P-73 A case of malignant struma ovary

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Abstract Introduction Germ cell malignancies originate from primordial gonadal and infrequently extragonadal germ cells. Germ cell tumors account for approximately 15–20% of all ovarian neoplasms, of which only 2% to 3% are malignant. Teratomas make up 95% of these malignancies. Struma ovarian teratomas are tumors in which thyroid tissue accounts for more than half of the bulk. Clinical Case A 42-year-old female patient with abdominal distress was admitted to the obstetrics and gynecology outpatient clinic. An examination of the pelvis revealed a palpable mass in the region of the right adnexa. On ultrasound examination, a 4.5 cm hypoechoic cyst and a 5 cm septal anechoic cyst were detected in the right adnexal region. The dynamic contrast-enhanced abdominal MRI, observed for additional evaluation, revealed dimensions of 12*5*9 cm within the right adnexal region, specifically the right lateral region, with a cystic dominant lesion measuring 5 cm in diameter and a 5 cm solid component. The laboratory analysis revealed normal hemogram and transaminase levels. Thyroid function assays revealed TSH concentrations of 1.61 mIU/L (reference range: 0.48-4.81),ft4 concentrations of 1.26 ng/dL (reference range: 0.78-1.51), and ft3 concentrations of 3.15 ng/dL (reference range: 2.04-4.42). In addition, LH was 3.69 IU/L, FSH was 9.42 IU/L, and E2 was 20.70 ng/L. All tumor markers fell within normal limits. TAH BSO plus lymph node dissection plus omentectomy plus peritoneal lavage was performed. The histopathological examination revealed a 4 cm diameter tumor consistent with thyroid papillary carcinoma tissue in the right ovary. BRAF V600 was negative. Thyroid USG revealed two 5 mm hypoechoic nodules, and a fine needle aspiration biopsy of the thyroid revealed atypical follicular epithelium (AUS Bethesda 3). She underwent a total thyroidectomy. The histopathological analysis was consistent with multifocal thyroid papillary microcarcinoma. Conclusion Due to the presence of a tumor focus greater than 10 mm in the struma ovary, the patient was deemed high risk and adjuvant RAI therapy was planned. Close surgical margin, >10 mm PTC focus in the struma ovary, presence of aggressive histopathology, lymphovascular invasion, and presence of BRAF/RAS mutation are histopathological high-risk indicators.