title: Metastatic malignant struma ovarii with coexistence of Hashimoto's thyroiditis.
abstract: Struma ovarii is a rare ovarian teratoma characterized by the presence of thyroid tissue as the major component. Malignant transformation of the thyroidal component (malignant struma ovarii) has been reported in approximately 5% of struma ovarii. The management and follow-up of this unusual disease remain controversial. We report the case of a woman with a history of autoimmune thyroiditis and a previous resection of a benign struma ovarii that underwent hystero-annexiectomy for malignant struma ovarii with multiple papillary thyroid cancer foci and peritoneal involvement. Total thyroidectomy and subsequent radioiodine treatment lead to complete disease remission after 104 months of follow-up. The diagnosis and natural progression of malignant struma ovarii are difficult to discern, and relapses can occur several years after diagnosis. A multidisciplinary approach is mandatory; after surgical excision of malignant struma, thyroidectomy in combination with (131)I therapy should be considered after risk stratification in accordance with a standard approach in differentiated thyroid cancer patients.
  
  
  CONCLUSIONS
  Malignant struma ovarii is a rare disease; diagnosis is difficult and management is not well defined.Predominant sites of metastasis are adjacent pelvic structures.Thyroidectomy and (131)I therapy should be considered after risk stratification in accordance with standard approaches in DTC patients.
authors.affiliation: Endocrinology, Department of Clinical and Experimental Medicine, University of Messina , Messina , Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Russo
authors.affiliation: Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Hospital , Catania , Italy.
authors.forename: Ilenia
authors.initials: I
authors.lastname: Marturano
authors.affiliation: Surgical Oncology, Garibaldi-Nesima Hospital , Catania , Italy.
authors.forename: Romilda
authors.initials: R
authors.lastname: Masucci
authors.affiliation: Gynecology and Obstetrics, Garibaldi-Nesima Hospital , Catania , Italy.
authors.forename: Melania
authors.initials: M
authors.lastname: Caruso
authors.affiliation: Nuclear Medicine, Garibaldi-Nesima Hospital , Catania , Italy.
authors.forename: Maria Concetta
authors.initials: MC
authors.lastname: Fornito
authors.affiliation: Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Hospital , Catania , Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Tumino
authors.affiliation: Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Hospital , Catania , Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Tavarelli
authors.affiliation: Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Hospital , Catania , Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Squatrito
authors.affiliation: Endocrinology, Garibaldi-Nesima Hospital , Catania , Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Pellegriti