Abstract


BACKGROUND : Struma ovarii is a well- known but rare manifestation of cystic teratoma involving the ovarian tissue. Malignant transformation of struma ovarii has only been described in case reports. Due to the paucity of data, there are no clearly established guidelines regarding the management and outcome of this clinical entity. It is, however, usually known to have an excellent prognosis and is compatible with prolonged survival.
OBJECTIVE : To contribute to the literature a rare case of Papillary thyroid carcinoma involving a Struma ovarii. view more

BACKGROUND : Struma ovarii is a well- known but rare manifestation of cystic teratoma involving the ovarian tissue. Malignant transformation of struma ovarii has only been described in case reports. Due to the paucity of data, there are no clearly established guidelines regarding the management and outcome of this clinical entity. It is, however, usually known to have an excellent prognosis and is compatible with prolonged survival.
OBJECTIVE : To contribute to the literature a rare case of Papillary thyroid carcinoma involving a Struma ovarii.
CASE PRESENTATION: We present a 23-year-old female who was found to have papillary thyroid cancer of a struma ovarii found on histopathology of a laparoscopically resected 10 cm left dermoid cyst. The actual size of the tumor could not be quantified due to piecemeal resection of the tumor.
Due to the risks posed by the intraoperative spillage of cyst contents into the pelvic cavity, and the need to eliminate other sources of thyroglobulin for ease of follow up, she subsequently underwent a total thyroidectomy. The withdrawal pretreatment whole- body I131 scintigraphy confirmed physiologic uptake in the thyroid bed and GI tract. The preablation stimulated thyroglobulin , 4 weeks after thyroidectomy was a 8.1ng/dl (TSH value of 60 mIU/ml). She received 100 mCi of adjuvant radioactive iodine therapy and reassuringly, the post treatment whole-body scintigraphy was unremarkable as well.
She ultimately had a completion left salpingo-oophorectomy as recommended in most Gyn-oncological literature, and had no histological evidence of residual papillary thyroid cancer. Currently, she is without biochemical or structural evidence of persistent disease. We have recommended a TSH goal of between 0.1 to 0.5mIU/ml for the short term, consistent with the ATA recommendation for intermediate to high risk disease .We plan to do a stimulated thyroglobulin and total body scan in an year from the first one.
CONCLUSION : Malignant struma ovarii poses a challenge to the treating physician. We recommend this entity to be managed on individual basis but based on similar principles as recommended for primary thyroid carcinoma.

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