Elsevier

Endocrine Practice

Volume 15, Issue 2, March 2009, Pages 167-173
Endocrine Practice

Review Article
Metastatic Struma Ovarii Treated With Total Thyroidectomy and Radioiodine Ablation

https://doi.org/10.4158/EP.15.2.167Get rights and content

ABSTRACT

Objective

To present a rare case of metastatic struma ovarii, review the related literature, and discuss the management.

Methods

A case report of a patient with metastatic struma ovarii is presented. The treatment plan, postoperative care, and follow-up are discussed. We conducted a MEDLINE search of the English-language literature seeking additional cases of metastatic struma ovarii. In addition to the current case, the previous 40 cases of metastatic struma ovarii were reviewed and analyzed.

Results

The mean age of the patients at presentation was 43 years. All patients underwent resection of the primary tumor. The most common sites of involvement for struma ovarii metastatic disease have been the peritoneum, mesentery, and omentum. After primary tumor resection, a wide range of additional treatments have been used, including chemotherapy, resection of metastatic disease, external beam radiation therapy, and radioiodine ablation.

Conclusion

In cases of metastatic struma ovarii, we recommend total thyroidectomy in conjunction with radioiodine scanning and radioiodine ablation. Thyroglobulin levels should be followed as a tumor marker, and diagnostic radioiodine scans should be performed to screen for residual or recurrent disease. Although this treatment strategy is well established for thyroid cancer, long-term outcomes of this treatment for struma ovarii are still unknown. (Endocr Pract. 2009;15:167-173)

Section snippets

INTRODUCTION

Struma ovarii is a highly specialized ovarian teratoma composed predominantly or entirely of biologically active thyroid tissue. The thyroid tissue of the struma ovarii exhibits the same histologic, physiologic, and pharmacologic properties as cervical thyroid tissue (1). Approximately 5% of cases of struma ovarii are estimated to be malignant. Metastatic disease has been reported but is extremely rare. Because of the rarity of metastatic disease, treatment strategies have not been rigorously

CASE PRESENTATION

A 43-year-old woman with a history of a resected struma ovarii tumor presented with a pathologic left hip fracture after a 9-year disease-free interval. She underwent left hemiarthroplasty and bone biopsy. The pathology examination of the fracture site biopsy revealed metastatic adenocarcinoma, consistent with a primary thyroid lesion. The immunostain was positive for thyroglobulin. The slides from her prior salpingo-oophorectomy were obtained and demonstrated a struma ovarii tumor with

LITERATURE REVIEW

A MEDLINE literature search of the English language was performed, with use of the following terms: “malignant struma ovarii,” “struma ovarii,” and “malignant ovarian teratoma.” We identified 337 related articles, all of which were reviewed for relevance. The references were examined to identify additional relevant articles, including those that preceded the MEDLINE database. All cases of metastatic struma ovarii were collected.

In 1889, an ovarian tumor with follicular thyroid tissue was first

DISCUSSION

Struma ovarii tumor is a monodermal and highly specialized ovarian teratoma (36). Teratomas are neoplasms containing tissue that is foreign to the anatomic site in which they occur and are composed of 1 or more of the 3 embryonic germ layers. Struma ovarii is a teratoma in which more than 50% of the mass is composed of thyroid tissue. Only 3% of ovarian teratomas contain sufficient thyroid tissue to classify them as struma ovarii (37). Most cases of struma ovarii are benign. Literature reports

CONCLUSION

Struma ovarii is a rare ovarian tumor containing biologically active thyroid tissue. Review of the English-language literature revealed 40 reported cases of metastatic struma ovarii since the first reported case in 1910. Struma ovarii should be treated with appropriate primary tumor clearance. The National Comprehensive Cancer Network (38) guidelines on ovarian tumors recommend that patients with ovarian germ cell tumors undergo surgical resection and comprehensive staging. Unilateral

DISCLOSURE

The authors have no conflicts of interest to disclose.

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