Journal List > Korean J Hepatobiliary Pancreat Surg > v.16(3) > 1040551

Lee, Yi, Kim, Choi, Park, Hong, Choi, Chung, Lee, Park, Min, Chung, and Suh: Metastatic follicular struma ovarii complicating pregnancy: a case report and review of the literature


A 35-year-old woman was determined to have an ovarian cyst and underwent a right ovarian cystectomy at 10 weeks of gestation. A histopathological examination revealed follicular carcinoma arising in a teratoma. No evidence of metastasis was found after delivery. She underwent a total thyroidectomy, followed by radioactive iodine (RAI) therapy. However, her serum thyroglobulin level increased to 1,437 ng/ml (normal range: 0-52 ng/ml) after 10 months. Radioiodine scintigraphy and abdominal computed tomography revealed liver metastasis and peritoneal seeding. She underwent debulking surgery of the liver, right salpinx, and peritoneal seeding nodules. A pathological examination showed metastatic follicular carcinoma with focal poorly differentiated features. Adjuvant RAI therapy was restarted, and her serum thyroglobulin levels returned to normal. In conclusion, metastatic lesions were successfully treated with a combination of debulking surgery and RAI therapy. Close medical follow-up monitoring serum thyroglobulin levels is mandatory in such patients.

Figures and Tables

Fig. 1
Imaging studies of the metastatic struma ovarii. (A) An iodine-131 scan after radioactive iodine therapy. This test revealed several nodules in the right upper quadrant of the abdomen (liver, arrow), peritoneum (arrow), and pelvic cavity (arrow). (B) Computed tomography scans showing an enhanced conglomerate nodular mass (arrow) in segment 6 of the liver with several daughter nodules and multiple seeding nodules (arrow). (C) The fluorodeoxyglucose-positron emission tomography (18-FDG-PET) scans showing increased uptake in the exophytic liver mass (arrow) and lymph nodes in neck level II.
Fig. 2
Pathological examination of the metastatic follicular struma ovarii. (A) A metastatic follicular carcinoma in the liver at the bottom. (B) High-power magnification of the metastatic lesion in the liver shows many follicular masses. (C, D) Mulifocal necrosis (C) and positive P53 staining (D) represent the possibility of malignant transformation.
Table 1
Literature review of malignant follicular struma ovarii cases

TAH/BSO, total abdominal hysterectomy/bilateral salpingo-oophorectomy; RTx, radiotherapy; NED, no evidence of disease; USO, unilateral salpingo-oophorectomy; NI, not indicated; CTx, chemotherapy; DOD, died of disease


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