Struma ovarii, microscopic picture - atlas of Ovary

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Struma ovarii is a teratoma defined by the presence of thyroid tissue in more than 50% of the tumor. Struma ovarii comprises 1–4% of benign ovarian teratoma.

It is a benign condition, but occasionally malignant transformation is observed in about 5% of cases. However, due to rarity of this type of tumor there has been a paucity of data in the past literature pertaining to diagnosis and treatment of this tumor.

For the vast majority of cases, surgical resection of the ovary is sufficient to treat benign, unilateral disease. A paucity of evidence exists in the literature regarding conservative management in cases with evidence of malignancy. In these patients, serum thyroglobulin levels can be followed as a marker for recurrence following fertility-sparing unilateral salpingo-oophorectomy. In patients who do not desire future fertility, malignant struma ovarii necessitates surgical staging for ovarian cancer with pelvic washings, total abdominal hysterectomy, bilateral salpingo-oophorectomy, lymph node sampling, total thyroidectomy, and radioactive I-131 ablation. The recurrence rate in patients with malignant struma ovarii who undergo surgery without subsequent radioablation has been cited as high as 50%.




Microscopically, this teratoma has cartilage, adipose tissue, and intestinal glands at the right, while at the left is a lot of thyroid tissue. This condition can be termed struma ovarii. Rarely, a struma ovarii can even be a cause for hyperthyroidism.