Category: Thyroid

Monitor: 11

11 - MALIGNANT STRUMA OVARII WITH A COEXISTING THYROID NODULE: A CASE REPORT

Saturday, Apr 27
11:00 AM – 11:30 AM

Objective :

Struma ovarii is a rare variant of monodermal teratoma. It is mostly benign condition, but occasionally malignant transformation is observed. Due to rarity of malignant Struma ovarii, there has been controversy about the treatment. We are presenting a rare case of malignant Struma ovarii with a coexisting thyroid nodules.



Methods :

Case presentation

A 49-year-old female who underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy for an abnormal uterine bleeding that did not respond to medical treatment. An incidental mass confined to the left ovary was found, histology revealed malignant struma ovarii with papillary thyroid carcinoma expression. Thyroid function test (TFT) was normal. Thyroid ultrasound showed multiple nodules bilaterally, largest in the right thyroid lobe measuring 3.1 cm, fine needle aspiration pathology showed benign component of the nodules. Decision was made to monitor patient with a serial of ultrasound and TFT every 6 months. Today, patient is 14 months from the diagnosis of Struma ovarii with no signs of metastases and stable size thyroid nodules.


Results : N/A


Discussion :

Struma ovarii is a rare variant of teratoma, accounts for approximately 5 percent of all ovarian teratomas. Histologic features of thyroid cancer are found in 5 to 37 percent of struma ovarii. Distant metastases were reportedly uncommon, occurring in 5 percent. Women with malignant struma ovarii confined to the ovary typically do not require radioiodine therapy after oophorectomy. In a review of a total of 57 cases of malignant struma ovarii confined to the ovary, 50 of whom did not undergo thyroidectomy-radioactive iodine therapy, the pooled recurrence rate was 7.5 percent at 25 years. There is a weak suggestion (Grade 2C) to give levothyroxine to suppress TSH in patients with low risk of recurrence. These recommendations are solely based on observations of case reports and case series. Because there is no strong recommendation on the treatment of Struma ovarii with low risk of metastases, we included our patient in the decision making and she decided to continue to monitor with TFT and ultrasound, given the low grade of the patient’s tumor and the rarity of recurrence and metastases all physicians involved in her care agreed to watchful waiting approach.


Conclusion :

Due to rarity of malignant Struma ovarii cases, there has been no strong recommendations about the treatment of a coexisting thyroid nodules. Given the benign course of a confined malignant Struma ovarii and low incidence of metastases, we believe a watchful monitor is a reasonable and less aggressive approach. A randomized trial to compare aggressive treatment with watchful waiting is suggested.

Safa Ibrahim

Medical resident
Western Reserve Health Education/ NEOMED
Katy, Texas

Internal medicine resident, PGY3 Western Reserve Health Education/ NEOMED Youngstown, OH

Geeti Sharma

resident
Western Reserve Health Education/ NEOMED

Internal medicine resident, PGY2 Western Reserve Health Education/ NEOMED Youngstown, OH

Biswaraj Tharu

Resident
western reserve health education
Youngstown, Ohio

Western Reserve Health Education- PGY1

Manivel Eswaran

Endocrinology specialist i
Trumbull Memorial Hospital, Inc

Dr. Manivel K Eswaran is an Endocrinology Specialist in Gainesville, Florida. He graduated with honors in 2002. Having more than 16 years of diverse experiences, especially in ENDOCRINOLOGY, Dr. Manivel K Eswaran affiliates with many hospitals including Steward Trumbull Memorial Hospital, Inc, St Joseph Warren Hospital, Steward Northside Medical Center, Inc, and cooperates with other doctors and specialists without joining any medical groups.

Safa Ibrahim

Medical resident
Western Reserve Health Education/ NEOMED
Katy, Texas

Internal medicine resident, PGY3 Western Reserve Health Education/ NEOMED Youngstown, OH