Struma ovarii

Case contributed by Dr Milad Ghasemzadeh

Presentation

Sudden onset of lower abdominal pain with poor response to analgesia. No vaginal bleeding or discharge. Nil fevers, nausea or vomiting. No significant medical history.

Patient Data

Age: 30 years
Gender: Female
Ultrasound

Transabdominal pelvic ultrasound

A complex cystic lesion within the right adnexal region, which measures 57 x 55 x 46 mm (volume 75 mL). It is predominantly hypoechoic with internal septa and multiple thin echogenic bands. There is a slightly hyperechoic focus within the lesion which demonstrates post acoustic shadowing. There is no internal vascularity. The right ovary is not separately identified. Recommend gynecology review for potential torsion.

The left ovary has a volume of 15 cc and contains an 18 mm simple cyst.

The uterus is unremarkable; it is anteverted and measures 75 x 42 x 62 mm. Endometrial thickness is 4 mm.

No free fluid within the pelvis.

Bowel and bladder were normal (not shown).

Photo

Intraoperative photos

Intraoperative photos obtained during the laparoscopic right ovarian cystectomy.

Pathology

Figure 1: Struma ovarii (low power)
In this hyperemic ovary multiple collapsed cysts filled by colloid and lined by a single layer of thyreocytes are observed. In the wall of the cysts, small groups of thyroid follicles are also present.

Figure 2: Struma ovarii (high power)
Small groups of thyroid follicles are present.

Figure3: Struma ovarii thyroglobulin (high power)
Thyroid follicles show strong staining for thyroglobulin.

Case Discussion

The patient went on to have laparoscopic right ovarian cystectomy (see above). Operative notes revealed a 7 cm right ovarian cyst, with contents which macroscopically appeared consistent with a dermoid. There was associated 180 degree ovarian torsion, without fully cutting off the blood supply. The cyst was excised in its entirety.

Histopathology revealed struma ovarii with focal squamous differentiation (see above).

The patient was subsequently recalled for laparoscopic right salpingo-oophorectomy, with no evidence of residual tumor or malignancy on histopathology. Pre-operative serum TSH was normal.

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Case information

rID: 71279
Published: 3rd Oct 2019
Last edited: 3rd Nov 2019
Inclusion in quiz mode: Included
Institution: Central Coast LHD

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