Endocrinology and Metabolism

Original Article

Thyroid
Clinical Manifestations of Malignant Struma Ovarii: A Retrospective Case Series in a Tertiary Hospital in Korea: Hyun Jin Ryu, Da Eun Leem, Ji Hyun Yoo, Tae Hyuk Kim, Sun Wook Kim, Jae Hoon Chung; Endocrinol Metab. 2024;39(3):461-467. Published online May 9, 2024; DOI: https://doi.org/10.3803/EnM.2023.1863

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Background
Malignant struma ovarii (MSO) is a very rare disease in which thyroid cancer originates from the ovary. Because it is rare for endocrinologists to encounter patients with MSO, endocrinologists may have a limited understanding of the disease. Therefore, we analyzed and introduced its incidence and clinical course in a tertiary hospital in Korea.
Methods
We retrospectively investigated the clinical data of 170 patients who underwent surgery for struma ovarii at the Department of Obstetrics and Gynecology of Samsung Medical Center from 1994 to May 2023.
Results
Among 170 patients with struma ovarii, 15 (8.8%) were diagnosed with MSO. The median age of patients with MSO was 48 years (range, 30 to 74), and the median tumor size was 3.3 cm (range, 0.5 to 11.0). Papillary thyroid carcinoma (46.7%) was the most common subtypes followed by follicular thyroid carcinoma (26.7%). All patients were diagnosed after surgery, with no predictions from preoperative imaging. The surgical extent of gynecological surgery was variable. Four patients (26.7%) underwent thyroidectomy for thyroid cancer, while one underwent total thyroidectomy and radioactive iodine therapy for MSO with peritoneal metastasis. Except for one patient who underwent hemithyroidectomy, thyroid stimulating hormone suppression therapy was performed in four patients. Only 53% of MSO patients were consulted by an endocrinologist. With a median follow-up period of 33 months (range, 4 to 156), 11 patients remained disease-free, one experienced progression with peritoneal seeding, and the remaining one was in treatment. There have been no recurrences or deaths due to MSO.
Conclusion
An endocrinologist should be involved in establishing a therapeutic plan for MSO, for which the overall prognosis is generally favorable.

Citations

Citations to this article as recorded by

Diagnostic Value of Nuclear Hybrid Imaging in Malignant Struma Ovarii: A Systematic Review of Case Reports
Claudiu Peștean, Doina Piciu
Diagnostics.2024; 14(23): 2630. CrossRef
The Role of Radioiodine Therapy in Differentiated Thyroid Cancer Arising from Struma Ovarii: A Systematic Review
Pietro Bellini, Francesco Dondi, Valentina Zilioli, Elisa Gatta, Maria Cavadini, Carlo Cappelli, Gian Luca Viganò, Francesco Bertagna
Journal of Clinical Medicine.2024; 13(24): 7729. CrossRef

Case Reports

A Case of Incidental Struma Ovarii Confounded with the Metastasis of Papillary Thyroid Cancer.: Young Hee Jung, Sung Min Jung, Jong Min Lee, Yi Sun Jang, In Suk Lee, Jong Ok Kim, Hye Soo Kim; Endocrinol Metab. 2012;27(3):227-231. Published online September 19, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.3.227

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Abstract PDF: A focal radioactive iodine uptake in the pelvis of a patient with differentiated thyroid cancer needs differential diagnosis besides bone metastasis. Struma ovarii is a rare monodermal ovarian teratoma composed predominantly of mature thyroid tissue; 5-10% of these tumors are malignant. As diagnosis and surgery of thyroid cancer have increased recently, incidental cases of struma ovarii, after radioactive iodine treatment, were occasionally reported. Rare cases of ovary metastasis of thyroid cancer were also reported. We report a case of benign struma ovarii incidentally found in a patient with papillary thyroid cancer. The patient showed a sustained high level of thyroglobulin and focal radioactive iodine uptake in the right pelvis, confused with distant metastasis, after total thyroidectomy and radioactive iodine treatment.

A Case of Bilateral Struma Ovarii Combined with Subclinical Hyperthyroidism.: Sang Mi Kim, Bo Kwang Choi, Ji Hyun Kang, Mi Ra Kim, Yun Kyung Jeon, Sang Soo Kim, Bo Hyun Kim, In Ju Kim; Endocrinol Metab. 2012;27(1):72-76. Published online March 1, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.1.72

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Abstract PDF

Struma ovarii is a rare monodermal variant of ovarian teratoma accounting for only 2% of all mature teratomas. To be classified as a struma ovarii, teratoma must be composed predominantly of mature thyroid tissue (> 50%). This tumor is generally benign, although malignant transformation has been reported. Struma ovarii occur mostly as unilateral cases, so bilateral cases are quite rare (less than 6% of cases). Struma ovarii occur largely without symptoms or are accompanied by non-specific symptoms, such as abdominal pain, a palpable abdominal mass, and abdominal distension. The preoperative diagnosis is generally difficult. The incidence of hyperthyroidism has been reported to be 5-10% of patients with struma ovarii. Thus, cases of functional bilateral struma ovarii are very rare. We report a case of bilateral struma ovarii with subclinical thyrotoxicosis and a diffuse goiter, mimicking a malignant ovarian tumor, and include a brief review of related literature.

Citations

Citations to this article as recorded by

Benign Teratoma of the Thyroid Gland
Chan Young Oak, Hee Kyung Kim, Tae Mi Yoon, Sang Chul Lim, Hyun Bum Park, Hyung Chul Park, Min Gui Han, Ho-Cheol Kang
Endocrinology and Metabolism.2013; 28(2): 144. CrossRef
Metastatic follicular struma ovarii complicating pregnancy: a case report and review of the literature
Woohyung Lee, Nam-Joon Yi, Hyeyoung Kim, Youngrok Choi, Minsu Park, Geun Hong, June Young Choi, Hyun Hoon Chung, Kwang-Woong Lee, Do-Joon Park, Hye Sook Min, June-key Chung, Kyung-Suk Suh
Korean Journal of Hepato-Biliary-Pancreatic Surgery.2012; 16(3): 123. CrossRef

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