Malignant struma ovarii: An unusual presentation

Malignant struma. ovarii is a rare disease; only a few cases are well docum ented in the literature. Thus, the overall prognosis and modalities of trea tment are still somewhat controversial. In this article, the authors report a case of malignant struma ovarii discovered 4 years after ovariectomy aft er metasasis to the lungs and bones. Review of the pathology of the ovarian struma did not reveal the classic criteria of malignancy, there were, howe ver, many features considered to be atypical and thus suspicious. The patie nt was treated by total thyroidectomy followed by repetitive doses of I-131 . However, because of difficulties in increasing the level of endogenous th yrotropin (TSH) because of functional thyroid metastases in such an advance d disease, recombinant human thyrotropin (rhTSH; Thyrogen (R), thyrotropin alpha, Genzyme Corporation, Cambridge, MA) was used before administration o f radioiodine. With this therapeutic protocol, the patient is still clinica lly stable 2 years after diagnosis.