Endocrine Abstracts

Introduction: Malignant struma ovari is a rare ovarian mature teratoma. The diagnosis can be done histopathologically. There are no specific diagnostic findings in terms of imaging, clinical and laboratory. We present two cases of malignant struma ovarii in papillary follicular variant subtypes in this report.

Case report: Case 1; The patient was a 44 year old female, she had complaints of pelvic pain and a palpable lower abdominal mass. Pelvic MRI examination showed a semisolid mass of 90×80×103 mm in the left ovarian region. Tumor markers and thyroid tests were normal. Laparotomy was performed. Left salpingo-oopherectomy material was sent for frozen section and was reported to be malignant. Right salpingo-oopherectomy and total abdominal hysterectomy were performed. Histopathology results showed as follicular variant papillary thyroid carcinoma. There was minimal invasion in the tumor capsule. Thyroid ultrasonography examination showed a hypoechoic nodule without blood supply with measuring 3.5×3×3.5 mm. Total thyroidectomy followed by radioactive iodine treatment was offered for the patient. However the treatment could not be continued because the patient was out of follow-up.

Case 2; A 37 year old female, she had complaints of pelvic pain in the left lower quadrant and distention. Pelvic MRI examination showed two masses of 91×60×73 mm and 34×35×40 mm in the left ovarian region. Left salpingo-oopherectomy were performed. Histopathologic examination showed follicular variant papillary thyroid carcinoma in the struma ovari. Right salpingo-oopherectomy and total abdominal hysterectomy were performed. Thyroid ultrasonography examination and thyroid tests were normal. Total thyroidectomy followed by radioactive iodine treatment was offered for the patient. The patient was referred to general surgery for thyroidectomy.

Conclusions: Due to the rarity of malignant struma ovari and the lack of adequate case series, diagnosis and treatment are unclear. Bilateral salpingo-oopherectomy, total abdominal hysterectomy and I 131 ablation after thyroidectomy reduce the risk of recurrence and facilitate patient follow up with thyroglobulin.

Keywords: Malignant Struma Ovari, pelvic pain, thyroidectomy