Clinical Presentation
A case report [PMID:38834312] describes a patient with metastatic malignant struma ovarii presenting with a 2.7 cm sellar mass and symptoms of hypopituitarism, highlighting an unusual metastatic pathway to the pituitary.
A 19-year-old pregnant woman at 12 weeks presented with untreatable severe abdominal pain, nausea, and vomiting, alongside a large complex ovarian mass [PMID:31484009].
Diagnosis
In the presented case, a patient with malignant struma ovarii had normal serum Tg levels despite evidence of highly differentiated follicular thyroid carcinoma with invasive features [PMID:39644277].
Surgery for a presumed pituitary macroadenoma unexpectedly identified ectopic thyroid tissue, leading to the diagnosis of metastatic struma ovarii [PMID:38834312].
In a case of struma ovarii with recurrent peritoneal metastasis, 99m TcO4 whole-body scintigraphy SPECT/CT demonstrated multiple significantly enhanced nodules in the abdominopelvic cavity, aiding in the diagnosis [PMID:38389218].
Ultrasound imaging revealed a right complex ovarian mass, measuring 14x12 cm, without papillary projections, in a pregnant patient [PMID:31484009].
Management
The patient underwent total thyroidectomy followed by 131I treatment at a dose of 150mCi, indicating its application in managing metastatic disease [PMID:39644277].
The patient underwent total thyroidectomy and received radioactive iodine therapy, resulting in good response and absence of tumor regrowth or distant metastasis over 5 years of follow-up [PMID:38834312].
Following the diagnosis of extensive peritoneal implants metastasis, the patient underwent total thyroidectomy and received 131I therapy, suggesting these interventions as viable management strategies [PMID:38389218].
Given suspicion of ovarian torsion, the patient underwent laparotomy resulting in a right adnexectomy due to the symptomatic nature of the struma ovarii [PMID:31484009].
A patient with metastatic struma ovarii and premature ovarian failure following radioiodine-therapy underwent cryopreserved ovarian tissue transplantation, though no ovarian function recovery was observed [PMID:29318892].
Complications
Despite transplantation, the patient showed only few small follicles at ultrasound and maintained menopausal hormonal levels, indicating limited functional recovery [PMID:29318892].
Prognosis & Follow-up
After one year of regular follow-up, including monitoring of Tg levels, thyroid function, and imaging (neck ultrasound and abdominopelvic CT), no significant abnormalities were observed [PMID:39644277].
The patient presented with metastatic disease 4 years post-initial struma ovarii resection, highlighting the need for long-term follow-up to monitor for recurrence [PMID:38389218].
Three years post-transplantation, there was no observed recovery of ovarian function, highlighting the potential limitations of this approach in managing premature ovarian failure in such patients [PMID:29318892].
References
1 Ning Y, Lou C, Huang Z. Disease management of malignant struma ovarii. Hellenic journal of nuclear medicine 2024. link 2 Dissanayake A, Liu AY, Gooderham PA, MacKenzie-Feder J. Metastatic malignant struma ovarii to the pituitary presenting as a sellar mass and responding to total thyroidectomy with adjuvant radioactive iodine therapy. BMJ case reports 2024. link 3 Xie H, Huang R, Lei J, Li L. Struma Ovarii With Extensive Peritoneal Implants Metastasis Revealed by 99m TcO 4 SPECT/CT. Clinical nuclear medicine 2024. link 4 Pepe F, Valenti O, Insalaco G, Zigarelli MMG, Pepe L, Piana M. Struma ovarii complicating pregnancy. Case report and literature review. Il Giornale di chirurgia 2019. link 5 Fabbri R, Vicenti R, Paradisi R, Rossi S, De Meis L, Seracchioli R et al.. Transplantation of cryopreserved ovarian tissue in a patient affected by metastatic struma ovarii and endometriosis. Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology 2018. link
5 papers cited of 6 indexed.