METASTATIC RADIOIODINE AVID STRUMA OVARII ASSOCIATED WITH PSEUDO-MEIGS’ SYNDROME
AbstractWe report a case of 21 years old lady who presented with ascites, left adnexal mass and elevated CA-125. With suspicion of ovarian malignancy, she underwent left salpingo-oophorectomy with omental biopsy. Histopathology revealed: ‘follicular variant of papillary thyroid carcinoma arising in struma ovarii’ with metastatic papillary thyroid carcinoma in omental and peritoneal nodules. Patient underwent total thyroidectomy followed by radioactive iodine therapy for metastatic omental and peritoneal disease. Post-therapy whole body scan, revealed extensive I-131 avid disease metastatic disease involving the chest, abdomen, pelvis and the musculoskeletal system. Patient was treated with multiple doses of high dose radioactive iodine. She became symptom free on supra-physiologic doses of oral thyroxin however her high thyroglobulin levels and residual radioiodine avid metastatic disease required further treatment. In literature a few cases of struma ovarii have been reported with elevated CA-125 and associated pseudo-Meigs' syndrome. The treatment for this rare disease is still not standardized and poses a therapeutic challenge. Our case emphasizes the need for a multidisciplinary approach for managing struma ovarii.
Boettlin R. Uber Zahnentwicklung in Dermoidcysten des Ovariums. Virchows Arch Path Arat 1889;115:493–504.
Krishnamurthy A, Ramshankar V, Vaidyalingam V, Majhi U. Synchronous papillary carcinoma thyroid with malignant struma ovarii: A management dilemma. Indian J Nucl Med 2013; 28(4):243–5.
Clement PB, Young RH, Scully RE. Clinical syndromes associated with tumors of the female genital tract. Semin Diagn Pathol 1991;8:204–33.
Yoo SC, Chang KH, Lyu MO, Chang SJ, Ryu HS, Kim HS. Clinical characteristics of struma ovarii. J Gynecol Oncol 2008;19(2):135–138.
Loizzi V, Cormio G, Resta L, Fattizzi N, Vinio M, Selvaggi L. Pseudo-Meigs' syndrome and elevated CA125 associated with struma ovarii. Gynecol Oncol 2005;97(1):282–4.
Rana V, Srinivas V, Bandyopadhyay S, Ghosh SK, Singh Y. Bilateral benign non functional struma ovarii with Pseudo-Meigs’ syndrome. Indian J Pathol Microbiol 2009;52(1):94–6.
Shaco-Levy R, Pend YR, 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 behaviour. Arch Pathol Lab Med 2012;136(2):172–8.
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 2009;28(5):405–22.
McGill JF, Sturgeon C, Angelos P. Metastatic struma ovarii treated with total thyroidectomy and radioiodine ablation. Endocr Pract 2009;15(2):167–73.
Dujardin MI, Sekhri P, Turnbull LW. Struma ovarii: role of imaging? Insights Imaging 2014;5(1):41–51.
Devaney K, Snyder R, Norris HJ, Tavassoil FA. Proliferative and histologically malignant struma ovarii: a clinicopathologic study of 54 cases. Int J Gynecol Pathol 1993;12(4):333–43.
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 2003;89(3):543–8.