Endocrine Abstracts

Background: Papillary thyroid carcinoma (PTC) arising within an ovarian teratoma is an extremely rare condition that comes with certain difficulties in the preoperative diagnosis and postoperative treatment strategy. It is either asymptomatic (detected incidentally) or with nonspecific symptoms. Currently, no consensus exists on the surgical and postoperative treatment of patients with malignant struma ovarii.

Case presentation: A 26-year-old female presented with dizziness, reoccurring epistaxis and a palpable mass on her right breast, diagnosed by mammography as fibroadenoma. Preoperative pelvic ultrasonography revealed a presence of a 9 cm right ovarian tumor and free fluid filling the pouch of Douglas. She had elevated Ca19-9 levels of 88 IU/ml and normal Ca-125 levels (25.7 IU/ml). The patient underwent a laparoscopic ovarian cystectomy along with fibroadenomectomy. Pathohistological evaluation of the operative material declared as a dermoid cyst confirmed a diagnosis of PTC measuring 2.4 cm in the ovarian teratoma. She was admitted to the Institute of Pathophisiology and Nuclear Medicine for further investigation and management. Her thyroid examinations showed euthyroid condition with normal thyroid and neck morphology on ultrasound and normal thyroglobulin (Tg) levels. The PET – CT scan showed no sites of metastatic spread. The patient was informed about the treatment approaches and was given suppressive doses of Levothyroxine (TSH 0.004 mIU/l were achieved with 150 μg/day) until her final decision.

Conclusions: The management of malignant struma ovarii is based on rare case-report studies. The therapy ranges from radical surgery and radio-chemotherapy, thyroidectomy, radioiodine ablation and levothyroxine TSH suppression, to conservative surgery in younger patients with fertility preservation. Early diagnosis based on modern imaging techniques impacts the clinical decision and management, which produces a better outcome regarding the future prognosis.