Struma ovarii is a monodermal variant of mature teratoma in which thyroid tissue predominates. Struma ovarii is a monodermal variant of ovarian teratoma, which was initially described by Bottlin in 1888 and, later, by Pick in 1902 and 1903, who recognized that struma ovarii was composed of thyroid tissue.1 Malignancy of struma ovarii is rare. Lisa Rubinsak, MD Fellow in Advanced Pelvic Surgery, Emory University School of Medicine View all Google Scholar citations Alvarez, Edwin A. Piquer, Dolors 2009 Sep. 28(5):405-22. Diseases & Conditions, 2002 Int J Surg Case Rep. 2017. Weinberger V, Kadlecova J, Minář L, Felsinger M, Anton M, Ovesna P, et al. The incidence of malignancy arising in patients with struma ovarii is rare. Investigations revealed a mass arising from the left ovary. Three months post-operatively, she remained thyrotoxic despite stopping thyroxine. Struma ovarii is a rare ovarian tumor defined by the presence of thyroid tissue comprising more than 50% of the overall mass. /viewarticle/941903 Thyroid tissue can be observed in 5-15% of dermoid tumors but to designate the tumor as struma ovarii, it must comprise more than 50% of the ovarian tissue. First described by Von Klden in 1895 and Gottschalk in 1899, struma ovarii is the most common type of monodermal teratoma, and comprises about 3.0% of all ovarian teratomas. Thyroid tissue is either the major constituent or is the cause of thyrotoxicosis in 2‑4% of teratomata (2). Sarah H Hughes, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, Society of Gynecologic OncologyDisclosure: Nothing to disclose. Due to difficulties in assessing the rare biological nature and the discrepancies in the reported cases, a consensus on the appropriate treatment has not been definitively reached. It is defined by the presence of thyroid tissue comprising more than 50% of the overall mass. The incidence of malignancy arising in patients with struma ovarii is rare. Struma ovarii is a monodermal variant of ovarian teratoma, which was initially described by Bottlin in 1888 and, later, by Pick in 1902 and 1903, who recognized that struma ovarii was composed of thyroid tissue. The common presentation is abdominal, with pelvic mass and pain, traditionally managed by gynaecologists. 2008 Nov-Dec. 33(6):740-3. Malignant struma ovarii presenting with follicular carcinoma is extremely rare, and its mechanism of tumorigenesis remains unknown. Ovarian teratoma either composed predominantly or exclusively of benign thyroid tissue or with any amount of malignant thyroid tissue Most common thyroid malignancy to occur in struma ovarii is papillary thyroid carcinoma, followed by follicular carcinoma Thyroid tissue is either the major constituent or is the cause of thyrotoxicosis in 2‑4% of teratomata (2). Wolsky, Rebecca J. Struma ovarii is ectopic thyroid tissue associated with dermoid tumors or ovarian teratomas that can secrete excessive amounts of thyroid hormone and produce thyrotoxicosis. [Medline]. 1950573-overview It is an uncommon neoplasm, usually asymptomatic with an unknown risk of malignant transformation. The simultaneous presence of thyroid carcinoma in the struma ovarii and the thyroid gland is extremely rare. Ovarian symptoms include metrorrhagia, abdominal or pelvic pain or palpable abdominal mass that has no specific traits on clinical examination, making diagnosis difficult. 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