Endocrinol Metab.  2012 Mar;27(1):72-76. 10.3803/EnM.2012.27.1.72.

A Case of Bilateral Struma Ovarii Combined with Subclinical Hyperthyroidism

• Kim SM
• Choi BK
• Kang JH
• Kim MR
• Jeon YK
• Kim SS
• Kim BH
• Kim IJ

• KMID: 2134822
• DOI: http://doi.org/10.3803/EnM.2012.27.1.72

Abstract

Struma ovarii is a rare monodermal variant of ovarian teratoma accounting for only 2% of all mature teratomas. To be classified as a struma ovarii, teratoma must be composed predominantly of mature thyroid tissue (> 50%). This tumor is generally benign, although malignant transformation has been reported. Struma ovarii occur mostly as unilateral cases, so bilateral cases are quite rare (less than 6% of cases). Struma ovarii occur largely without symptoms or are accompanied by non-specific symptoms, such as abdominal pain, a palpable abdominal mass, and abdominal distension. The preoperative diagnosis is generally difficult. The incidence of hyperthyroidism has been reported to be 5-10% of patients with struma ovarii. Thus, cases of functional bilateral struma ovarii are very rare. We report a case of bilateral struma ovarii with subclinical thyrotoxicosis and a diffuse goiter, mimicking a malignant ovarian tumor, and include a brief review of related literature.

Keyword

Bilateral struma ovarii; Hyperthyroidism; Ovarian neoplasms

MeSH Terms

Abdominal Pain
Accounting
Goiter
Humans
Hyperthyroidism
Incidence
Ovarian Neoplasms
Struma Ovarii
Teratoma
Thyroid Gland
Thyrotoxicosis

Figure

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  Fig. 1 T1WI magnetic resonance imaging with gadolinium enhancement shows bilateral ovarian masses. A. Right ovarian mass measuring 11 × 9 cm in its largest diameter with multiple septated cystic and solid portion is noted. B. Left ovarian mass measuring 7 × 4.5 cm in its largest diameter with suspicious enhancing solid portion is also noted.

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  Fig. 2 Thyroid utrasonography shows relatively well defined hypoechoic nodule in right thyroid gland (A) and isoechoic nodules in left thyroid gland (B) with moderate diffuse goiter.

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  Fig. 3 99mTc O4 thyroid scan shows diffuse enlarged thyroid with inhomogenous uptake. Uptake, 3.5%.

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  Fig. 4 A. Right ovary shows multiple cysts and smooth surface in gross finding. B. Cut surface of right ovary shows compartment of ambor-colored thyroid tissue separated by thick fibrous septae in gross finding. C, D. Thyroid tissues with colloid filled follicles varying in size, lined by flat to cuboidal cells with representing struma ovarii are noted in microscopic findings (C, H&E stain, × 40; D, H&E stain, × 400).

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