Malignant Struma Ovarii Τreated With Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

Abstract

Background/Aim: Malignant struma ovarii is an extremely rare tumor entity among ovarian tumors. In the presence of ascites and peritoneal metastases, the preoperative appearance may resemble the most common epithelial ovarian carcinoma (EOC) and accordingly, the surgical therapy may be identical if a preoperative histology diagnosis is not possible. The objective of this case report is to present a patient with histopathologically confirmed malignant struma ovarii who underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS and HIPEC) with the aim of complete tumor resection.Case Report: This study reports on a patient with preoperatively proven peritoneal metastasis of an 18 cm ovarian tumor with large struma ovarii and papillary thyroid carcinoma within the struma, who was treated with CRS and HIPEC after neoadjuvant chemotherapy. Conclusion: This disease has a significantly better prognosis than EOC, however, HIPEC could provide an additional effect in examining the presence of peritoneal metastasis.Struma ovarii is a monodermal teratoma among the germ cell tumors of the ovary mainly consisting of thyroid tissue (>50% of overall tissue) (1). This disease was first described by Gottschalk in 1899 (2). Struma ovarii is a very rare tumor, which represents 1% of all ovarian tumors and 2-5% of all ovarian teratomas (3, 4).Out of these, 5% can transform into malignant tumors (5). The clinical presentation is usually non-specific and difficult to recognize and is mostly discovered incidentally according to pathological findings. Due to its rarity, the perioperative management is not uniform and not completely clarified to date. There is no case report in the literature in which HIPEC has been performed on malignant struma ovarii. Herein a patient with malignant struma ovary of papillary carcinoma histology is presented. She was treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) after preoperatively proven peritoneal metastases and ascites in our tertiary referral center.

Malignant Struma Ovarii (Papillary Carcinoma) with Hyperthyroidism: A Case Report and Literature Review

“…Some authors recommend routine thyroidectomy followed by I131 treatment, regardless of the presence of metastasis at diagnosis, to avoid local recurrence and distant metastasis. Asc et al [13] reported a case of MSO treated with cell depletion and thermal intraperitoneal chemotherapy. Favorable survival rates (95.3%, 88.7%, and 88.7% at 5, 10, and 20 years of OS, respectively) were found regardless of treatment.…”