Introduction: Struma ovarii is a rare form of ovarian teratoma mostly composed of thyroid tissue. In about 5% of the cases, well-differentiated thyroid carcinoma may arise in struma ovarii. As this medical entity is so exceptional, there is still no consensus on diagnosis and treatment.
Case Reports: A 52-year-old old woman was submitted in 2009 to total hysterectomy with bilateral adnexectomy and pelvic lymphadenectomy. Histopathology revealed papillary thyroid carcinoma with 2.5 cm arising in struma ovarii, with no lymph node metastasis. It was decided not to perform thyroidectomy and the patient was kept under surveillance. Nine years after the surgery, there is no evidence of imaging relapse, with thyroglobulin levels of 22.71 ng/ml (<77 ng/ml). A 53-year-old woman underwent total hysterectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy in 2010. The histopathology result showed a 7 cm papillary carcinoma arising in struma ovarii. The patient was subsequently treated with total thyroidectomy and radioactive iodine. Eight years after, she remains disease free with undetectable serum thyroglobulin levels.
Discussion: Both our cases of thyroid carcinoma in struma ovarii showed favourable outcomes, as usually described. Performing total thyroidectomy and therapy with radioactive iodine should be considered, bearing in mind the initial risk and the clinical, analytical and imaging follow-up data. Long-term follow up is recommended, as late recurrences are known to occur.
18 - 21 May 2019
European Society of Endocrinology