eMedicine Specialties > Obstetrics and Gynecology > General Gynecology
Struma Ovarii: Differential Diagnoses & Workup
Updated: Oct 26, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Differential Diagnoses
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.
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Differential Diagnoses & Workup: Struma Ovarii |
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References
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].
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].
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].
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].
Ihalagama IR, Hewavisenthi SJ, Wijesinghe PS. Pregnancy following treated malignant struma ovarii. Ceylon Med J. Sep 2004;49(3):90-1. [Medline].
Roth LM, Talerman A. The enigma of struma ovarii. Pathology. Feb 2007;39(1):139-46. [Medline].
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].
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].
Further Reading
Keywords
teratomatous ovarian tumor, hyperthyroidism, cystadenomas, strumosis, teratoma, pelvic mass, oophorectomy, total hysterectomy, bilateral salpingo-oophorectomy, thyroidectomy
Differential Diagnoses & Workup: Struma Ovarii