Thudi, Vaishali1; Honasoge, Mahalakshmi1; Levy, Shiri1
1 Division of Endocrinology , Bone and Mineral metabolism, Henry Ford Hospital, Detroit, Michigan, USA
Introduction: Meigs’ syndrome is a triad of ascites, pleural effusion and ovarian tumor. We report a case of follicular variant papillary thyroid carcinoma of struma ovarii (SO) in the setting of Meigs’ syndrome.
Case description: 54 yo female presented with shortness of breath. Imaging showed large right sided pleural effusion and trace ascites. She underwent multiple procedures due to re accumulation of pleural fluid. Cytology was benign. Further imaging showed an ovarian mass, ascites and elevated CA125: 1472 (< 35 U/mL). She underwent total abdominal hysterectomy, left salpingo-oophorectomy. Pathology: follicular variant of papillary thyroid carcinoma in struma ovarii limited to 8.5 cm left ovary. Thyroid ultrasound: no suspicious features. Pre-thyroidectomy – Tg: 9.9 (2-60 ng/ml), Tg antibody :< 1(< 4 IU/mL), TSH: 1.43 (0.45-5.3 µIU/mL).She had total thyroidectomy and the pathology was benign. Thyroid cancer scan: 2.8% uptake in thyroid bed, without metastasis. She was treated with 35.9 mCi of I-131 orally. Post therapy scan remained unchanged.
Discussion: SO accounts for 5% ovarian teratomas. Thyroid carcinoma is seen in 5-37% of SO3. Very rarely, Meigs’ syndrome with high CA125 is associated with SO. Yassa et al1 classified well differentiated tumor as low risk (< 2 cm, local) and high risk (> 2 cm, extra ovarian extension). They suggest salpingo-oophorectomy with thyroid hormone suppression for low risk and to pursue additional total thyroidectomy with RAI in high risk patients.
Conclusion: Based on current literature, there are only 10 cases of SO, associated Meigs’ syndrome and increased CA1252.
- Yassa L, Sadow P, Marqusee E. Malignant struma ovarii. Nat Clin Pract Endocrinol Metab. 2008;4(8):469-72
- Jiang W, Lu X, Zhu ZL, Liu XS, Xu CJ. Struma ovarii associated with pseudo-Meigs’ syndrome and elevated serum CA 125: a case report and review of the literature. J Ovarian Res. 2010;3:18
- Marti JL, Clark VE, Harper H, Chhieng DC, Sosa JA, Roman SA. Optimal surgical management of well-differentiated thyroid cancer arising in struma ovarii: a series of 4 patients and a review of 53 reported cases. Thyroid. 2012;22(4):400-6.