Papillary Thyroid Carcinoma Arising in Struma Ovarii: Case Report and Literature Review

Abstract

Background & Objective: Papillary thyroid carcinoma (PTC) arising in struma ovarii is an exceptionally rare malignancy, accounting for approximately 3% of all struma ovarii cases. In this paper, we report a case of a 61-year-old woman presenting with progressive abdominal enlargement and significant ascites, initially suspected as ovarian carcinoma. Materials & Methods: The patient underwent primary debulking surgery. Postoperative evaluation included imaging and assessment of CA-125 levels. Histopathology was used to confirm the diagnosis. Results: The results shows that imaging revealed a large multiloculated pelvic mass with ascites and pleural effusion, and markedly elevated CA-125 levels further supported the suspicion of ovarian malignancy. Histopathology confirmed papillary thyroid carcinoma arising in struma ovarii. Postoperative evaluation revealed TI-RADS 5 thyroid nodules and suspicious cervical lymphadenopathy, raising concern for synchronous primary thyroid carcinoma. Multidisciplinary management included recommendations for total thyroidectomy, radioactive iodine therapy, and thyroid hormone suppression. Conclusion: This case highlights the diagnostic challenges associated with malignant struma ovarii and underscores the importance of comprehensive postoperative thyroid evaluation. Current evidence supports a risk-stratified approach integrating therapeutic principles from differentiated thyroid cancer to optimize long-term outcomes.