Aditya Mavinkurve
Cambridge University Hospital, United KingdomPresentation Title:
Metastatic struma ovarii with differentiated follicular carcinoma: A case report
Abstract
We report the case of a
63-year-old woman diagnosed with malignant struma ovarii, a rare ovarian tumour
predominantly composed of thyroid tissue. Her medical history included partial
thyroidectomy on levothyroxine and prior ovarian cystectomy. The ovarian mass
was discovered incidentally following a biking accident during CT trauma
imaging. She was asymptomatic, with normal tumour markers (CA125: 23). CT
revealed a heterogeneous left adnexal mass (89 × 42 × 60 mm) with a mesorectal
lesion (36 × 20 × 34 mm) and no definite metastasis. MRI confirmed a complex
left adnexal lesion with mixed signal intensities, direct extension into the
mesorectum, and no significant nodal disease.
Following multidisciplinary
review, combined colorectal and gynaecological surgery was undertaken. The
procedures included total abdominal hysterectomy, bilateral
salpingo-oophorectomy, pelvic peritoneal resection, and rectosigmoid resection
with anastomosis. Intraoperative findings demonstrated a 10 cm left adnexal
mass and a 4 cm mesenteric lesion closely related to bowel vessels.
Histopathology revealed a follicular neoplasm within struma ovarii, with
thyroid tissue in mesenteric and peritoneal deposits but no high-grade features
or bowel wall invasion. Omentum and bowel sections were free of malignancy.
Postoperatively, the patient’s
case was discussed at the regional multidisciplinary meeting, which recommended
completion thyroidectomy and radioiodine ablation to enable surveillance using
serum thyroglobulin. Revision thyroidectomy showed a small atrophic thyroid
remnant confirmed to have no malignancy on histology. Postoperative
biochemistry demonstrated thyroglobulin of 12.6 and negative anti-thyroglobulin
antibodies.
This case illustrates the
clinical and diagnostic complexity of malignant struma ovarii, particularly
when presenting incidentally with extra-ovarian disease. Optimal management
requires coordinated multidisciplinary care, incorporating extensive surgical
resection and subsequent thyroid-directed therapy. Awareness of this rare
diagnosis is essential to ensure accurate histological recognition, appropriate
treatment planning, and effective long-term follow-up strategies.
Biography
Dr. Aditya
Mavinkurve completed his medical training at St. Georges’ University of London.
He is currently fulfilling his role as a Clinical Research Fellow in ENT at
Cambridge University Hospital.
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