EP41 – Papillary thyroid Carcinoma in struma Ovarii Case report in tertiary Hospital

      Abdelaal, Abdelrahman1; Alhassan, Mohammed2; Alansari, Afaf3 1 General Surgery Department, Hamad General Hospital, Doha, Qatar 2 General Surgery Department, Hamad General Hospital, Doha, Qatar 3 Obstetric and Gynecology Department, Women Hospital, Doha, Qatar   Background: Struma Ovarii is a rare and highly specialized form of mature teratoma [1]. Preoperative diagnosis can be suspected in cases with hyperthyroidism [2-6]. Struma Ovarii may demonstrate all pathological pattern that are seen in the thyroid gland including malignancy [3]. Method: 42y old female patient who was admitted with right lower abdominal pain for 3 weeks, physical examination revealed midline palpable tender firm mass arising from the pelvis extending up to 2cm below the umbilicus. Laboratory investigation: CA125: 251 (normal range: 0 to 35) U/S showed left adanexel complex solid cystic mass (likely Malignant ovarian mass) with mild ascites. CT abdomen and MRI pelvis showed well defined complex mixed lesion with solid and cystic component in the pelvis extending to either side of midline reaching to both adnaxae measuring 13×9.4×8.1cm. The solid component measure 6.7×6.3×6cm in size with the possibility of ovarian malignant tumor.  Patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and infracolic omentectomy. Results: histopathology result: Papillary thyroid carcinoma arising in stroma Ovarii, left ovary. Maximum tumor dimensions of 11cms. Pathologic staging (p TNM): p T1b (FIGO IB) Case was discussed in thyroid multidisciplinary team meeting for total thyroidectomy and whole body scan followed by radioactive iodine ablation therapy. Conclusion: Papillary thyroid Carcinoma in struma Ovarii is a rare and difficult to diagnose preoperatively and its treatment depend on Pathologic staging of the disease and aggressiveness nature of the tumor.   References:
    1. Dunzendorfer T, deLas Morenas A, Kalir T, Levin RM. Struma ovarii and hyperthyroidism. Thyroid 1999; 9:499.
    2. Yassa L, Sadow P, Marqusee E. Malignant struma ovarii. Nat Clin Pract Endocrinol Metab 2008; 4:469.
    3. Kraemer B, Grischke EM, Staebler A, et al. Laparoscopic excision of malignant struma ovarii and 1 year follow-up without further treatment. Fertil Steril 2011; 95:2124.e9.
    4. Ayhan A, Yanik F, Tuncer R, et al. Struma ovarii. Int J Gynaecol Obstet 1993; 42:143.
    5. Young RH. New and unusual aspects of ovarian germ cell tumors. Am J Surg Pathol 1993; 17:1210.
    6. DeSimone CP, Lele SM, Modesitt SC. Malignant struma ovarii: a case report and analysis of cases reported in the literature with focus on survival and I131 therapy. Gynecol Oncol 2003; 89:543.


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