or monodermal teratoma, is a specialized ovarian neoplasm composed entirely of mature thyroid tissue. We report a case of papillary thyroid carcinoma arising from struma ovarii. It most commonly occurs as part of a teratoma, but may occasionally be encountered with serous or mucinous cystadenomas.
Struma ovarii is defined as ovarian goiter which comprises either entirely or predominantly. Thyroid tissue may be also found in the peritoneal cavity as in benign strumosis. Papillary thyroid cancer ptc in so is a rare finding, as only 5% of so cases undergo malignant transformation. Clinical variables, tumor profiling, oncogenic and genetic analysis provided support for synchronous albeit distinct primary tumors in the ovary and cervical thyroid. Struma ovarii, as a monodermal variant of ovarian teratoma, constitutes 3% of ovarian teratomas. Malignant struma ovarii mso is a very rare, germ cell tumor of the ovary, histologically identical to differentiated thyroid cancers. Struma ovarii is an infrequent type of dermoid ovarian tumor that is usually benign and composed of at least 50% thyroid tissue.
Clear cell struma ovarii clear cell struma ovarii loughrey, m b. Files are available under licenses specified on their description page. Struma ovarii is a rare form of teratoma characterised predominantly 50% of thyroid tissue in the ovary. Struma ovarii is a monodermal variant of ovarian teratoma, which was initially described by bottlin in 1888 and, later, by pick in 1902 and 1903, who recognized that struma ovarii was composed of thyroid tissue. Jul 24, 2018 malignant struma ovarii mso is a very rare, germ cell tumor of the ovary, histologically identical to differentiated thyroid cancers. The largest reported papillary thyroid carcinoma arising in. Malignant struma ovarii in a 30year old nulliparous patient. The histologic features of ovarian strumal lesions sometimes cause diagnostic problems due to the confusion with other. Papillary thyroid cancer located in malignant struma ovarii. Thyroid tissue must comprise more than 50 percent of the overall tissue to be classified as a struma ovarii. At a glance struma ovarii usually refers to the presence of significant amount of thyroid tissue in ovarian tumors, typically monodermal teratomas.
The role of immunohistochemical examination in diagnosis of. Struma ovarii is a rare form of ovarian neoplasm in a form of mature teratoma and is composed predominantly of thyroid tissue. Imaging features of struma ovarii at 3 t are illustrated in figs. Thyroid tissue can be observed in 515% of dermoid tumors but to designate the tumor as struma ovarii, it must comprise more than 50% of the ovarian tissue. Most common thyroid malignancy to occur in struma ovarii is papillary thyroid carcinoma, followed by follicular carcinoma. The age of presentation ranges between 6 to 74 years. Histopathology of the left ovarian tumor showed variably sized thyroid follicles filled with colloid and lined by cuboidal to flattened epithelium. Thyroid tissue made follicular form with coloid in ovary he 10x 10 mandi. Papillary thyroidtype carcinoma arising from struma ovarii. The most common type is papillary carcinoma, followed by typical follicular carcinoma, and the new entity of follicular carcinomahighly differentiated follicular carcinoma of ovarian origin. Of the 27 cases reported in world literature, manifested initial dissemination to the peritoneal cavity1a 5. Struma ovarii comprises 14% of all dermoid tumors of the ovary, and very rarely presents in a malignant form, occurring in 0.
Struma ovarii is a specialized or monodermal teratoma predominantly composed of mature thyroid tissue. The first reports of this tumor were published by boettlin in 1889 and pick in 1901 1. Malignant struma ovarii generally has a favorable prognosis while the prognosis of mso with metastases. Struma ovarii low power in this hyperemic ovary multiple collapsed cysts filled by colloid and lined by a single layer of thyreocytes are observed. Most importantly, however, because of the history of struma ovarii, when the patient developed new clinical hyperthyroidism in the presence of hashimotos thyroiditis, the diagnosis of ovarian tumor was made and the ovary was. The diagnosis of a cystic struma ovarii is usually made on histopathology.
Thyroid tissue may demonstrate the same spectrum of pathological features as in the normal thyroid including benign and malignant changes. Thyroid tissue is a relatively frequent component of mature teratoma and can occur in 520 % of cases. Struma ovarii is a rare monodermal germ cell tumor where the ovary is comprised of at least half thyroid tissue. A case of papillary thyroid carcinoma in struma ovarii and. The excised ovarian mass showed evidence of strumaderived papillary. The size of the strumal component rather than the overall size of the ovarian teratoma also had some predictive value. Because of its rarity, the diagnosis and management of the tumour have not been clearly defined. Poorly differentiated thyroid carcinoma arising in struma ovarii. The most common type is papillary carcinoma, followed by typical follicular carcinoma, and the new. It may be part of a teratoma or cystadenoma and may also have a malignant character papillary thyroid carcinoma. The lungs lesions were confirmed to be follicular thyroid cancer by biopsy. A 30year old nulliparous woman presented with acute right lower quadrant pain and underwent laparoscopic right salpingooophorectomy.
Mar 08, 2019 struma ovarii is a rare ovarian tumor defined by the presence of thyroid tissue comprising more than 50% of the overall mass. We present a case of hyperthyroidism caused by thyroid tissue in a large ovarian cystic teratoma and provide detailed endocrinological, radiological, and pathological. Since its first description in the early part of the twentieth century, struma ovarii has elicited considerable interest because of its many unique features. Prognosis of benign strumosis and malignant struma ovarii without metastases is good. Pdf clinical and histopathological study of struma ovarii. Some authors have even questioned the malignant nature of the peritoneal spread, suggesting that, in the majority of cases, it. This page was last edited on 19 november 2018, at 17. Struma ovarii are a rare type of monodermal teratoma. It is a relatively rare tumor which comprises 1% of all ovarian tumors and 2. Abstract struma ovarii or monodermal teratoma is a specialized ovarian neoplasm which mainly constitutes mature thyroid tissue. Like the cervical thyroid gland, this ectopic thyroid tissue can become autonomous.