Metastatic malignant struma ovarii with coexistence of Hashimoto's thyroiditis. (21st May 2016)

• Record Type: Journal Article
• Authors: Russo, Marco; Marturano, Ilenia; Masucci, Romilda; Caruso, Melania; Fornito, Maria Concetta; Tumino, Dario; Tavarelli, Martina; Squatrito, Sebastiano; Pellegriti, Gabriella
• Is Part Of: Endocrinology, diabetes & metabolism case reports. (2016)
• Publication Date: 2016-05-21
• Subjects: Adult -- Female -- White -- Italy; Ovaries -- Thyroid -- TSH -- Thyroxine (T4) -- Triiodothyronine (T3) -- Struma ovarii -- Hashimoto's disease -- Thyroiditis -- Papillary thyroid cancer -- Ovarian cancer; Abdominal pain -- Asthenia -- Tachycardia -- Hyperthyroidism -- Abdominal cramp -- Ovarian cysts -- Lymphadenectomy -- Histopathology -- Laparoscopy -- Thyroid ultrasonography -- TSH receptor antibodies -- Thyroid antibodies -- Ultrasound scan -- MRI -- CT scan -- Hysterectomy -- Radionuclide therapy -- Resection of tumour -- Thyroidectomy -- Radioiodine -- Levothyroxine; Error in diagnosis/pitfalls and caveats -- May -- 2016; Endocrinology -- Periodicals; Diabetes -- Periodicals; Diabetes Mellitus; Endocrinology; Diabetes; Endocrinology; Case Reports; Periodicals; Periodicals; 616.4
• DOI: 10.1530/EDM-16-0030
• Languages: English
• ISSNs: 2052-0573

Abstract

Summary: Struma ovarii is a rare ovarian teratoma characterized by the presence of thyroid tissue as the major component. Malignant transformation of the thyroidal component (malignant struma ovarii) has been reported in approximately 5% of struma ovarii. The management and follow-up of this unusual disease remain controversial. We report the case of a woman with a history of autoimmune thyroiditis and a previous resection of a benign struma ovarii that underwent hystero-annexiectomy for malignant struma ovarii with multiple papillary thyroid cancer foci and peritoneal involvement. Total thyroidectomy and subsequent radioiodine treatment lead to complete disease remission after 104 months of follow-up. The diagnosis and natural progression of malignant struma ovarii are difficult to discern, and relapses can occur several years after diagnosis. A multidisciplinary approach is mandatory; after surgical excision of malignant struma, thyroidectomy in combination with 131 I therapy should be considered after risk stratification in accordance with a standard approach in differentiated thyroid cancer patients. Learning points: Malignant struma ovarii is a rare disease; diagnosis is difficult and management is not well defined. Predominant sites of metastasis are adjacent pelvic structures. Thyroidectomy and 131 I therapy should be considered after risk stratification in accordance with standard approaches in DTC patients.