Struma ovarii belongs to the group of monodermic
and highly specific teratomas. It comprises less than 5% of mature
teratomas (4,5). Our study covers one patient with the diagnosis
of struma ovarii. simple oophorectomy were preformed. Histopathological
examination confirmed struma ovarii, with follicular, fetal and
embryonic forms of thyroid tissue, without metastases and malignancy.
Struma ovarii is an uncommon type of teratomas, difficult to identify
without histopathological examination.
* The most frequently symptom is abdominal pain (50 %) though
a high percentage (40 %) of patients were asymptomatic (1).
* A struma always occurs as a pelvic mass, which may be palpable
on physical examination, depending upon size and location.
* Pleural effusion and ascites are sometimes present.
* Only 8% of patients with strumas present with clinical hyperthyroidism.
30 % of patients have associated and significant thyroid function
Struma ovarii could be hormonally active and manifest clinical
symptoms of thyroid hyperactivity or thyrotoxicosis. Postoperative
complications in hormonal active struma ovarii were reported as
well. Struma ovarii may be associated with ascites and pleural
effusion, known as "pseudo - Meigs syndrome" (6). In the majority
of reported cases tumor excision led to complete remission. Malignant
changes in struma ovarii are uncommon.
Preoperative diagnosis is very difficult because ultrasonography
(and computer tomography, and nuclear magnet resonance) is not
specific enough. With this technique we can only see adnexal mass
consisting of solid and cystic parts. Ultrasound show a multicystic
mass with a well-vascularized solid part (2). Only preoperative
scintigraphy with iodine ( 131 I) could show active thyroid tissue
in small pelvis.
However 75 % of cystic teratomas are avascular, if the solid components
of an apparent benign cystic teratoma have vascular flow, a struma
ovarii consisting largely of thyroid tissue should be considered.
Dermoid cysts of the ovary are devoid of blood flow, with flow
detection rate being only 25% from the cyst capsule. When apparently
vascularized solid tissue is detected in the central part of a
sonographically suspected benign cystic teratoma, struma ovary
is highly suspected (3).
* Haemorrhagic ovarian cyst.
* Other Solid teratoma and dermoid cysts.
* Fibroma and fibrothecoma.
* Granulosa cell tumour.
* Mucinous or serous cystadenomas or cystadenocarcinoma.
* Endometroid carcinoma.
* Adenocarcinoma without serous or mucous collection.
* Krukenberg's tumeurs.
* Lymphoma of ovaries.
Most cases are unilateral and benign : simple oophorectomy is
appropriate for most patients. Ablation with iodine-131 has been
advocated as adjunctive therapy if pathological examination or
staging suggests malignant transformation.
* 1: Morillo Conejo M, Martin Canadas F, Munoz Carmona V, Gonzalez-Sicilia
Munoz E, Gonzalez Sicilia Cotter E, Carrasco Rico S. [Ovarian
mature teratoma. Clinico-pathological study of 112 cases and review
of the literature] Ginecol Obstet Mex. 2003 Sep;71:447-54. Review.
* 2: Van de Moortele K, Vanbeckevoort D, Hendrickx S. Struma ovarii:
US and CT findings. JBR-BTR. 2003 Jul-Aug;86(4):209-10.
* 3: Zalel Y, Caspi B, Tepper R. Doppler flow characteristics
of dermoid cysts: unique appearance of struma ovarii. J Ultrasound
Med. 1997 May;16(5):355-8.
* 4. Carvalho RB, Cintra ML, Matos PS, Campos PS. Cystic struma
ovarii: a rare presentation of an infrequent tumor. Sao Paulo
Med J 2000;118(1):17-20.
* 5. Alfie Cohen I, Castillo Aguilar E, Sereno Gomez B, Martinez
Rodriguez O.Struma ovarii: a variety of monodermic teratoma of
the ovary. Report of 8 cases. Ginecol Obstet Mex 1999;67:153-7.
* 6. Kawahara H. Struma ovarii with ascites and hydrothorax. Am
J Obstet Gynecol 1963;85:85