Bilateral benign non functional struma ovarii with Pseudo-Meigs' syndrome.

Bilateral presentation of benign Struma ovarii is rare and has not been reported frequently in published literature. A 70-year-old postmenopausal female presented with progressive ascites, bilateral pleural effusion and elevated CA-125 levels. The contrast-enhanced computed tomography (CECT) of the abdomen and pelvis revealed a heterogenous mass in the left adnexa. These findings were suspicious for an ovarian malignancy. After surgery the diagnosis of non functional, bilateral benign Struma ovarii was made. Struma ovarii is a specialized ovarian teratoma composed predominantly of mature thyroid tissue. It is associated with pleural effusion and ascites (Pseudo-Meigs' syndrome) in 5% of cases. The combination of struma ovarii and elevated CA-125 levels has been reported infrequently. This is a rare case of bilateral benign struma ovarii associated with Pseudo-Meigs' syndrome and elevated CA-125 levels. Surgical excision of the ovarian masses induced immediate resolution of the ascites and pleural effusion and a reduction of the serum CA-125 level.

Histologic spectrum of struma ovarii.

Six cases of struma ovarii, including two with associated carcinoid, with unusual microscopic features are described. The patients' age ranged from 22 to 50 years. The patients were clinically euthyroid. The largest tumour was 10 cms. in great dimension. All tumours were unilateral. Microscopically various changes observed in a non-neoplastic thyroid gland were observed in the struma including Hashimotos thyroiditis and goitrous change. Adenomatous foci with microfollicles were observed in one case. A trabecular carcinoid admixed with mucinous glands lined bygoblet cells which were argyrophilic was seen in two of the neoplasms. This finding is rare and has been reported only once before. In conclusion it is important for a pathologist to be aware of the changes that may be associated with struma ovarii, so as not to confuse it with other neoplasms. A careful search for typical thyroid follicles, or other components of a dermoid help to arrive at a diagnosis.