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].

• Cervical Lymphadenopathy

  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]

• Recurrent Abdominal Pain

  A 35-year-old married woman with no previous or family history of thyroid disease presented in 1951 with severe recurrent abdominal pain. Laparotomy was performed and both ovaries were found to be cystic. [birpublications.org]

• Peritoneal Disease

  Patient underwent total thyroidectomy followed by radioactive iodine therapy for metastatic omental and peritoneal disease. [ncbi.nlm.nih.gov]

• Liver Mass

  Liver mass came out to be cavernous hemangioma. Peritoneal fluid was negative for malignant cells. Case 2 Mrs. [jmidlifehealth.org]

• Hemianopsia

  Twenty-four hours later, patient experienced left hemiparesia, dysarthria, anosognosia and hemianopsia. A brain CT ruled out hematoma, and a second cerebral ischemic event was diagnosed. [elsevier.es]

• Dysarthria

  Twenty-four hours later, patient experienced left hemiparesia, dysarthria, anosognosia and hemianopsia. A brain CT ruled out hematoma, and a second cerebral ischemic event was diagnosed. [elsevier.es]

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.

• Multiple Pulmonary Nodules

  We report the case of a 42-year-old woman who presented with multiple pulmonary nodules. Surgical resection of 3 nodules revealed differentiated thyroid carcinoma. Thyroid and neck ultrasound was normal. [ncbi.nlm.nih.gov]

• Hemorrhagic Ascites

  Intraoperative findings were - minimal hemorrhagic ascites (30–40cc) sent for fluid cytology for malignant cells. Large multiloculated left ovarian cyst (8 cm × 8 cm), which was adherent to surrounding structures. [jmidlifehealth.org]

• Ischemic Changes

  Hemorrhage and ischemic changes were seen. Other elements were not recognized. No malignant transformation was noted. These two elements were separately present, and no mergers between them were recognized. [ncbi.nlm.nih.gov]

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]

Thyroid-type carcinomas arising in struma ovarii, especially the newly recognized entity-highly differentiated follicular carcinoma of ovarian origin-have a favorable prognosis. [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]

In November 2008, she was admitted for right transverse sinus thrombosis and multiple cerebral infarction from which she recovered completely; no etiology was found. [elsevier.es]

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]

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]

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]

Objective: To present a case of specialized ovarian teratoma and a review of the published literature on the epidemiology and the diagnostic characteristics of this tumor, emphasizing the histopathological diagnosis. [scielo.org.co]

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 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]

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]

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]

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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.