eMedicine Specialties > Obstetrics and Gynecology > General Gynecology

Struma Ovarii: Differential Diagnoses & Workup

Author: Bradford W Fenton, MD, PhD, FACOG, Clinical Assistant Professor, Northeast Ohio Universities College of Medicine; Faculty, Obstetrics and Gynecology Residency Training Program, Summa Hospitals Department of Obstetrics and Gynecology; Medical Director, Pelvic Pain Specialty Center
Contributor Information and Disclosures

Updated: Oct 26, 2009

Differential Diagnoses

Hyperthyroidism

Other Problems to Be Considered

Pelvic mass

Workup

Laboratory Studies

  • CBC count
  • Blood type and screen
  • A cancer antigen 125 (CA125) test is usually ordered in patients with solid pelvic masses. Results should be within normal limits.
  • Thyroid function tests are ordered only in patients with symptomatic hyperthyroidism.

Imaging Studies

  • Order triple-contrast CT scan of the abdomen and pelvis to evaluate the extent of disease and the involvement of lymph nodes and other adjacent structures (eg, bowel).
  • Pelvic sonography is optional if a CT scan has already been performed. Frequently, this is an initial study.
  • Mammography should be performed in patients with pelvic masses of unknown origin.
  • Order chest radiographs in indicated patients.
  • In select cases, preoperative evaluation with uptake of sodium iodide I-123 has been performed to demonstrate thyroid uptake in pelvic masses.

Other Tests

  • If not current, order a Papanicolaou test.
  • Iodine-131 scanning
    • For masses greater than 5 cm or in patients with suspected struma
    • To evaluate active thyroid tissue in the pelvis or abdomen
  • Order sigmoidoscopy or colonoscopy to evaluate bowel involvement if a triple-contrast CT scan is not available or if bowel involvement is suspected.

Procedures

  • Thoracentesis
    • Perform this procedure in patients with malignant pleural effusion.
    • Cytology may reveal adenocarcinoma in the pattern of malignant thyroid cells.

Histologic Findings

Pathological examination reveals thyroid tissue as the major component of the teratoma. Malignant transformation of the thyroid tissue may be papillary, follicular, or mixed pattern, and it can include elements of mucinous cystadenocarcinoma, Brenner tumor, carcinoid, or melanoma. Birefringent crystals of calcium monohydrate are present in most patients, which is considered specific for tumors of thyroid origin. Immunohistochemical staining for thyroglobulin, triiodothyronine (T3), and thyroxine (T4) can confirm the diagnosis. Vascular invasion is rare.

More on Struma Ovarii

Overview: Struma Ovarii
Differential Diagnoses & Workup: Struma Ovarii
Treatment & Medication: Struma Ovarii
Follow-up: Struma Ovarii
References
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References

  1. Utsunomiya D, Shiraishi S, Kawanaka K. Struma ovarii coexisting with mucinous cystadenoma detected by radioactive iodine. Clin Nucl Med. 2003;28(9):725-7. [Medline]. [Full Text].

  2. McGill JF, Sturgeon C, Angelos P. Metastatic struma ovarii treated with total thyroidectomy and radioiodine ablation. Endocr Pract. Mar 2009;15(2):167-73. [Medline].

  3. Robboy SJ, Shaco-Levy R, Peng RY, Snyder MJ, Donahue J, Bentley RC, et al. Malignant struma ovarii: an analysis of 88 cases, including 27 with extraovarian spread. Int J Gynecol Pathol. Sep 2009;28(5):405-22. [Medline].

  4. Dardik RB, Dardik M, Westra W. Malignant struma ovarii: two case reports and a review of the literature. Gynecol Oncol. Jun 1999;73(3):447-51. [Medline].

  5. Ihalagama IR, Hewavisenthi SJ, Wijesinghe PS. Pregnancy following treated malignant struma ovarii. Ceylon Med J. Sep 2004;49(3):90-1. [Medline].

  6. Roth LM, Talerman A. The enigma of struma ovarii. Pathology. Feb 2007;39(1):139-46. [Medline].

  7. Yoo SC, Chang KH, Lyu MO, Chang SJ, Ryu HS, Kim HS. Clinical characteristics of struma ovarii. J Gynecol Oncol. Jun 2008;19(2):135-8. [Medline].

  8. Zakhem A, Aftimos G, Kreidy R. Malignant struma ovarii: report of two cases and selected review of the literature. J Surg Oncol. Jan 1990;43(1):61-5. [Medline].

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Further Reading

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Keywords

teratomatous ovarian tumor, hyperthyroidism, cystadenomas, strumosis, teratoma, pelvic mass, oophorectomy, total hysterectomy, bilateral salpingo-oophorectomy, thyroidectomy

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Contributor Information and Disclosures

Author

Bradford W Fenton, MD, PhD, FACOG, Clinical Assistant Professor, Northeast Ohio Universities College of Medicine; Faculty, Obstetrics and Gynecology Residency Training Program, Summa Hospitals Department of Obstetrics and Gynecology; Medical Director, Pelvic Pain Specialty Center
Bradford W Fenton, MD, PhD, FACOG is a member of the following medical societies: American College of Obstetricians and Gynecologists
Disclosure: Nothing to disclose.

Medical Editor

Jordan G Pritzker, MD, MBA, FACOG, Assistant Professor of Obstetrics, Gynecology, and Women's Health, Women's Comprehensive Health Center, Albert Einstein College of Medicine; Physician-In-Charge, Department of Obstetrics and Gynecology, Long Island Jewish Medical Center
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

A David Barnes, MD, PhD, MPH, FACOG, Consulting Staff, Department of Obstetrics and Gynecology, Mammoth Hospital (Mammoth Lakes, California), Pioneer Valley Hospital (Salt Lake City, Utah), Warren General Hospital (Warren, Pennsylvania), and Mountain West Hospital (Tooele, Utah)
A David Barnes, MD, PhD, MPH, FACOG is a member of the following medical societies: American College of Forensic Examiners, American College of Obstetricians and Gynecologists, American Medical Association, Association of Military Surgeons of the US, and Utah Medical Association
Disclosure: Nothing to disclose.

CME Editor

Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Hancock Medical Center
Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians
Disclosure: Nothing to disclose.

Chief Editor

Michel E Rivlin, MD, Professor, Coordinator of Quality Assurance/Quality Improvement, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine
Michel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, and Royal College of Surgeons of Edinburgh
Disclosure: Nothing to disclose.

 
 
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