EP23 – Challenging management of malignant struma ovarii, follicular thyroid carcinoma and Graves’ disease

      Goldstein, Horia1; Dobrescu, Ruxandra2; Coles, Diana2; Goldstein, Daniela2; Gherlan, Iulian1,2; Chiriac, Iulia Andreea2; Badiu, Corin1,2; Ioachim, Dumitru2; Terzea, Dana2; Voicu, Gabriela2; Goldstein, Andrei2 1 “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania 2 “C.I.Parhon” National institute of Endocrinology, Bucharest, Romania Background/Purpose: An uncommon type of ovarian teratoma, struma ovarii is seldom associated with malignancy. Objectives: We present a rare association of malignant struma ovarii (MSO), follicular thyroid carcinoma (FTC) and Graves’ disease. Methods: A 50-year-old woman presented with persistent thyrotoxicosis post-thyroidectomy for a benign thyroid nodule in the context of hyperthyroidism of Graves’ disease. Abdominal ultrasonography revealed a 6 cm tumor on the right ovary suggesting struma ovarii, and the patient was advised to undergo ovariectomy, but postponed. A year later she presented with lower limb neurological deficits, and CT and MRI scans revealed multiple pulmonary, vertebral and liver metastases. Results: Orthopedic resection of a large T11 vertebral tumor was performed, and pathology indicated metastasis of follicular thyroid carcinoma (FTC). Review of the original thyroid pathology revealed well differentiated FTC. 131I whole body scan (WBS) showed intense iodine uptake in the lungs, right pelvis, axial skeleton, skull. Right ovariectomy confirmed malignant struma ovarii. Additional parietal and vertebral tumor resection (T2) and stabilisation were done, followed by chemoembolisation of two hepatic lesions and radioiodine ablation – total dose 878 mCi 131I. At the last admission WBS revealed numerous bone metastases and high stimulated thyroglobulin (STg=5070ng/ml), but in regression, proving efficient management of a challenging case. Discussion & Conclusion:  The association of MSO with FTC and Graves’ disease makes this case unique in the reported literature. Genetic testing will determine whether the MSO and FTC might represent multifocal expression of the same tumor.     References:
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