Struma Ovarii 

  • Author: Jeannie Chen Kelly, MD; Chief Editor: Michel E Rivlin, MD   more...
 
Updated: Feb 23, 2012
 

Background

Struma ovarii is a rare ovarian tumor defined by the presence of thyroid tissue comprising more than 50% of the overall mass. Most commonly, they occur as part of a teratoma, but may occasionally be encountered with serous or mucinous cystadenomas.[1] Struma ovarii were first described in 1899 and comprise 1% of all ovarian tumors.

Several variants of the tumor exist. 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. The vast majority of struma ovarii are benign; however, malignant disease is found in a small percentage of cases.

The symptoms of struma ovarii are similar to other ovarian tumors and are nonspecific in nature. The tumor can be characterized by radiological imaging; however, the final diagnosis is made upon pathological and histological examination of the tissue itself. Surgical resection remains the definitive treatment for benign disease, and surgery with adjuvant radioiodine therapy has been shown to be successful in treating metastatic and recurrent disease.[2]

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Epidemiology

Frequency

United States

Struma ovarii is rare. Approximately 1% of all ovarian tumors and 2.7% of all dermoid tumors are classified as struma ovarii.[3]

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.[4]
  • Metastatic spread, which follows the pattern of ovarian cancer, occurs in approximately 5% of malignant cases.[4]

Although the tumor is predominately composed of thyroid tissue, thyrotoxicosis is seen in only 5% of all cases. Only 1 case of thyrotoxicosis resulting from peritoneal strumosis has been reported.[5]

Race

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

Sex

Defined as a tumor of ovarian origin, struma ovarii occurs exclusively in genetic females.

Age

  • Struma ovarii typically presents during the reproductive years. The fifth and sixth decades are the ages of peak frequency.
  • Struma ovarii rarely occurs before puberty.
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Contributor Information and Disclosures
Author

Jeannie Chen Kelly, MD  Resident Physician, Department of Obstetrics and Gynecology, Tufts Medical Center

Disclosure: Nothing to disclose.

Coauthor(s)

Sarah H Hughes, MD  Assistant Professor, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Massachusetts Medical School

Sarah H Hughes, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists and Society of Gynecologist Oncologists

Disclosure: Nothing to disclose.

David Chelmow, MD  Leo J Dunn Distinguished Professor and Chair, Department of Obstetrics and Gynecology, Virginia Commonwealth University Medical Center

David Chelmow, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, American Society for Colposcopy and Cervical Pathology, Association of Professors of Gynecology and Obstetrics, Council of University Chairs of Obstetrics and Gynecology, Phi Beta Kappa, Sigma Xi, Society for Gynecologic Investigation, and Society for Medical Decision Making

Disclosure: Nothing to disclose.

Specialty Editor Board

Jordan G Pritzker, MD, MBA, FACOG  Assistant Professor of Obstetrics/Gynecology and Women's Health, Women's Comprehensive Health Center, Hofstra University School of Medicine; Attending Physician, Department of Obstetrics and Gynecology, Long Island Jewish Medical Center

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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.

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, 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.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Bradford W Fenton, MD, PhD, FACOG to the development and writing of this article.

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. 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].

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

  4. Bal A, Mohan H, Singh SB, Sehgal A. Malignant transformation in mature cystic teratoma of the ovary: report of five cases and review of the literature. Arch Gynecol Obstet. Mar 2007;275(3):179-82. [Medline].

  5. Kim D, Cho HC, Park JW, Lee WA, Kim YM, Chung PS. Struma ovarii and peritoneal strumosis with thyrotoxicosis. Thyroid. Mar 2009;19(3):305-8. [Medline].

  6. Mui MP, Tam KF, Tam FK, Ngan HY. Coexistence of struma ovarii with marked ascites and elevated CA-125 levels: case report and literature review. Arch Gynecol Obstet. May 2009;279(5):753-7. [Medline].

  7. Shen J, Xia X, Lin Y, Zhu W, Yuan J. Diagnosis of Struma ovarii with medical imaging. Abdom Imaging. Oct 2011;36(5):627-31. [Medline].

  8. Jung SI, Kim YJ, Lee MW, Jeon HJ, Choi JS, Moon MH. Struma ovarii: CT findings. Abdom Imaging. Nov-Dec 2008;33(6):740-3. [Medline].

  9. Shaco-Levy R, Peng RY, Snyder MJ, Osmond GW, Veras E, Bean SM, et al. Malignant struma ovarii: a blinded study of 86 cases assessing which histologic features correlate with aggressive clinical behavior. Arch Pathol Lab Med. Feb 2012;136(2):172-8. [Medline].

  10. Makani S, Kim W, Gaba AR. Struma Ovarii with a focus of papillary thyroid cancer: a case report and review of the literature. Gynecol Oncol. Sep 2004;94(3):835-9. [Medline].

  11. 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. Jun 2003;89(3):543-8. [Medline].

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

 
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