Incidental scintigraphic detection of struma ovarii following total thyroidectomy for papillary thyroid cancer

Abstract

A postmenopausal female presented with an enlarging multinodular goiter. Microcalcifications within the largest thyroid nodule found by ultrasound prompted her to elect a total thyroidectomy. Histopathologic evaluation led to the diagnosis of confined papillary thyroid carcinoma (follicular variant). Elevated serum thyroglobulin levels were noted on postoperative laboratory workup, with the differential diagnosis of residual thyroid tissue, substernal extension of an adenomatoid multinodular goiter, and/or metastatic thyroid cancer. The patient then underwent thyrogen-stimulated I-131 ablation therapy, with postablation scans detecting a solitary focus of intensely increased radiotracer accumulation in the midline pelvis. Ultrasound of the pelvis revealed a corresponding right ovarian mass with mixed solid and cystic components. These combined findings were highly suggestive of struma ovarii. An exploratory laparotomy/bilateral salpingo-oophorectomy was performed, and pathologic examination confirmed a mature teratoma with predominant benign thyroid component consistent with struma ovarii.

Struma ovarii

“…Local symptoms can be pelvic pain or discomfort. It can also produce systemic symptoms of thyrotoxicosis [5] . This tumor is very rare and makes up only 0.3%-1% of all ovarian tumors [1] .…”

“…Only small percentage of patients has a malignant course with potential for distant metastasis [6] . The prognosis is usually excellent [5] .…”

Struma Ovarii Dokusunda Papiller Tiroid Mikrokarsinomu: Olgu Sunumu

“…SO'nun malign transformasyonu en sık tiroid papiller ve folliküler karsinom olmak üzere farklı çalışmalarda %0.5-5 oranında bildirilmiştir ve malign vakaların %5'inde metastaz görülmektedir (1)(2)(3)(4)(5). Genelde en sık başvuru şikayeti pelvik kitleye bağlı semptomlar olsa da asemptomatik bir hastada rastlantısal olarak I131 tüm vücut taramasında saptanmıştır (6…”