Case presentation: A 17-year-old patient was diagnosed with papillary thyroid cancer in struma ovarii. The presence of areas of very low signal intensity on T2-weighted images, due to the viscous colloid material is sometimes considered as suggestive for the presence of struma ovarii tumor. We discuss the approaches leading to the correct diagnosis and we review the management of the disease. Despite its name, struma ovarii is not restricted to the ovary. Qian Y, Xiao Y, Zhen-Zhen L, Yu-Xin J, Jian-Chu LI, Na SU, Bo C, Bo Z Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2015 Jun;37(3):309-14. doi: 10.3881/j.issn.1000-503X.2015.03.012. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Struma ovarii: MRI findings. Struma ovarii is a rare type of mature teratoma, but its imaging features are rather distinct. 7. Obstet. There is no internal vascularity. Hatami M, Breining D, Owers RL et-al. Struma ovarii is diagnosed when thyroid tissue comprises more than 50 % of the teratoma [4, 5]. Because complete TSH suppression occurs in struma ovarii, the neoplastic thyroid tissue is assumed to be functionally autonomous to cause thyrotoxicosis. Patients may also experience expanding abdominal growth and a fluid wave consistent with ascites. Iodine-123 will be taken up by any functioning thyroid tissue, and is diagnostic of struma ovarii if seen in the adnexal region. Struma ovarii: CT findings. We identified 10 such cases in our files. They usually present a palpable abdominal mass and the tumors are unilateral and range from very small lesions up to as large as 10 cm in diameter. Struma ovarii is difficult to diagnose and physical examination often does not reveal any abnormalities. Most MSO are histologically classified as papillary thyroid carcinomas (PTC). Some of the cystic spaces may demonstrate low signal intensity on both T1- and T2-weighted images due to the thick, gelatinous colloid of the struma. The complications may include: Stress and anxiety due to fear of cancer of the ovary; Large tumor masses may get secondarily infected with bacteria or fungus; Hyperthyroidism: Presence of an overactive thyroid gland causing symptoms such as … 2000;73 (865): 87-90. Struma ovarii concurrently occurring with other ovarian epithelial tumors has been rarely reported. By definition, at least 50% of the tumor mass must be represented by thyroid tissue (3). Struma ovarii is diagnosed when thyroid tissue accounts for >50% of the teratoma. {"url":"/signup-modal-props.json?lang=us\u0026email="}, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":14478,"mcqUrl":"https://radiopaedia.org/articles/struma-ovarii-tumour/questions/1892?lang=us"}. Despite its name, struma ovarii is not restricted to the ovary. A careful examination for any thyroid microfollicles within fibrous septa or areas of solid stroma is key. RAS mutations both in the PTC … Struma ovarii is a rare cause of hyperthyroidism. and II Clinic (Professor Paavo Vara, M.D.) Cystic struma ovarii (with macrocystic change) By MD Christopher Otis and MD Liron Pantanowitz. Molecular analysis of tissues obtained from both the malignant struma ovarii and thyroid gland was performed. Struma ovarii: management and follow-up … The vast majority of struma ovarii are benign tumours; however, malignant tumours of this type are found in a small percentage of cases. Benign Struma Ovarii; Malignant Struma Ovarii; Recent clinical studies. Malignant transformation is rare, occurring in <5% of struma ovarii cases. Struma ovarii is a rare ovarian tumor comprising less than 2% of ovarian teratomas (1), with only 5% of these being malignant tumors (2). To qualify as a struma ovarii tumors more than 50% of the tumor should be composed of thyroid tissue 7. 1889;115:493–504. Struma ovarii occurs in patients with a substantially higher average age than for those with common mature teratomas. * A struma always occurs as a pelvic mass, which may be palpable on physical examination, depending upon size and location. Il peut subir les remaniements habituels du tissu thy- roïdien (adénome, thyroïdite, carci- nome) et se compliquer de thyréo- toxicose dans 5 % des cas environ. 3. While imaging features can be non-specific and overlap with other ovarian neoplasms, ultrasound and CT usually demonstrate a complex adnexal lesion with multiple cystic and solid areas, reflecting the gross pathologic appearance of the tumor 1. * Pleural effusion and … Struma ovarii is a specialized or monodermal teratoma predominantly composed of mature thyroid tissue . Cysts derived from struma ovarii may mimic a mucinous or serous cystadenoma. Abstract. The vast majority of struma ovarii are benign tumours; however, malignant tumours of this type are found in a small percentage of cases.[2]. Struma ovarii means ovarian goiter which originates from a single germ cell after the first meiotic division [1, 2] and is the most common type of mono- dermal teratoma in 3% of mature teratomas, 0.3-1% of ovarian tumour, 5-20% of mature teratoma has the component of thyroid tissue and only 2% of these cases were diagnos- ed SO. Struma ovarii (SO) is a variant of dermoid tumors which completely or mainly composed of thyroid tissues. Virchows Arch Path Arat. Scintigraphy showing increased radioiodine uptake in the pelvic mass compared to the thyroid is confirmatory. A struma ovarii (literally: goitre of the ovary) is a rare form of monodermal teratoma that contains mostly thyroid tissue, which may cause hyperthyroidism.[1]. Gynecol. CT and MR imaging of ovarian tumors with emphasis on differential diagnosis. Abdom Imaging. Sonographic and Pathologic Features of Struma Ovarii. It represents about 0.01% of overall ovarian tumours, and 5 to 10% of struma ovarii. Patients may also experience expanding abdominal growth and a fluid wave consistent with ascites. The mean age at diagnosis of MSO was 43 years old [ 6, 9 ]. Two months after the pelvic surgery, total thyroidectomy was performed, and a small nodule (0.8 cm) in the left lobe was diagnosed as a classical variant of PTC. 6. A complex cystic lesion within the right adnexal region, which measures 57 x 55 x 46 mm (volume 75 mL). The patient exhibited menstrual disorders. Malignant struma ovarii--a case report and review of the literature. Malignant struma ovarii. Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Struma Ovarii The complications of Struma Ovarii may depend on whether the tumor is benign or malignant. Struma ovarii is a rare ovarian tumor that was first described in 1899. Struma ovarii accounts for only 2 % of all mature teratomas, and less than 5 % of struma ovarii present malignant transformation [4, 6, 7]. Struma ovarii is a rare ovarian tumour that has been reported to represent 0.5%–1.0% of all ovarian tumours. 2. Yoo SC, Chang KH, Lyu MO et-al. Thyroid tissue must comprise more than 50 percent of the overall tissue to be classified as a struma ovarii. 8. The vast majority of struma ovarii tumors (90-95% 1,5) tend to be benign and therefore carry a good prognosis. Radiographics. Struma ovarii tumor is a subtype of an ovarian teratoma and is composed entirely or predominantly of thyroid tissue and containing variable-sized follicles with colloid material. Unable to process the form. It is predominantly hypoechoic with internal septa and multiple thin echogenic bands. Ascites may be present in up to a third of cases 7. Invest. A struma ovarii is a rare form of monodermal teratoma that contains mostly thyroid tissue, which may cause hyperthyroidism. Introduction: Struma ovarii accounts for 2% of mature teratomas. Introduction. Gynecol. (1-6) It is defined as an ovarian teratoma that is composed predominantly of thyroid tissue (> 50%), or forms a … Background: Malignant struma ovarii (MSO) are rare tumors that arise from ectopic thyroid tissue in the ovary, benign struma ovarii (BSO). 2008;65 (2): 104-7. The diagnosis is histologic and retrospective after pelvic surgery. 22 (6): 1305-25. Br J Radiol. Most cases of MSO are subclinical. Berghella V, Ngadiman S, Rosenberg H et-al. Obstet. A case report and review of the literature. Struma ovarii is a teratoma in which thyroid tissue is present exclusively or forms a grossly recognizable component of a more complex teratoma [ 8 ]. The gross pathologic appearance of struma ovarii differs from that of mature cystic teratomas where struma ovarii consist of amber-colored thyroid tissue, with hemorrhage, necrosis, and fibrosis. 1997;43 (1): 68-72. First described by Von Klden in 1895 and Gottschalk in 1899, struma ovarii is the most common type of monodermal teratoma, and comprises about 3.0% of all ovarian teratomas. Struma ovarii accounts for approximately 5 percent of all ovarian teratomas . It is defined by the presence of thyroid tissue comprising more than 50% of the … Jung SI, Kim YJ, Lee MW et-al. Struma Ovarii. 2008;19 (2): 135-8. Ce terme est réservé aux tératomes comportant de façon exclusive ou prédominante du tissu thyroïdien. Matsuki M, Kaji Y, Matsuo M et-al. It accounts for 0.3-1% of all ovarian tumors and ~3% of all mature cystic teratomas 1. Oncogenic activation of BRAF (35% to 69%), RAS (10%), or RET (5% to 30%) is common in PTC, and the mutations correlate with tumor subtype, patient age, and clinical behavior. First described by R Boettin in 1889 7,8. US demonstrates a complex appearance with multiple cystic and solid areas, findings that reflect the gross pathologic appearance of the tumor. The ultrasound (US) features of struma ovarii are nonspecific, but a heterogeneous, predominantly solid mass may be seen. Jung SE, Lee JM, Rha SE et-al. Struma ovarii is diagnosed when thyroid tissue comprises more than 50 % of the teratoma [4, 5]. Approximately 5-8% of cases can show symptoms or signs of thyrotoxicosis. [3], "Ovarian teratomas: tumor types and imaging characteristics", https://en.wikipedia.org/w/index.php?title=Struma_ovarii&oldid=986132365, Creative Commons Attribution-ShareAlike License, This page was last edited on 30 October 2020, at 00:14. The cystic spaces can demonstrate both high and low (from gelatinous colloid 3) signal intensity on T1 and T2 weighted images. In this study, we … There is a slightly hyperechoic focus within the lesion which demonstrates post acoustic shadowing. Invest. The tumor may present as a large abdominal mass, which can be palpable on examination depending upon size and location. Struma ovarii causes overt thyrotoxicosis only rarely, depending on the amount of follicular tissue present in the neoplasia. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. In this article, a case of cystic struma ovarii with macrocystic change is presented. It represents 2–3% of all ovarian tumours and by definition must be comprised of at least half thyroid tissue [2–4]. Park SB, Kim JK, Kim KR et-al. 4. Thyroid tissue must comprise more than 50 percent of the overall tissue to be classified as a struma ovarii. Histologic examination of tissues is a must to evaluate the extent of thyroid tissue in the teratoma, as well as for diagnostic purposes and differentiation from other types of ovarian tumors. What are the possible Complications of Struma Ovarii? Les struma ovarii malins représentent 5 à 10 % de … A 7.2-cm classical variant of PTC arising in a struma ovarii was identified in the right ovary. Struma ovarii is a monodermal germ cell tumor first de-scribed by R. Boëttlin in 1889 [1]. 5. Although the preoperative suspicion of struma ovarii does not change the surgical attitude, it can modify and alert the clinician to the appropriate perioperative care of these patients, thereby diminishing their morbimortality. Discussion Le struma ovarii est un tératome mature monotissulaire rare. Owing to malignant struma ovarii (MSO) rarity, there has been some controversy about We report a case of a 52-year-old woman with the typical signs and symptoms of hyperthyroidism, in whom the diagnosis of struma ovarii was missed. The tumor may present as a large abdominal mass, which can be palpable on examination depending upon size and location. Imaging findings of complications and unusual manifestations of ovarian teratomas. 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