Journal of South Asian Federation of Obstetrics and Gynaecology

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VOLUME 16 , ISSUE S1 ( April, 2024 ) > List of Articles

CASE REPORT

Malignant Struma Ovarii—Management and Follow-up of a Rare Ovarian Tumor: A Case Report

Shikha S Thakur, Shaheen Anjum, Shagufta Qadri

Keywords : Case report, Dermoid cyst, Mature cystic teratoma, Patient care technician, Struma ovarii

Citation Information :

DOI: 10.5005/jp-journals-10006-2385

License: CC BY-NC 4.0

Published Online: 06-03-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Mature cystic ovarian teratomas (MCT) are the commonest germ cell tumors accounting for about 30–45% of all ovarian neoplasms and 60% of all benign neoplasms arising in the ovary. Only 2% of MCTs undergo malignant transformation. We report a rare case of a 48-year-old woman diagnosed with a primary malignant struma ovarii arising in a dermoid cyst of the ovary. The patient was admitted with the complaint of pelvic pain and a pelvic mass in the lower abdomen on gynecological examination and ultrasonography showed a dermoid cyst of the ovary. Preoperative tumor markers and routine biochemistry were unremarkable. A laparoscopic left-sided salpingo-oophorectomy was done. Histopathology of the tissue showed a malignant struma ovarii and immunohistochemistry (CK-19 levels) similar to the guidelines for primary thyroid gland disease. The patient was subsequently taken up for staging laparotomy with total abdominal hysterectomy with right salpingo-oophorectomy and retroperitoneal pelvic and para-aortic lymphadenectomy and omentectomy. The histopathological report of all staging tissues was normal and surgical staging IA was assigned. Thyroglobulin level was monitored in the postoperative period. She is free of the disease for the last 2 years.


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  1. Berek JS, Hacker NF. Practical gynecologic oncology, 3rd edition. Philadelphia: Lippincott Williams & Wilkins; 2003. pp. 3–38.
  2. Caruso PA, Marsh MR, Minkowitz S, et al. An intense clinicopathologic study of 305 teratomas of the ovary. Cancer 1971;27(2):343–348. DOI: 10.1002/1097-0142(197102)27:2<343::aid-cncr2820270215>3.0.co;2-b.
  3. Hackethal A, Brueggmann D, Bohlmann MK, et al. Squamous cell carcinoma in mature cystic teratoma of the ovary: Systematic review and analysis of published data. Lancet Oncol 2009;10(5):446. DOI: https://doi.org/10.1016/S1470-2045(08)70306-1.
  4. Koonings PP, Campbell K, Mishell DR, et al. Relative frequency of primary ovarian neoplasms: A 10-year review. Obstet Gynecol 1989;74 (6):921–926. PMID: 2685680.
  5. Whitecar MP, Turner S, Higby MK. Adnexal masses in pregnancy: A review of 130 cases undergoing surgical management. Am J Obstet Gynecol 1999;181(1):19–24. DOI: 10.1016/s0002-9378(99)70429-1.
  6. Blackwell WJ, Dockerty MB, Mason JC, et al. Dermoid cysts of the ovary: Their clinical and pathological significance. Am J Obstet Gynecol 1946;51:151–172. DOI: 10.1016/s0002-9378(16)39889-1.
  7. Talerman A. Germ cell tumors of the ovary. In: Kurman RJ (Ed). Blaustein's Pathology of the Female Genital Tract. 4th edition. New York: Springer-Verlag; 1994. pp. 849–914.
  8. Matz MH. Benign cystic teratomas of the ovary. Obstet Gynecol Surv 1961;16:591–605.
  9. Serov SF, Scully RE, Sobin LH. Histological typing of ovarian tumors. International Histological Classification of Tumors. No. 9. Geneva: World Health Organization; 1973.
  10. Kabukcuoglu F, Baksu A, Yilmaz B, et al. Malignant struma ovarii. Pathol Oncol Res 2002;8:145–147.
  11. Rosenblum NG, LiVolsi VA, Edmonds PR, et al. Malignant struma ovarii. Gynecol Oncol 1989;32 (2):224–227. DOI: 10.1016/s0090-8258(89) 80037-x.
  12. Volpi E, Ferrero A, Nasi PG, et al. Malignant struma ovarii: A case report of laparoscopic management. Gynecol Oncol 2003;90(1):191–194. DOI: 10.1016/s0090-8258(03)00142-2.
  13. Yoo SC, Chang KH, Lyu MO, et al. Clinical characteristics of struma ovarii. J Gynecol Oncol 2008;19(2):135–138. DOI: 10.3802/jgo.2008.19.2.135.
  14. Marti JL, Clark VE, Harper H, et al. Optimal surgical management of well-differentiated thyroid cancer arising in struma ovarii: A series of 4 patients and a review of 53 reported cases. Thyroid 2012; 22(4):400–406. DOI: 10.1089/thy.2011.0162.
  15. Peterson WF, Prevost EC, Edmunds FT, et al. Benign cystic teratomas of the ovary: A clinico-statistical study of 1007 cases with a review of the literature. Am J Obstet Gynecol 1955;70(2):368–382. DOI: 10.1016/s0002-9378(16)37681-5.
  16. Talerman A. Germ cell tumors of the ovary. In: Kurman RJ (Ed). Blaustein's Pathology of the Female Genital Tract, 3rd edition. New York: Springer Verlag; 2001. pp. 967–1033.
  17. Yamashita Y, Hatanaka Y, Takahashi M, et al. Struma ovarii: MR appearances. Abdom Imaging 1997;22(1):100–102. DOI: 10.1007/s002619900150.
  18. Ayhan A, Yanik F, Tuncer R, et al. Struma ovarii. Int J Gynaecol Obstet 1993;42:143–146. DOI: https://doi.org/10.1016/0020-7292(93) 90628-A.
  19. Hatanaka Y, Yamashita Y, Torashima M, et al. MR appearance of fat distribution in ovarian teratoma: Pathologic correlation. Nippon Igaku Hoshasen Gakkai Zasshi 1996;56(7):477–481. PMID: 8692663.
  20. Kawakami S, Togashi K, Egawa H. Solid mature teratoma of the ovary: Appearances at MR imaging. Comput Med Imaging Graph 1994;18(3):203–207. DOI: 10.1016/0895-6111(94)90030-2.
  21. Rim SY, Kim SM, Choi HS. Struma ovarii showing clinical characteristics of ovarian malignancy. Int J Gynaecol Cancer 2005;15(6):1156–1159. DOI: 10.1111/j.1525-1438.2005.00328.x.
  22. Comerci Jr, Licciardi F, Bergh PA, et al. Mature cystic teratoma: A clinicopathologic evaluation of 517 cases and review of the literature. Obstet Gynecol 1994;84(1):22–28. PMID: 8008317.
  23. Dardik RB, Dardik M, Westra W, et al. Malignant struma ovarii; Two case reports and review of the literature. Gynecol Oncol 1999;73(3): 447–451. DOI: 10.1006/gyno.1999.5355.
  24. Chan SW, Farrell KE. Metastatic thyroid carcinoma in the presence of struma ovarii. Med J Aust 2001;175(7):373–374. DOI: 10.5694/j.1326-5377.2001.tb143623.x.
  25. Devaney K, Snyder R, Norris HJ, et al. Proliferative and histologically malignant struma ovarii: A clinicopathologic study of 54 cases. Int J Gynecol Pathol 1993;12(4):333–343. DOI: 10.1097/00004347-199310000-00008.
  26. Makani S, Kim W, Gaba AR. Struma ovarii with a focus of papillary thyroid cancer: A case report and review of the literature. Gynecol Oncol 2004;94(3):835–839. DOI: 10.1016/j.ygyno.2004.06.003.
  27. DeSimone CP, Lele SM, Modesitt SC. Malignant struma ovarii: A case report and analysis of cases reported in the literature with focus on survival and I131 therapy. Gynecol Oncol 2003;89(3):543–548. DOI: 10.1016/s0090-8258(03)00141-0.
  28. Yücesoy G, Cakiroglu Y, Muezzinoglu B, et al. Malignant struma ovarii: A case report. J Korean Med Sci 2010;25(2):327–329. DOI: https://doi.org/10.3346/jkms.2010.25.2.327.
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