Malignant struma ovarii mimic clear cell carcinoma

Area of Science:

• Gynecologic Oncology
• Endocrinology
• Pathology

Background:

• Struma ovarii are rare germ cell tumors, comprising <3% of teratomas, with malignant transformation being exceptionally uncommon.
• Clinical presentation typically mimics a pelvic tumor, with hormonal metabolism usually unaffected.
• Pre-surgical diagnosis relies on imaging (ultrasound), but definitive diagnosis requires histological examination, which can be challenging for malignancy.

Observation:

• A case report details a 22-year-old patient with an ovarian tumor detected via ultrasound.
• Histological examination revealed struma ovarii with malignant transformation to follicular carcinoma, notably featuring a clear cell predominance.
• The patient underwent a second-look surgical staging intervention with conservative surgery due to her young age and desire for children.

Findings:

• The histological diagnosis confirmed malignant struma ovarii with a follicular carcinoma subtype and clear cell features.
• Conservative surgical management was chosen for fertility preservation.
• Post-operative clinical and analytical monitoring, including thyroglobulin levels, has been satisfactory.

Implications:

• This case highlights the diagnostic challenges and the importance of thorough pathological examination for identifying malignant struma ovarii.
• Conservative surgical approaches may be suitable for young patients desiring future fertility.
• Satisfactory thyroglobulin levels suggest effective management and potential for favorable prognosis in select cases.