title: Unilateral malignant struma ovarii in a case of bilateral ovarian teratoma with raised CA-125 level: a rare case with treatment dilemmas.
abstract: Struma ovarii are specialized form of mature ovarian teratoma comprised predominantly of thyroid tissue (>50%). Most of the struma ovarii are benign; rarely can they undergo malignant transformation. Elevated CA-125 levels with benign struma ovarii have been seen in only 5 cases in literature. The association of malignant struma ovarii and high CA-125 levels with pseudo-Meig syndrome has been reported in only 2 cases in English literature. We describe a case of a 46-year-old multigravida who presented with an abdominal mass and raised CA-125 levels. Radiological investigations revealed bilateral cystic adnexal masses with ossified elements on left side suggesting a teratoma. Intraoperative frozen section and final pathology revealed bilateral teratoma with follicular variant of papillary thyroid carcinoma arising in the left ovary. To the best of our knowledge, this is the first case of malignant struma ovarii in combination with bilateral teratoma. The dilemmas related to preoperative diagnoses with elevated CA-125 levels, mimicking an epithelial ovarian neoplasm; intraoperative frozen section consultation; management and follow-up issues in this rare malignancy are discussed.
authors.affiliation: Department of Pathology, Tata Memorial Hospital, Parel, Mumbai, India. santosh.menon@rediffmail.com
authors.forename: Santosh
authors.initials: S
authors.lastname: Menon
authors.forename: Kedar
authors.initials: K
authors.lastname: Deodhar
authors.forename: Bharat
authors.initials: B
authors.lastname: Rekhi
authors.forename: Abraham
authors.initials: A
authors.lastname: John
authors.forename: Amita
authors.initials: A
authors.lastname: Maheshwari
mesh_terms: D018394:CA-125 Antigen / Q000097:blood*; D005260:Female; D006651:Histocytochemistry; D006801:Humans; D008853:Microscopy; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D044967:Serum / Q000737:chemistry; D013330:Struma Ovarii / Q000175:diagnosis* / Q000473:pathology*
chemical_list: D018394:CA-125 Antigen