Management of malignant struma ovarii: is aggressive therapy justified? Case report and literature review

Abstract

Background Struma ovarii (SO) is a rare ovarian teratoma containing predominantly thyroid tissue. In rare situations SO may develop malignancy. Most cases of malignant struma ovarii (MSO) are diagnosed after surgical removal, based on histopathological examination. There are still controversies regarding the extent of surgery and postoperative management in MSO, due to its unpredictable behavior, possible risk of metastasis and relatively high rate of recurrence. Case Presentation We present the case of a patient diagnosed with a right ovarian cyst discovered incidentally during routine ultrasound examination. Its rapid growth and pelvic MRI raised the suspicion of a neoplastic process. She underwent total hysterectomy and bilateral adnexectomy. The anatomopathological diagnosis was MSO with follicular variant of papillary thyroid carcinoma. Prophylactic total thyroidectomy was performed, followed by radioactive iodine ablation (RAI), and suppressive therapy with levothyroxine. At 1 year follow-up, the patient was disease free. Conclusions Even if latest literature reports consider that completion of local surgery with total thyroidectomy and RAI might be too aggressive in cases of MSO without extraovarian extension, in our case it was decided to follow the protocol for primary thyroid carcinoma, in order to reduce the recurrence risk.

A case report of malignant struma ovarii with papillary thyroid carcinoma

“…Therefore, any detectable thyroglobulin in serum indicates the need for further assessment for recurrence. 27,28 In our case, thyroglobulin (Tg) and anti-thyroglobulin (anti-Tg) were measured, and the results were normal. There was no sign of recurrence after 3 years.…”

“…The measurement of thyroglobulin and Tg antibodies, coupled with pelvic and thyroid imaging, can serve as biomarkers for detecting metastasis and relapse. Therefore, any detectable thyroglobulin in serum indicates the need for further assessment for recurrence 27,28 . In our case, thyroglobulin (Tg) and anti‐thyroglobulin (anti‐Tg) were measured, and the results were normal.…”

Struma Ovarii com Síndrome Pseudo-Meigs e Aumento dos Níveis de CA-125: Relato de Caso

“…Por outro lado, o CA-125 é um marcador tumoral importante na investigação, no diagnóstico, no tratamento e no prognóstico do carcinoma do ovário. Entretanto, em razão da sua baixa especificidade, é possível que apresente elevações excepcionais em casos de struma ovarii como atestam relatos escassos na literatura médica 6,9 .…”

“…Pode ainda mimetizar tumores ovarianos do cordão sexual, adotando arranjo pseudotubular similar à do tumor de células de Sertoli 2 , ou configuração de pequenos folículos remetendo ao tumor de células da granulosa. Nesse contexto, reconhecer formas típicas de struma ovarii ou utilizar marcadores imuno-histoquímicos para tireoglobulina ou fator de transcrição da tireoide 1 (TTF-1) pode contribuir para o diagnóstico diferencial 5,9 .…”

“…A ascite ocorre em um terço dos casos e ocasionalmente cursa com síndrome de pseudo-Meigs -presença de ascite e hidrotórax, porém não está relacionada ao fibroma ou tecoma ovariano 1,5,6 , com desaparecimento dos sintomas logo após remoção cirúrgica 7 . A maior parte dos struma ovarii é funcionalmente inativa e a incidência de hipertireoidismo secundário é rara, representando cerca de 5% a 8% dos casos 8,9 . Ao exame físico, pode apresentar--se como massa palpável, dependendo do seu tamanho e localização 1 .…”