eMedicine Specialties > Obstetrics and Gynecology > General Gynecology

Struma Ovarii

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
Coauthor(s): Willard Barnes, MD, Associate Professor, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Georgetown University
Contributor Information and Disclosures

Updated: Dec 7, 2007

Introduction

Background

Struma ovarii was first described in 1899 and is extremely rare, with only 150 reported cases in the medical literature. Because of the nature of thyroid tissue in the ovary, the definition of malignancy and the management of struma have been debated by those who believe the tumor favors an ovarian versus a thyroid neoplasm.

Struma ovarii is defined by the presence of an ovarian tumor containing thyroid tissue as the predominant cell type. They typically occur as part of a teratoma but may occasionally be encountered with serous or mucinous cystadenomas. Malignant transformation is rare, but it is usually defined on histologic criteria. Benign strumosis is a rare version of mature thyroid tissue implants throughout the peritoneal cavity. Strumal carcinoid is defined by the presence of carcinoid tissue within a struma and is exceptionally rare.

Pathophysiology

On gross examination, the struma is brown or green-brown and solid, but it can also be partly or entirely cystic, filled with gelatinous fluid. The contralateral ovary may contain another teratoma, but the struma is rarely bilateral. Most strumal tissue is not functionally active, and cases associated with thyrotoxicosis can be due to autoimmune stimulation of the normal thyroid gland.

Frequency

United States

Between 0.8-3% of teratomas contain functional thyroid tissue or thyroid tissue occupying most of the mass. They are thus classified as a struma ovarii. Approximately 15% of teratomas have a small, nonsignificant focus of thyroid tissue.

Mortality/Morbidity

Malignancy is defined by various criteria in different studies, principally differing on classifying struma as either a thyroid or ovarian cancer. Several other types of tumors, such as Brenner tumor or cystadenoma, may also be found with a struma.

  • Malignant change seems to occur in about a third of cases.
  • Metastatic spread, which follows the pattern of ovarian cancer, occurs in approximately 5% of malignant cases.

Race

Because of its rarity, no clear racial predilection for struma ovarii has been determined.

Age

  • The fifth and sixth decades are the ages of peak frequency.
  • Struma ovarii rarely occurs before puberty.

Clinical

History

Most strumas are found during pathologic examination of an excised pelvic mass. A patient with a struma typically presents with the symptoms of a pelvic mass, including pain, pressure, and irregular menses.

  • Only 8% of patients with strumas present with clinical hyperthyroidism. Associated and significant thyroid function abnormalities are present in 25-33% of patients.
  • Pleural effusion and ascites are sometimes present.

Physical

  • A struma always occurs as a pelvic mass, which may be palpable on physical examination, depending upon size and location. Approximately 15% of patients present with enlargement of the thyroid gland.

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. 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].

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

  3. 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].

  4. 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].

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

Coauthor(s)

Willard Barnes, MD, Associate Professor, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Georgetown University
Disclosure: Nothing to disclose.

Medical Editor

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

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

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, Assumption Community Hospital
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, Associate Professor, Coordinator, 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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