Share This Article:

Intra-operative consult for cystic struma ovarii—An experience in an academic medical center: A study of 53 cases over 21 years

DOI: 10.4236/ojog.2013.37A1001    3,554 Downloads   4,824 Views  


Struma ovarii often escapes recognition during intraoperative consultation because of its rarity, subtle characteristic gross appearance, and lack of clinical suspicion. An intraoperative diagnosis of benign struma ovarii enables the general gynecologic surgeon to continue the planned surgery. However, a diagnosis of malignnancy in a struma ovarii would alter the course of surgery with the involvement of a gynecologic oncology surgeon. We present here that our experience with intraoperative consultation for preoperatively undiagnosed struma ovarii presenting as an adnexal cystic or solid mass at our teaching hospital. Fifty-three cases of struma ovarii, 5.2% of all cystic teratoma of the same period, were diagnosed between January 1991 and March 2011. All intraoperative consultation reports, gross descriptions and final pathology reports were reviewed. The H&E stained slides and in selected cases, immunohistochemistry stained slides, were reviewed. Of the 53 cases of struma ovarii, intraoperative consultation was requested on 48 cases. Frozen section was done on 24 cases and only gross examination was felt appropriate in remaining 24 cases. 83% cases were diagnosed when a frozen section was done. None of the remaining 24 cases were recognized as struma by gross inspection. Our findings reveal that in a large number of cases the diagnosis of struma ovarii remained unrecognized during intraoperative consultation, indicating its often subtle/deceptive gross morphologic appearance. However, the purpose of the intraoperative consultation was served, as appropriate information was provided to the surgeon to guide the surgical management.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Quddus, M. , Xiong, J. , Begum, S. , Lomme, M. , Hansen, K. , Sung, C. and Lawrence, W. (2013) Intra-operative consult for cystic struma ovarii—An experience in an academic medical center: A study of 53 cases over 21 years. Open Journal of Obstetrics and Gynecology, 3, 1-6. doi: 10.4236/ojog.2013.37A1001.


[1] Gusberg, S.B. and Danforth, D.N. (1944) Clinical significance of struma ovarii. American Journal of Obstetrics & Gynecology, 48, 537.
[2] Szyfelbein, W.M., Young, R.H. and Scully, R.E. (1995) Struma ovarii simulating ovarian tumors of other types. A report of 30 cases. The American Journal of Surgical Pathology, 19, 21-29. doi:10.1097/00000478-199501000-00003
[3] Szyfelbein, W.M., Young, R.H. and Scully, R.E. (1994) Cystic struma ovarii: A frequently unrecognized tumor. A report of 20 cases. The American Journal of Surgical Pathology, 18, 785-788. doi:10.1097/00000478-199408000-00004
[4] Devaney, K., Snyder, R., Norris, H.J. and Tavassoli, F.A. (1993) Proliferative and histologically malignant struma ovarii: A clinicopathologic study of 54 cases. The International Journal of Gynecological Pathology, 12, 333-343. doi:10.1097/00004347-199310000-00008
[5] Robboy, S.J. and Scully, R.E. (1980) Strumal carcinoid of ovary: An analysis of 50 cases of a distinctive tumor composed of thyroid tissue and carcinoid. Cancer, 46, 2019-2034. doi:10.1002/1097-0142(19801101)46:9<2019::AID-CNCR2820460921>3.0.CO;2-W
[6] Stagno, P.A., Petras, R.E. and Hart, W.R. (1987) Strumal carcinoid of the ovary. An immunohistochemical and ultrastructural study. Archives of Pathology & Laboratory Medicine, 111, 440-446.
[7] Smith, F.G. (1946) Pathology and physiology of struma ovarii. Archives of Surgery, 53, 603. doi:10.1001/archsurg.1946.01230060614001
[8] Utsunomiya, D., Shiraishi, S., Kawanaka, K., et al. (2003) Struma ovarii coexisting with mucinous cystadenoma detected by radioactive iodine. Clinical Nuclear Medicine, 28, 725-727. doi:10.1097/ 01.rlu.0000082657.06194.b3
[9] Terada, T. and Tateoka, K. (2012) Ovarian cystic tumor composed of Brenner tumor and struma ovarii. International Journal of Clinical and Experimental Pathology, 5, 274-277.
[10] Alduaij, A. and Quddus, M.R. (2012) Clear cell carcinoma of the ovary mimicking struma ovarii and carcinoid tumor. Annals of Diagnostic Pathology, 15, 124-127. doi:10.1016/j.anndiagpath. 2010.02.002
[11] Talerman, A. (1994) Germ cell tumors of the ovary. In: Kurman, R.J. Ed., Blaustein’s Pathology of the Female Genital Tract, 4th Edition, Springer-Verlag, New York, 884-886. doi:10.1007/978-1-4757-3889-6_20
[12] Young, R.H., Clement, P.B., Scully, R.E. (1994) The ovary. In: Sternberg, S.S., Ed., Diagnostic Surgical Pathology, Raven Press, New York, 2252-2253.
[13] Peterson, W.F., Prevost, E.C., Edmunds, F.T., Huntley, Jr. J.M. and Morris, F.K. (1955) Benign cystic teratomas of the ovary. A clinico-statistical study of 1007 cases with review of the literature. American Journal of Obstetrics & Gynecology, 70, 368.
[14] Russell, P. (1994) Surface epithelial-stromal tumors of the ovary. In: Kurman, R.J., Ed., Blaustein’s Pathology of the Female Genital Tract, 4th Edition, Springer-Verlag, New York, 724. doi:10.1007/978-1-4757-3889-6_18

comments powered by Disqus

Copyright © 2019 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.