Synchronous papillary carcinoma thyroid with malignant struma ovarii: A management dilemma

Abstract

Struma ovarii (SO) is a rare form of ovarian tumor, which is defined by the presence of thyroid tissue comprising more than 50% of the overall tumor volume. The vast majority of the variants of SO are benign; however, malignant tumors have been reported in a small percentage of cases. An aggressive multimodality approach using ovarian cancer staging laparotomy, total thyroidectomy along with radioactive iodine-131 ablation, and thyroxin suppression therapy has been shown to safely treat malignant SO both its initial presentation as well as in the event of any subsequent recurrence with excellent efficacy and possibly better oncological outcomes. The rarity of the disease and the lack of evidence surrounding its management and prognosis continue to remain a challenge to the treating clinician. We present a unique case of malignant SO with an incidental synchronous association of follicular variant of papillary carcinoma of the cervical thyroid gland, this is possibly the second case reported in the English language literature.

Struma ovarii accompanied by mature cystic teratoma of the other ovary: A case report and literature review

“…In cases where the thyroid component of the tumor accounts for >50% of all tumor tissue, or <50% but with symptoms of hyperthyroidism, this may be diagnosed as SO (2). SO is a rare condition, accounting for 0.3% of ovarian tumors and 2.7% of ovarian teratomas; 5-10% of tumors become malignant (3).…”

Papillary carcinoma of the thyroid in a mature cystic teratoma of the ovary: a case report

“…Diagnosis of struma ovarii prior to surgery is not always possible, so the final diagnosis depends on pathological examination. Diagnosis is feasible if the thyroid component of the tumor consists >50% of all tumor tissue, or <50% but with symptoms of hyperthyroidism (1).…”

“…This is the most common form of monodermal teratoma. Struma ovarii is diagnosed if the thyroid component of the tumor consists >50% of all tumor tissue, or <50% but with symptoms of hyperthyroidism (1). Teratomas have a wide range of age distribution, with approximately 50% occurring in women between 20 and 40 years of age and at least half of these patients are asymptomatic at the time of diagnosis (2).…”

Malignant Struma Ovarii Requiring Emergency Surgery for Acute Abdomen: A Case Report and Literature Review

“…In particular, only a few reports have addressed the treatment policy that must be adopted to preserve fertility while reducing the risk of recurrence in patients with this tumor. Given this paucity of data, the impact of malignant struma ovarii on life expectancy remains controversial, and its optimal management is currently debated [1][2][3][4]. Most authors advocate for aggressive treatment involving local surgery followed by total thyroidectomy, radioactive iodine ablation, and thyroid hormone-suppressive therapy regardless of the presence of distant metastases at the time of diagnosis [5][6][7][8][9].…”