A Rare Case of Histologic Benign Struma Ovarii With Distant Metastasis

Der-Wei Hwu, Shan-Yin Tsai, Hon-Man Chan, Yu-Wen Chen, Yu-Chieh Chen, Pi-Jung Hsiao

Abstract


Struma ovarii (SO) is a rare variant of ovarian teratoma composed mainly of mature thyroid tissue. It is usually benign in histology. We present a case of benign SO with frequent recurrence and widespread extra-ovarian seeding. A 28-year-old woman was diagnosed initially with dermoid cysts over the right ovary. Over a 7-year period, frequent recurrence of ovarian tumor was accompanied by peritoneal strumosis and distant metastasis to liver and lung. Bilateral salpingo-oophorectomy (BSO), total thyroidectomy (TT) and radioactive iodine (RAI) therapy were performed with successfully declining serum thyroglobulin. The patient remains on scheduled follow-up in clinic. Histologic benign SO to behave like biological malignancy with frequent recurrence and distant metastasis is exceptional. Tumor enriched expression of the vascular endothelial growth factor (VEGF) and p53 protein may explain the risk of malignant behavior. There is still a lack of consensus on how to choose the optimal management for histologically benign SO with metastatic behavior. Based on our limited case experience, BSO is preferred. TT and RAI therapy is mandatory if persistence of elevated serum thyroglobulin and wide-seeding of the tumor was detected by I131 whole body scintigraphy or fluorodeoxyglucose (PET-FDG) scan.




J Clin Gynecol Obstet. 2014;3(3):108-113
doi: http://dx.doi.org/10.14740/jcgo232w

Keywords


Histologic benign struma ovarii; Biologically malignant struma ovarii; Vascular endothelial growth factor; p53; Optimal surgical management

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