Journal Mobile Options
Table of Contents
Vol. 75, No. 2, 2013
Issue release date: February 2013
Gynecol Obstet Invest 2013;75:139-144

Two Cases of Malignant Struma Ovarii with Metastasis to Pelvic Bone

Steinman R.A. · De Castro I.O. · Shrayyef M. · Chengazi V. · Giampoli E. · Van Der Sloot P. · Calvi L.M. · Wittlin S.D. · Hammes S.R. · Hou R.
aDivision of Endocrinology and Metabolism, Departments of bRadiology, and cPathology, dDivision of Otolaryngology, University of Rochester School of Medicine, Rochester, N.Y., USA; eDepartment of Medicine, Moncton Hospital, Moncton, N.B., fDepartment of Medicine, Dalhousie University, Halifax, N.S., and gDepartment of Medicine, Memorial University, St. John, Nfld., Canada

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in


Histologically, malignant struma ovarii metastasizes rarely, and only a few cases reported bone metastasis. Here, we describe 2 cases of biologically malignant struma ovarii with pelvic bone metastasis. Case 1 is a 22-year-old female who was found to have a large left ovarian mass during routine prenatal ultrasound. Papillary thyroid cancer arising in struma ovarii was identified after laparoscopic salpingo-oophorectomy. After total thyroidectomy, radioactive iodine whole-body scan revealed extrathyroidal iodine uptake in left anterior pelvis. Subsequent I-131 treatment resolved the pelvic metastasis. Case 2 is a 49-year-old female who was diagnosed with malignant struma ovarii in 1996 and presented in 2007 with pelvic recurrence and extensive left hip metastasis. Treatment with resection of the pelvic tumor, total thyroidectomy, and multiple I-131 ablation led to eventual resolution of the abdominal and left hip foci. In conclusion, we present 2 rare cases of malignant struma ovarii, both with metastasis to the pelvic bone. This report makes pelvic bone the most frequent site for bone metastasis in malignant struma ovarii. It also emphasizes the importance of total thyroidectomy in allowing identification and treatment of bony metastasis with radioactive iodine.

Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  1. 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;89:543-548.
  2. Garg K, Soslow RA, Rivera M, Tuttle MR, Ghossein RA: Histologically bland ‘extremely well differentiated' thyroid carcinomas arising in struma ovarii can recur and metastasize. Int J Gynecol Pathol 2009;28:222-230.
  3. Yoo SC, Chang KH, Lyu MO, Chang SJ, Ryu HS, Kim HS: Clinical characteristics of struma ovarii. J Gynecol Oncol 2008;19:135-138.
  4. Yamashita M, Ishii T, Ohtori S, Oikawa Y, Watanabe T, Ito T: Metastasis of malignant struma ovarii to the lumbar spine. J Clin Neurosci 2010;17:269-272.
  5. Dardik RB, Dardik M, Westra W, Montz FJ: Malignant struma ovarii: two case reports and a review of the literature. Gynecol Oncol 1999;73:447-451.
  6. McGill JF, Sturgeon C, Angelos P: Metastatic struma ovarii treated with total thyroidectomy and radioiodine ablation. Endocr Pract 2009;15:167-173.

    External Resources

  7. Checrallah A, Medlej R, Saade C, Khayat G, Halaby G: Malignant struma ovarii: an unusual presentation. Thyroid 2001;11:889-892.
  8. Wynne HMN, McCartney JC, McClendon JF: Struma ovarii. Am J Obst Gynecol 1940;39:262-269.
  9. McDougall IR, Krasne D, Hanbery JW, Collins JA: Metastatic malignant struma ovarii presenting as paraparesis from a spinal metastasis. J Nucl Med 1989;30:407-411.

    External Resources

  10. McDougall IR: Metastatic struma ovarii: the burden of truth. Clin Nucl Med 2006;31:321-324.
  11. Chan SW, Farrell KE: Metastatic thyroid carcinoma in the presence of struma ovarii. Med J Aust 2001;175:373-374.

    External Resources

  12. Tokuda Y, Hatayama T, Sakoda K: Metastasis of malignant struma ovarii to the cranial vault during pregnancy. Neurosurgery 1993;33:515-518.

    External Resources

  13. Zekri JM, Manifold IH, Wadsley JC: Metastatic struma ovarii: late presentation, unusual features and multiple radioactive iodine treatments. Clin Oncol (R Coll Radiol) 2006;18:768-772.
  14. Kempers RD, Dockerty MB, Hoffman DL, Bartholomew LG: Struma ovarii - ascitic, hyperthyroid, and asymptomatic syndromes. Ann Intern Med 1970;72:883- 893.

    External Resources

  15. Hatami M, Breining D, Owers RL, Del Priore G, Goldberg GL: Malignant struma ovarii - a case report and review of the literature. Gynecol Obstet Invest 2008;65:104-107.
  16. Makani S, Kim W, Gaba AR: Struma ovarii with a focus of papillary thyroid cancer: a case report and review of the literature. Gynecol Oncol 2004;94:835-839.
  17. Brenner W, Bohuslavizki KH, Wolf H, Sippel C, Clausen M, Henze E: Radiotherapy with iodine-131 in recurrent malignant struma ovarii. Eur J Nucl Med 1996;23:91-94.
  18. Rotman-Pikielny P, Reynolds JC, Barker WC, Yen PM, Skarulis MC, Sarlis NJ: Recombinant human thyrotropin for the diagnosis and treatment of a highly functional metastatic struma ovarii. J Clin Endocrinol Metab 2000;85:237-244.
  19. Devaney K, Snyder R, Norris HJ, Tavassoli FA: Proliferative and histological malignant struma ovarrii: a clinicopathologic study of 54 cases. Int J Gynecol Pathol 1993;12:333-343.

    External Resources

  20. Robboy SJ, Shaco-Levy R, Peng RY, Snyder MJ, Donahue J, Bentley RC: Malignant struma ovarii: an analysis of 88 cases, including 27 with extraovarian spread. Int J Gynecol Pathol 2009;28:405-422.
  21. Shaco-Levy R, Bean SM, Bentley RC, Robboy SJ: Natural history of biologically malignant struma ovarii: analysis of 27 cases with extra-ovarian spread. Int J Gynecol Pathol 2010;29:212-227.
  22. Logani S, Baloch ZW, Snyder PJ, Weinstein R, LiVolsi VA: Cystic ovarian metastasis from papillary thyroid carcinoma: a case report. Thyroid 2001;11:1073-1075.
  23. Silverberg SG, Hutter RV, Foote FW Jr: Fatal carcinoma of the thyroid: histology, metastases, and causes of death. Cancer 1970;25:792-802.

    External Resources

  24. Tollefsen HR, Decosse JJ, Hutter RV: Papillary carcinoma of the thyroid. A clinical and pathological study of 70 fatal cases. Cancer 1964;17:1035-1044.

    External Resources

  25. Marti JL, Clark VE, Harper H, Chhieng DC, Sosa JA, Roman SA: Optimal surgical management of well-differentiated thyroid cancer arising in struma ovarii: a series of 4 patients and a review of 53 reported cases. Thyroid 2012;22:400-406.

Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50