Papillary thyroid carcinoma arising in struma ovarii

Abstract

Abstract Introduction: Struma Ovarii is one type of mature teratoma in which thyroid tissue represents more than 50% of the ovarian tumor. Diagnosis is very difficult due to lack of typical symptoms. In majority of these patients, diagnosis is incidental. Patient concerns: A 65- year-old female presented to our hospital with complaints of uterine bleeding and abdominal pain. Diagnosis: Ultrasonography showed no lesions in the uterus and left ovary, while the right ovary was enlarged, comprising a dense mass of 4 cm in diameter. Computed tomography scan revealed a mass, with fatty density and absence of fluid in the Douglas space. The lymph nodes in the posterior peritoneal space showed no enlargement. Additional Magnetic Resonance Imaging confirmed the presence of the mass with clear margins, high T1 signal and T2 sequence indicating dermal cysts. Blood tumor markers were normal. However, beta-human chorionic gonadotropin levels were slightly high. Interventions: Total hysterectomy was performed along with bilateral salpingo-oophorectomy. Outcomes: The biopsy of the mass revealed features of papillary thyroid carcinoma. The lesion was found to be benign, and the patient showed no recurrence so far. Conclusion: Struma Ovarii is a rare condition, found in only 1% of all ovarian tumors; it is benign in 95% of the cases. The clinical presentation can vary in terms of symptoms and signs. Ultrasonography can reveal the differences between a benign struma ovarii and a malignant one. Complete hysterectomy and bilateral salpingo-oophorectomy are the treatment of choice. Specific guidelines for pre- and postoperative management of the patients are yet to be elucidated.