Introduction: Struma ovarii contains exclusively or predominantly thyroid tissue arising from germ cells in a mature teratoma. In rare cases, malignant transformation with metastases occur. Because of the rarity and unusual occurrence of this tumour, its management and follow-up after staging laparotomy are still controversial.
Case presentation: We report the case of a 65-year-old P9+0 (7 alive), 10 years postmenopausal woman, who presented with a two-year history of recurrent lower abdominal pain. She had a right salpingo-oophorectomy for a right ovarian cyst 23 years ago. Examination findings did not reveal any palpable abdominal or adnexal mass. Imaging studies demonstrated non-specific features of a complex left adnexal mass with bilateral obstructive uropathy (worse on the left) and hepatic secondaries. She had a total abdominal hysterectomy, left salpingo-oophorectomy (TAH+LSO) and infra-colic omentectomy. Histopathology revealed malignant thyroid tissue (papillary) on a background of mature cystic teratoma with immunohistochemical positive expression of thyroid transcription factor 1 (TTF-1) and thyroglobulin (Tg). She received six courses of chemotherapy post-surgery and has been on follow-up for 18 months.
Conclusion: Apart from pelvic surgery, there is no consensus on the post-operative management of malignant struma ovarii. This patient has done fairly well on platinum-based chemotherapy despite being a stage 4 disease at diagnosis.
Key words: Teratoma, malignant struma ovarii, mature cystic teratoma, metastasis, chemotherapy, hysterectomy.
|
