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Case Reports
. 2023 Sep 21:16:571-578.
doi: 10.2147/IMCRJ.S432333. eCollection 2023.

Struma Ovarii with Papillary Thyroid Carcinoma and Metastasis to the Appendix: A Case Report and Literature Review

Samuel Addisu Abera  1 , Daniel Kassie Molla  1 , Kirubel Addisu Abera  1 , Girma Damtew Adisu  1 , Misganaw Abere Worku  2 , Yohannis Derbew Molla  3
Affiliations
Case Reports

Struma Ovarii with Papillary Thyroid Carcinoma and Metastasis to the Appendix: A Case Report and Literature Review

Samuel Addisu Abera et al. Int Med Case Rep J. .

Abstract

Struma ovarii is an infrequent type of teratoma arising from the ovary accounting for only 2% of all ovarian teratomas. These tumors have a benign biology with rare malignant transformation in about 3% of cases. The most common malignant transformation that arises from struma ovarii is papillary thyroid carcinoma. These neoplasms act in the same way as those arising from the thyroid gland, but due to the rarity of their occurrence there is still a debate over therapeutic options. We present a case of a 41-year-old Ethiopian Para IX woman presented with abdominal swelling for four years, accompanied by dull pain, satiety, and weight loss. Her vital signs were normal, and her abdominal examination revealed a large abdominopelvic mass. Her CA-125 was elevated, and her blood count, organ function tests, and serum electrolyte levels were normal. Abdominal ultrasound revealed a complex abdominopelvic mass with cystic and solid components, possibly ovarian teratoma. The patient underwent surgery, revealing a 14 by 10 cm right ovarian mass and a 3×3 cm appendiceal mass. Subsequently, total abdominal hysterectomy, bilateral salpingo-oophorectomy, total omentectomy, and appendectomy was done. Histopathologic evaluation revealed follicular proliferation of enlarged cells, with no papillary growth pattern. The case was diagnosed as malignant struma ovarii, a follicular variant of papillary thyroid carcinoma (FVPTC) with secondary deposits on the appendix. A complete thyroidectomy was done after the histopathology diagnosis. Malignant struma ovarii is rare making it challenging to treat since there are no established prognosticating histopathologic or clinical characteristics. The tumor size and metastasis determine the surgical treatment scope. Large-scale investigations are essential for prognostication and treatment options considering pathologic traits.

Keywords: appendix; malignant; metastasis; papillary carcinoma; struma ovarii; teratoma.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Gross appearance of the right ovarian mass.
Figure 2
Figure 2
Cut surface of the right ovarian mass.
Figure 3
Figure 3
(A) Gross appearance of the appendix with a nodule over its tip. (B) Cut surface appearance of the appendix.
Figure 4
Figure 4
(A) Low power view (40x) from the right ovary showing predominantly follicular growth pattern. (B) Medium power view (200x) from the right ovary showing predominantly follicular growth pattern.
Figure 5
Figure 5
High power view (600x) showing classic cytomorphologic features of PTC with washed out chromatin, nuclear elongation, grooving and pseudo inclusions (arrows).
Figure 6
Figure 6
Microscopic view of appendiceal mass with apparent metastatic thyroid tissue that has pushed the appendiceal mucosa (arrow).
Figure 7
Figure 7
Inset view of the appendix (red arrow) and the periphery of the tumor deposit (blue arrow).
See this image and copyright information in PMC

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