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Struma Ovarii
Akram M. Shaaban, MBBCh
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Definitions

            • Example of monodermal ovarian teratoma
              • Monodermal teratomas are defined as teratomas composed predominantly or solely of single tissue type
                • Examples include struma ovarii (most common), carcinoid, and neural tumors
            • Occurs when thyroid tissue is exclusively present or constitutes > 50% of mature cystic teratoma

          IMAGING

          • General Features

            • CT Findings

              • MR Findings

                • Ultrasonographic Findings

                  • Nuclear Medicine Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Dujardin MI et al: Struma ovarii: role of imaging? Insights Imaging. 5(1):41-51, 2014
                                            2. Koo PJ et al: SPECT/CT of metastatic struma ovarii. Clin Nucl Med. 39(2):186-7, 2014
                                            3. Nurliza Binti Md Nor et al: Three cases of struma ovarii underwent laparoscopic surgery with definite preoperative diagnosis. Acta Med Okayama. 67(3):191-5, 2013
                                            4. Poncelet E et al: Value of dynamic contrast-enhanced MRI for tissue characterization of ovarian teratomas: correlation with histopathology. Clin Radiol. 68(9):909-16, 2013
                                            5. Ikeuchi T et al: CT and MR features of struma ovarii. Abdom Imaging. 37(5):904-10, 2012
                                            6. Khashper A et al: T2-hypointense adnexal lesions: an imaging algorithm. Radiographics. 32(4):1047-64, 2012
                                            7. Shen J et al: Diagnosis of Struma ovarii with medical imaging. Abdom Imaging. 36(5):627-31, 2011
                                            8. Shanbhogue AK et al: Clinical syndromes associated with ovarian neoplasms: a comprehensive review. Radiographics. 30(4):903-19, 2010
                                            9. Saba L et al: Mature and immature ovarian teratomas: CT, US and MR imaging characteristics. Eur J Radiol. 72(3):454-63, 2009
                                            10. Jung SI et al: Struma ovarii: CT findings. Abdom Imaging. 33(6):740-3, 2008
                                            11. Park SB et al: Imaging findings of complications and unusual manifestations of ovarian teratomas. Radiographics. 28(4):969-83, 2008
                                            12. Savelli L et al: Imaging of gynecological disease (4): clinical and ultrasound characteristics of struma ovarii. Ultrasound Obstet Gynecol. 32(2):210-9, 2008
                                            13. Yoo SC et al: Clinical characteristics of struma ovarii. J Gynecol Oncol. 19(2):135-8, 2008
                                            14. McDougall IR: Metastatic struma ovarii: the burden of truth. Clin Nucl Med. 31(6):321-4, 2006
                                            15. Cherng SC et al: Malignant struma ovarii with peritoneal implants and pelvic structures and liver metastases demonstrated by I-131 SPECT and low-dose CT. Clin Nucl Med. 30(12):797-8, 2005
                                            16. Garcia A et al: Malignant struma ovarii mimic clear cell carcinoma. Arch Gynecol Obstet. 271(3):251-5, 2005
                                            17. Ciccarelli A et al: Thyrotoxic adenoma followed by atypical hyperthyroidism due to struma ovarii: clinical and genetic studies. Eur J Endocrinol. 150(4):431-7, 2004
                                            18. Utsunomiya D et al: Struma ovarii coexisting with mucinous cystadenoma detected by radioactive iodine. Clin Nucl Med. 28(9):725-7, 2003
                                            19. Van de Moortele K et al: Struma ovarii: US and CT findings. JBR-BTR. 86(4):209-10, 2003
                                            20. Huh JJ et al: Struma ovarii associated with pseudo-Meigs' syndrome and elevated serum CA 125. Gynecol Oncol. 86(2):231-4, 2002
                                            21. Robboy SJ et al: Pathology of the Female Genital Tract. 1st ed. London: Harcourt. 672-4, 2002
                                            22. Outwater EK et al: Ovarian teratomas: tumor types and imaging characteristics. Radiographics. 21(2):475-90, 2001
                                            23. Emoto M et al: Transvaginal color Doppler ultrasonic characterization of benign and malignant ovarian cystic teratomas and comparison with serum squamous cell carcinoma antigen. Cancer. 88(10):2298-304, 2000
                                            24. Kim JC et al: MR findings of struma ovarii. Clin Imaging. 24(1):28-33, 2000
                                            25. Matsuki M et al: Struma ovarii: MRI findings. Br J Radiol. 73(865):87-90, 2000
                                            26. Okada S et al: Cystic struma ovarii: imaging findings. J Comput Assist Tomogr. 24(3):413-5, 2000
                                            27. Zalel Y et al: Sonographic and clinical characteristics of struma ovarii. J Ultrasound Med. 19(12):857-61, 2000
                                            28. Joja I et al: I-123 uptake in nonfunctional struma ovarii. Clin Nucl Med. 23(1):10-2, 1998
                                            29. Joja I et al: Struma ovarii: appearance on MR images. Abdom Imaging. 23(6):652-6, 1998
                                            30. Dohke M et al: Struma ovarii: MR findings. J Comput Assist Tomogr. 21(2):265-7, 1997
                                            31. Yamashita Y et al: Struma ovarii: MR appearances. Abdom Imaging. 22(1):100-2, 1997
                                            32. Zalel Y et al: Doppler flow characteristics of dermoid cysts: unique appearance of struma ovarii. J Ultrasound Med. 16(5):355-8, 1997
                                            33. Brenner W et al: Radiotherapy with iodine-131 in recurrent malignant struma ovarii. Eur J Nucl Med. 23(1):91-4, 1996
                                            34. Matsumoto F et al: Struma ovarii: CT and MR findings. J Comput Assist Tomogr. 14(2):310-2, 1990
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Clinical Issues

                                                    TERMINOLOGY

                                                    • Definitions

                                                      • Example of monodermal ovarian teratoma
                                                        • Monodermal teratomas are defined as teratomas composed predominantly or solely of single tissue type
                                                          • Examples include struma ovarii (most common), carcinoid, and neural tumors
                                                      • Occurs when thyroid tissue is exclusively present or constitutes > 50% of mature cystic teratoma

                                                    IMAGING

                                                    • General Features

                                                      • CT Findings

                                                        • MR Findings

                                                          • Ultrasonographic Findings

                                                            • Nuclear Medicine Findings

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Staging, Grading, & Classification

                                                                      • Gross Pathologic & Surgical Features

                                                                        • Microscopic Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Dujardin MI et al: Struma ovarii: role of imaging? Insights Imaging. 5(1):41-51, 2014
                                                                                      2. Koo PJ et al: SPECT/CT of metastatic struma ovarii. Clin Nucl Med. 39(2):186-7, 2014
                                                                                      3. Nurliza Binti Md Nor et al: Three cases of struma ovarii underwent laparoscopic surgery with definite preoperative diagnosis. Acta Med Okayama. 67(3):191-5, 2013
                                                                                      4. Poncelet E et al: Value of dynamic contrast-enhanced MRI for tissue characterization of ovarian teratomas: correlation with histopathology. Clin Radiol. 68(9):909-16, 2013
                                                                                      5. Ikeuchi T et al: CT and MR features of struma ovarii. Abdom Imaging. 37(5):904-10, 2012
                                                                                      6. Khashper A et al: T2-hypointense adnexal lesions: an imaging algorithm. Radiographics. 32(4):1047-64, 2012
                                                                                      7. Shen J et al: Diagnosis of Struma ovarii with medical imaging. Abdom Imaging. 36(5):627-31, 2011
                                                                                      8. Shanbhogue AK et al: Clinical syndromes associated with ovarian neoplasms: a comprehensive review. Radiographics. 30(4):903-19, 2010
                                                                                      9. Saba L et al: Mature and immature ovarian teratomas: CT, US and MR imaging characteristics. Eur J Radiol. 72(3):454-63, 2009
                                                                                      10. Jung SI et al: Struma ovarii: CT findings. Abdom Imaging. 33(6):740-3, 2008
                                                                                      11. Park SB et al: Imaging findings of complications and unusual manifestations of ovarian teratomas. Radiographics. 28(4):969-83, 2008
                                                                                      12. Savelli L et al: Imaging of gynecological disease (4): clinical and ultrasound characteristics of struma ovarii. Ultrasound Obstet Gynecol. 32(2):210-9, 2008
                                                                                      13. Yoo SC et al: Clinical characteristics of struma ovarii. J Gynecol Oncol. 19(2):135-8, 2008
                                                                                      14. McDougall IR: Metastatic struma ovarii: the burden of truth. Clin Nucl Med. 31(6):321-4, 2006
                                                                                      15. Cherng SC et al: Malignant struma ovarii with peritoneal implants and pelvic structures and liver metastases demonstrated by I-131 SPECT and low-dose CT. Clin Nucl Med. 30(12):797-8, 2005
                                                                                      16. Garcia A et al: Malignant struma ovarii mimic clear cell carcinoma. Arch Gynecol Obstet. 271(3):251-5, 2005
                                                                                      17. Ciccarelli A et al: Thyrotoxic adenoma followed by atypical hyperthyroidism due to struma ovarii: clinical and genetic studies. Eur J Endocrinol. 150(4):431-7, 2004
                                                                                      18. Utsunomiya D et al: Struma ovarii coexisting with mucinous cystadenoma detected by radioactive iodine. Clin Nucl Med. 28(9):725-7, 2003
                                                                                      19. Van de Moortele K et al: Struma ovarii: US and CT findings. JBR-BTR. 86(4):209-10, 2003
                                                                                      20. Huh JJ et al: Struma ovarii associated with pseudo-Meigs' syndrome and elevated serum CA 125. Gynecol Oncol. 86(2):231-4, 2002
                                                                                      21. Robboy SJ et al: Pathology of the Female Genital Tract. 1st ed. London: Harcourt. 672-4, 2002
                                                                                      22. Outwater EK et al: Ovarian teratomas: tumor types and imaging characteristics. Radiographics. 21(2):475-90, 2001
                                                                                      23. Emoto M et al: Transvaginal color Doppler ultrasonic characterization of benign and malignant ovarian cystic teratomas and comparison with serum squamous cell carcinoma antigen. Cancer. 88(10):2298-304, 2000
                                                                                      24. Kim JC et al: MR findings of struma ovarii. Clin Imaging. 24(1):28-33, 2000
                                                                                      25. Matsuki M et al: Struma ovarii: MRI findings. Br J Radiol. 73(865):87-90, 2000
                                                                                      26. Okada S et al: Cystic struma ovarii: imaging findings. J Comput Assist Tomogr. 24(3):413-5, 2000
                                                                                      27. Zalel Y et al: Sonographic and clinical characteristics of struma ovarii. J Ultrasound Med. 19(12):857-61, 2000
                                                                                      28. Joja I et al: I-123 uptake in nonfunctional struma ovarii. Clin Nucl Med. 23(1):10-2, 1998
                                                                                      29. Joja I et al: Struma ovarii: appearance on MR images. Abdom Imaging. 23(6):652-6, 1998
                                                                                      30. Dohke M et al: Struma ovarii: MR findings. J Comput Assist Tomogr. 21(2):265-7, 1997
                                                                                      31. Yamashita Y et al: Struma ovarii: MR appearances. Abdom Imaging. 22(1):100-2, 1997
                                                                                      32. Zalel Y et al: Doppler flow characteristics of dermoid cysts: unique appearance of struma ovarii. J Ultrasound Med. 16(5):355-8, 1997
                                                                                      33. Brenner W et al: Radiotherapy with iodine-131 in recurrent malignant struma ovarii. Eur J Nucl Med. 23(1):91-4, 1996
                                                                                      34. Matsumoto F et al: Struma ovarii: CT and MR findings. J Comput Assist Tomogr. 14(2):310-2, 1990