Struma ovarii patients, often aged 40 to 60, more frequently present with ovarian, rather than thyroid hyperfunction complaints [1]. Ovarian symptoms include metrorrhagia, abdominal or pelvic pain or palpable abdominal mass that has no specific traits on clinical examination, making diagnosis difficult. All these signs are nonspecific and overlap with those caused by an ovarian malignancy. Abnormal liquid accumulation like ascites [2] (leading to the presence of a positive fluid wave test) and hydrothorax with ascites (leading to crackles on pulmonary auscultation and dyspnea), known as the pseudo-Meigs syndrome may also be encountered. Ascites occurs in 17 to 33% of patients [3] and may spontaneously disappear after tumor excision. Thyroid tumors may also be present [4]. Struma ovarii may be completely asymptomatic [5] and discovered on pelvic imaging studies or surgery performed for other complaints [1]. Hyperthyroidism signs are present in 5 to 8% of patients [6] [7]. Some of the women affected by the condition also have a goiter [8] due to Graves' disease [9].

• Asymptomatic

  Patient was asymptomatic at presentation. A follow-up ultrasound confirmed the presence of a 3-cm mass in the left adnexa. [ncbi.nlm.nih.gov]

  Eleven patients had neither ascites nor hyperthyroidism and were classified as asymptomatic. These patients were either completely asymptomatic or complained of pelvic pressure related to a pelvic mass. One fifth of the tumors were malignant. [annals.org]

  Thyroxin replacement therapy was initiated, and the patient became completely asymptomatic. This is the first reported case of a previously asymptomatic woman who developed a definite clinical hypothyroidism after resection of a struma ovarii tumor. [scielo.br]

  The patient reported was asymptomatic. Preoperatively, the clinical diagnosis of struma ovarii is possible in patients having hyperthyroidism, but only 8 % of patients with struma ovarii present with clinical hyperthyroidism 3. [hippokratia.gr]

• Thyroid Nodule

  Thyroidectomy was necessary in preparation for radioiodine therapy and proofed the thyroid nodules to be benign. Complete remission was achieved by single radioiodine therapy (30 months of follow-up). [ncbi.nlm.nih.gov]

  Figure 4 Right thyroid nodule ultrasound demonstrating microcalcifications. Figure 5 Left thyroid nodule ultrasound demonstrating solid, hypoechoic mass with stiffness on the elastography. [gs.amegroups.com]

  Thyroid ultrasonography was performed, showing a 1.5 cm hypoechoic nodule with ill-defined borders, located in the left thyroid lobe; fine needle aspiration (FNA) of the thyroid nodule was consistent with a benign follicular nodule. [elsevier.es]

  Ultrasonography exhibited thyroid nodule of 0.8 x 0.6 cm, hipovascularizado with normal thyroid cintigraphy and cytology negative for neoplastic cells in fine needle aspiration (FNA). [bases.bireme.br]

• Fever

  Nil fevers, nausea or vomiting. No significant medical history. [radiopaedia.org]

  The first patient, a 57-year-old woman, complained of fever and abdominal pain and distension. A computed tomography (CT) showed a solid-cystic mass in the left ovary. [elsevier.es]

  She denied fever, chills, genitourinary symptoms, or any changes in her bowel habits but mentioned palpitations, heat intolerance, a 7-Kg unintentional weight loss, insomnia, and tremor over the preceding 6 months. [hindawi.com]

  BSO - *Mui et al. [12] 1 56 L 6 x 5 x 4 (struma ovarii) coexist with 3 cm mature cystis teratoma 8,210 Abdominal distention, ascites 5,218 TAH, BSO & omentectomy (frozen section perfomed) Well, > 4 months *Guida et al. [30] 1 42 R 12 x 8.5 x 4 4,000 Fever [omicsonline.org]

  There was no history of fever, significant weight loss, jaundice, or bleeding per vaginum. There were no symptoms of hyperthyroidism. [ijpmonline.org]

• Lymphadenopathy

  A 38-year-old woman with metastatic malignant struma ovarii, including massive liver metastases and retroperitoneal lymphadenopathy, underwent ovarian resection and retroperitoneal lymph nodes excision, partial hepatectomy, and radiofrequency ablation [ncbi.nlm.nih.gov]

  On physical examination, she had no thyroid nodules, cervical lymphadenopathy, or palpable abdominal masses. Laboratory evaluation revealed normal serum TSH (1.35 mU/liter) and thyroglobulin (23.3 ng/ml) levels. [academic.oup.com]

  On examination, no pallor or supraclavicular lymphadenopathy. Abdominal examination was normal. Bimanual examination revealed 8 cm × 10 cm cystic mass felt through left and anterior fornix. [jmidlifehealth.org]

  On general physical examination, there was no pallor, icterus, lymphadenopathy, pedal edema, or features suggestive of chronic liver disease. A systemic examination revealed ascites and bilateral pleural effusion. [ijpmonline.org]

• Infertility

  This may include pelvic surgery, thyroidectomy and radioactive iodine (I-131), which must be balanced against the risks of infertility and the low rate of metastasis. [thyroidresearchjournal.biomedcentral.com]

  Etiology Risk factors Genetic predisposition BRCA1 / BRCA2 mutation HNPCC syndrome Peutz-Jeghers syndrome Hormonal imbalance and menstrual cycle Elevated number of lifetime ovulations (the contraceptive pill appears to have a protective effect) Infertility [amboss.com]

  […] the breasts, and general fatigue Side effects of chemotherapy, which may include nausea, vomiting, hair loss, decreased appetite, mouth sores, fatigue, low blood cell counts, and a higher chance of developing infections The treatment can also cause infertility [dovemed.com]

  The patient had undergone laparoscopic exploration in 1998 for a two year infertility investigation. She was gravida 0. The patient had no other notable past medical history. Clinical examination was normal, and no pelvic mass was palpable. [ijcasereportsandimages.com]

  In the case of Polycystic Ovary Syndrome (PCOS) the starvation of the ovaries causes them to become cystic, swollen and eventually unable to regulate the synthesis of their hormones leading to imbalances and infertility. [iodine.kr]

• Pelvic Mass

  The pelvic ultrasound showed a complex pelvic mass on the left adnexa of 20x12 cm in dimensions with no ascites or aggressive features. [pubs.sciepub.com]

  Struma ovarii should be included in the differential diagnosis of a pelvic mass that presents with ascites, hydrothorax, and elevated tumor markers. [ncbi.nlm.nih.gov]

  Results: There was an immediate resolution of the ascites and associated normalization of the patient's serum CA-125 level following surgical excision of the pelvic mass. [liebertpub.com]

• Palpitations

  Results: Five years after diagnosis of Graves' disease and resolution of symptoms with 1 year of antithyroid drug therapy, a 53-year-old woman had recurrence of palpitations, tremors, and weight loss. [journals.aace.com]

  Case report: A 42-year-old woman presented palpitations, anxiety, sweating, emotional lability and weight loss for several months. Physical examination revealed goitre, tachycardia and slight tremor. [endocrine-abstracts.org]

  (increased heartbeat rate) Thyrotoxicosis: It can occur when the tumor releases thyroid hormones causing associated symptoms such as fatigue, heat intolerance, change in appetite, palpitations, and mood swings Fluid in the pleural cavity and/or peritoneal [dovemed.com]

  A 41-year-old woman from Libya presented with tremor, nervousness, weight loss, heat intolerance, and palpitation. She had also complained of lower abdominal pain and delayed periods. [ijmbs.org]

  Metabolism, Volume 90, Issue 6, 1 June 2005, Pages 3771–3772, https://doi.org/10.1210/jc.2005-0147 Close Email Twitter Facebook More Navbar Search Filter Mobile Microsite Search Term Search A 54-YEAR-OLD WOMAN presented with episodes of increased sweating, palpitations [academic.oup.com]

• Tremor

  Results: Five years after diagnosis of Graves' disease and resolution of symptoms with 1 year of antithyroid drug therapy, a 53-year-old woman had recurrence of palpitations, tremors, and weight loss. [journals.aace.com]

  Physical examination revealed goitre, tachycardia and slight tremor. [endocrine-abstracts.org]

  A 41-year-old woman from Libya presented with tremor, nervousness, weight loss, heat intolerance, and palpitation. She had also complained of lower abdominal pain and delayed periods. [ijmbs.org]

  She denied fever, chills, genitourinary symptoms, or any changes in her bowel habits but mentioned palpitations, heat intolerance, a 7-Kg unintentional weight loss, insomnia, and tremor over the preceding 6 months. [hindawi.com]

  Hyperthyroidism Signs  Tachycardia (AF)  Tremor  Goiter  Warm moist skin  Proximal muscle weakness  Lid retraction or lag  Gynecomastia [slideshare.net]

• Irritability

  The patient's past medical history revealed multinodular goiter, irritable bowel syndrome and nephrolithiasis. [karger.com]

  Mild elevation of Ca 125 is very frequent due to peritoneal irritation of ascitis ( Meigs Syndrome of struma ovarii) which it is also seen in ovarian cancer but with higher Ca 125 values and more severe ascites and pleural effusion. [fortunejournals.com]

  The complications may include: Stress and anxiety due to fear of cancer of the ovary Large tumor masses may get secondarily infected with bacteria or fungus Hyperthyroidism: Presence of an overactive thyroid gland causing symptoms such as anxiety, irritability [dovemed.com]

  Hyperthyroidism Symptoms  Hyperactivity/ irritability/ dysphoria  Heat intolerance and sweating  Palpitations  Fatigue and weakness  Weight loss with increase of appetite  Diarrhoea  Polyuria  Oligomenorrhoea, loss of libido 45. [slideshare.net]

• Fine Tremor

  One patient presented to hospital with palpitations, mild fine tremors, and proptosis. Her heart rate was 110 beats per minute. No diffuse goiters were apparent on inspection, and no abnormal masses were palpable in the thyroid gland. [journals.lww.com]

• Adnexal Mass

  The authors present a case of benign struma ovarii diagnosed as a right adnexal mass during first trimester of pregnancy with an uneventful clinical course. [ncbi.nlm.nih.gov]

  SO generally occurs in women in the fifth and sixth decades of life, presenting in the majority of cases, as a unilateral adnexal mass, with clear left side predominance [3–5]. [hindawi.com]

• Pelvic Pain

  The patient was admitted with the complaint of pelvic pain and a large pelvic mass in the mid-portion of lower abdomen on gynecological examination. Pre-operative tumor markers and routine biochemistry were unremarkable. [ncbi.nlm.nih.gov]

  Ovarian symptoms include metrorrhagia, abdominal or pelvic pain or palpable abdominal mass that has no specific traits on clinical examination, making diagnosis difficult. [symptoma.com]

• Cesarean Section

  Her past medical and family history were unremarkable, with the exception of a psychotic syndrome and 3 cesarean sections. [hippokratia.gr]

  A 33-year-old female patient with no familial or personal history of thyroid disease was incidentally found to have a tumor in her left ovary during a cesarean section. Unilateral oophorectomy was therefore performed during the surgical procedure. [elsevier.es]

• Mass of Ovary

  (WC/Nephron) Epidermoid cyst Some authors consider epidermoid cyst as a monodermal teratoma. [21] Sign out Mature teratoma Mass, Right Ovary, Excision: - Mature teratoma with dermal elements and mature neural tissue. - NEGATIVE for evidence of malignancy [librepathology.org]

Struma ovarii diagnosis is aided by blood workup and imaging modalities. Aside from complete blood cell count, the cancer antigen, although non-specific, may sometimes be useful [2]. However, its presence does not necessarily signify struma ovarii is present, as it is elevated in numerous other physiological and pathological instances. Although hyperthyroidism symptoms may be absent, the serum thyroid-stimulating hormone may be low and free thyroxine and/or triiodothyronine levels may be increased. However, they are not commonly ordered if increased thyroid function signs are absent. Also, despite the fact that clinical examination usually does not describe an enlarged thyroid, serum thyroglobulin level may be increased.

In the attempt to characterize the nature of the pelvic tumor, several methods may be applied. Pelvic ultrasound is usually the first study performed and offers limited information. Triple-contrast computed tomography (CT) scan describes the cystic aspect of the pathological mass and evaluates if lymph nodes and neighboring structures are also implicated [10]. Thoracic radiography is used when lung metastasis or hydrothorax are suspected. If pleural effusion is present, a diagnostic puncture may be useful. Fluid is evaluated to rule out adenocarcinoma. The true thyroid glandular nature of the tumor is highlighted by the sodium iodide I-123 uptake of the pelvic tumor.

After excision, strumal tissue is examined in order to determine if it is malignant or benign. Malignancy is suggested by cellular hyperplasia and atypia, increased mitotic activity, and invasion of underlying structures and consists of thyroid carcinoma or stromal carcinoid [11]. However, there seems to be a thin line between malignant and benign cases concerning histology traits, therefore the end result of therapy cannot be predicted by this method [12]. However, carcinoid variant, even if present, is usually not aggressive and cured by surgical excision [11]. Metastasis can be found in the mesentery, brain, liver, bone, contralateral ovary, peritoneum or lungs.

• Ovarian Mass

  Pelvic ultrasonography showed a 9 cm left ovarian mass. The patient underwent left oophorectomy, omental biopsy, and lymph node sampling. The ovarian mass proved to be a struma ovarii with numerous microscopic foci of papillary thyroid carcinoma. [ncbi.nlm.nih.gov]

  At laparotomy, a 7 × 6 cm right ovarian mass was seen with variegated appearance and multiple solid and cystic areas with an intact surface. There was ascites with no visible peritoneal seedlings. [pmj.bmj.com]

  Conclusions: Clinically, struma ovarii can mimic ovarian malignancy, especially when presented as a complex mass with associated ascites and a high serum CA-125 level. This should be considered when evaluating ovarian masses. [liebertpub.com]

The patients had a median progression-free survival of 31 months (range 12–53, without adjuvant treatment) or 32 months (range 2–96, with adjuvant treatment). [journals.lww.com]

In selected cases of malignancy, fertility preserving treatment could be taken under consideration 8. [hippokratia.gr]

Malignant struma ovarii (MSO) is a rare malignant ovarian germ cell tumor that has been scarcely reported by thyroid surgeons focusing on treatment. There are no golden standards for its treatment. [ncbi.nlm.nih.gov]

T1 C+ (Gd): the solid portions may show enhancement 2 Treatment and prognosis Treatment is with surgical resection. The vast majority of struma ovarii tumors (90-95% 1,5) tend to be benign and therefore carry a good prognosis. [radiopaedia.org]

What is the Prognosis of Struma Ovarii? (Outcomes/Resolutions) The prognosis of Struma Ovarii depends on whether the tumor is benign or malignant. [dovemed.com]

The prognosis of patients with thyroid cancer in a struma ovarii is generally poor. In our patient, as in those who undergo ablative radioactive iodine therapy, this was not the case. [ncbi.nlm.nih.gov]

Possible etiologies include residual ovarian tissue after oophorectomy, ectopic thyroid, or metastatic thyroid cancer. [ncbi.nlm.nih.gov]

Unexpectedly, a new onset of hyperthyroidism prompted us to look for a second etiology. [eje.bioscientifica.com]

Rosenberg SA (eds): AIDS: Etiology, Diagnosis. Treatment, and Prevention. ‏ الصفحة 190 - Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. Am J Med. ‏ الصفحة 193 - Henson D, Tarone R. [books.google.com]

D27.9 - benign neoplasm of unspecified ovary ICD-10: C56 - malignant neoplasm of ovary Epidemiology Most common type of monodermal teratoma Accounts for 3% of ovarian teratomas (Pathol 2007;39:139) Usually presents in the fifth decade Pathophysiology / etiology [pathologyoutlines.com]

The report, which utilized the Surveillance, Epidemiology, and End Results (SEER) database of the National Cancer Institute, also determined that the risk of aggressive thyroid cancer in patients with malignant struma ovarii is high. [emedicine.medscape.com]

Jump to: navigation, search Struma ovarii Microchapters Home Patient Information Overview Historical Perspective Classification Pathophysiology Causes Differentiating Struma ovarii from other Diseases Epidemiology and Demographics Risk Factors Screening [wikidoc.org]

PATIENTS AND METHODS: We analyzed the Surveillance, Epidemiology, and End Results (SEER) database from 1973 to 2011 to follow-up all the cases of malignant struma ovarii in an effort of calculate the occurrence of SPTs in this cohort of patients. [ncbi.nlm.nih.gov]

Diagnostic criteria and microbial and epidemiologic associations. Am J Med. ‏ الصفحة 193 - Henson D, Tarone R. An epidemiologic study of cancer of the cervix, vagina, and vulva based on the Third National Cancer Survey in the United States. [books.google.com]

Jump to: navigation, search Struma ovarii Microchapters Home Patient Information Overview Historical Perspective Classification Pathophysiology Causes Differentiating Struma ovarii from other Diseases Epidemiology and Demographics Risk Factors Screening [wikidoc.org]

[…] coding ICD-10: D27.9 - benign neoplasm of unspecified ovary ICD-10: C56 - malignant neoplasm of ovary Epidemiology Most common type of monodermal teratoma Accounts for 3% of ovarian teratomas (Pathol 2007;39:139) Usually presents in the fifth decade Pathophysiology [pathologyoutlines.com]

The pathophysiology of hyperthyroidism in SO is still unknown. Matsuda and colleagues have reported that malignant SO can be diagnosed before operation by the evaluation of free T3, and T4, Thyroglobulin, and TSH. [wjso.biomedcentral.com]

The findings of hyperthyroidism disappeared over several weeks after surgery.9 The pathophysiology of hyperthyroidism in malignant struma ovarii is unknown. [archivesofpathology.org]

As for treatment, we think laparoscopy could be successful for struma ovarii, but the surgeon must be careful not to rupture the tumor intra-abdominally in order to prevent dissemination, which could lead to malignancy. [ncbi.nlm.nih.gov]

Treatment, and Prevention. ‏ الصفحة 190 - Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. Am J Med. ‏ الصفحة 193 - Henson D, Tarone R. [books.google.com]

It takes 20 to 40 times the amount of Iodine needed to control breast cancer and fibrocystic disease than it does to prevent goiter. [iodine.kr]

Currently, there are no known methods to prevent the development of Struma Ovarii. What is the Prognosis of Struma Ovarii? (Outcomes/Resolutions) The prognosis of Struma Ovarii depends on whether the tumor is benign or malignant. [dovemed.com]

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6. Kraemer B, Grischke E, Staebler A, et al. Laparoscopic excision of malignant struma ovarii and 1 year follow-up without further treatment. Fertil Steril. 2011;95(6):2124.e9-e12.
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8. Young R. New and unusual aspects of ovarian germ cell tumors. Am J Surg Pathol. 1993;17:1210.
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10. Jung S, Kim Y, Lee MW, et al. Struma ovarii: CT findings. Abdom Imaging. 2008;33(6):740-743.
11. Wei S, Baloch Z, LiVolsi V. Pathology of Struma Ovarii: A Report of 96 Cases. Endocr Pathol. 2015;26(4):342-348.
12. Shaco-Levy R, Peng R, Snyder M, et al. Malignant struma ovarii: a blinded study of 86 cases assessing which histologic features correlate with aggressive clinical behavior. Arch Pathol Lab Med. 2012;136(2):172-178.