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Knowledge Area 14: Gynaecological Oncology
Published in Rekha Wuntakal, Ziena Abdullah, Tony Hollingworth, Get Through MRCOG Part 1, 2020
Rekha Wuntakal, Ziena Abdullah, Tony Hollingworth
Struma ovarii is a histological diagnosis. In 5%–20% of the dermoid cyst, thyroid tissue may be present. However, struma ovarii is set aside when the cyst contains predominantly thyroid tissue. It can occur in pure form or as a mixture of mature cystic teratoma and thyroid tissue. Struma ovarii accounts for 2.7% of all ovarian teratomas and 0.5% of all malignant ovarian tumours (malignancy is present in 5%–10% of cases). Usually they are confined to the ovary. Mostly patients are asymptomatic and present only with pelvic mass (usually the mass is unilateral), but in 5% of the cases they can present with clinical hyperthyroidism.
Rare forms of hyperthyroidism *
Published in David S. Cooper, Jennifer A. Sipos, Medical Management of Thyroid Disease, 2018
Nicole O. Vietor, Henry B. Burch
Struma ovarii is a rare form of an ovarian teratoma. Teratomas are tumors composed of epithelial tissue and have been reported to contain elements of bone, teeth, hair, skin, or thyroid. Struma ovarii is defined as an ovarian teratoma composed of >50% thyroid tissue and represents an extremely rare form of hyperthyroidism, as only 5–10% of struma ovarii patients present with thyrotoxicosis (24, 25). More commonly, patients present with pelvic pain, abnormal uterine bleeding, and abdominal or pelvic masses (25, 26). Only about 200 cases of struma ovarii have been reported in the literature, and these lesions represent <1% of all ovarian neoplasms (24, 27). The diagnosis is often made postoperatively due to the low frequency of clinical thyrotoxicosis at initial presentation. However, struma ovarii should be considered in any thyrotoxic patient with a very low or absent radioactive iodine uptake in the thyroid gland. The differential diagnosis in this situation includes thyroiditis, factitious thyrotoxicosis, and iodine-induced hyperthyroidism. Struma ovarii can be differentiated from these conditions with the detection of a pelvic mass that concentrates radioactive iodine.
Test Paper 5
Published in Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike, Get Through, 2017
Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike
Struma ovarii is a rare ovarian lesion that accounts for 2% of ovarian teratomas. Struma ovarii is a highly specialised form of ovarian teratoma and is composed entirely or predominantly of thyroid tissue. About 5% of patients develop clinical evidence of hyperthyroidism. At US, struma ovarii has a non-specific solid, cystic appearance. MRI demonstrates a loculated cystic mass with variable signal characteristics. Cystic spaces may show marked T2 hypointensity and intermediate T1 signal intensity due to the thick, gelatinous colloid of the struma. Some locules may contain microscopic fat, as indicated by signal drop-off and chemical shift artefact on opposed-phase T1-weighted MRI. Struma ovarii typically demonstrates strong enhancement of the solid components on post-contrast T1-weighted MRI. Struma ovarii are benign in 95% of cases and usually occur in premenopausal women; therefore, preoperative diagnosis is essential to avoid unnecessary radical surgery.
Transplantation of cryopreserved ovarian tissue in a patient affected by metastatic struma ovarii and endometriosis
Published in Gynecological Endocrinology, 2018
Raffaella Fabbri, Rossella Vicenti, Roberto Paradisi, Stefania Rossi, Lucia De Meis, Renato Seracchioli, Maria Macciocca
Fertility preservation should be considered also for patient suffering from struma ovarii given its occurrence in a reproductive organ and often in a younger population. Struma ovarii is a monodermal germ cell tumor. It represents 2–3% of all ovarian tumors and by definition must be comprised of at least half thyroid tissue. Struma ovarii is rare and accounts for only 2% of all mature teratomas. Malignant struma ovarii is rarer still with malignancy occurring in fewer than 5% of all struma. The most frequent sites of metastasis are liver, peritoneum and close pelvic structures and occasionally distant organs such as bone, brain and lungs. Metastasis rates range from 7.5 to 35% and survival rates are 85–94.3% at 10 years. While the most comprehensive treatment for malignant struma ovarii would be abdominal hysterectomy and bilateral salpingo-oophorectomy with omentectomy, some have cautioned against overtreatment given the significant implication of permanent infertility [4].
Complete response of recurrent malignant struma ovarii followed by 131I therapy
Published in Journal of Obstetrics and Gynaecology, 2021
Junhua Tang, Pan Hao, Wei Zhu, Jun Hu, Hongwu Wen
Struma ovarii (SO) is a rare monodermal germ-cell tumour defined by the presence of more than 50% thyroid tissue. SO accounts for 2%–3% of all ovarian tumours, of which malignancy occurs in 5%–10% of cases (Goffredo et al. 2015; Boyd et al. 2017). Malignant struma ovarii (MSO) shows long-term recurrence and favourable prognosis (Boyd et al. 2017). To-date, studies on the treatment of recurrent MSO have been sparse. Herein, we report a case of MSO that developed a recurrence after 21 years of staging surgery and P-32 intra-abdominal radiotherapy. Surprisingly, the tumour size remained unchanged during the ten years after relapse without treatment. Subsequently a complete response was achieved after total thyroidectomy followed by 131I therapy.
Hyperthyroidism associated with struma ovarii – a case report and review of literature
Published in Gynecological Endocrinology, 2021
Agnieszka Podfigurna, Anna Szeliga, Paulina Horwat, Marzena Maciejewska-Jeske, Blazej Meczekalski
The first documented observations of thyroid tissue found in the ovary was published in 1889 [1]. Struma ovarii (SO) is diagnosed when an ovarian teratoma consists in majority of thyroid tissue [2]. It is a very rare condition, forming 0.3%–1% of all the ovarian tumors [3]. Frequently, patients are asymptomatic at presentation and diagnosis is established while investigating other symptoms of hyperthyroidism, such as thyrotoxicosis [3]. Determining the underlying cause of hyperthyroidism in the context of an occult SO can become particularly challenging [1]. Most patients diagnosed with SO are between their fourth and sixth decade of life. The mean age at diagnosis is 45.9, with ages reported in the literature ranging from 26 to 78 years [3].