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      Struma ovarii: role of imaging?

      review-article
      , ,
      Insights into Imaging
      Springer Berlin Heidelberg
      Struma-ovarian tumour, Imaging, MRI, Cystic

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          Abstract

          As clinical features in struma ovarii patients in the absence of thyrotoxicosis are generally non-specific and resemble ovarian malignancy, preoperative radiological diagnosis becomes all the more relevant in order to avoid ovarian cancer type surgery (including bilateral salpingo-oophorectomy, hysterectomy, omentectomy and occasionally appendectomy) for this usually benign and rare ovarian mass. As struma ovarii is an uncommon entity, it is all the more important to perform state-of-the-art magnetic resonance (MR) imaging, including high-resolution imaging and diffusion-weighted imaging. The goal of this review paper is to give an update of the key findings of both benign and malignant struma ovarii and to present an unusual case of a purely cystic ovarian struma.

          Key Points

          Clinical features in struma ovarii are generally non- specific and resemble ovarian malignancy.

          Pre- operative radiological diagnosis is important to avoid ovarian cancer type surgery ( bilateral salpingo- oophorectomy, hysterectomy, omentectomy and occasionally appendectomy).

          State- of- the- art MR imaging might help to characterise this unusual ovarian mass.

          Struma ovarii can occasionally present as a purely cystic lesion.

          However, the role of imaging to identify struma ovarii preoperatively remains limited.

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          Most cited references45

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          Ovarian teratomas: tumor types and imaging characteristics.

          Ovarian teratomas include mature cystic teratomas (dermoid cysts), immature teratomas, and monodermal teratomas (eg, struma ovarii, carcinoid tumors, neural tumors). Most mature cystic teratomas can be diagnosed at ultrasonography (US) but may have a variety of appearances, characterized by echogenic sebaceous material and calcification. At computed tomography (CT), fat attenuation within a cyst is diagnostic. At magnetic resonance (MR) imaging, the sebaceous component is specifically identified with fat-saturation techniques. The US appearances of immature teratoma are nonspecific, although the tumors are typically heterogeneous, partially solid lesions, usually with scattered calcifications. At CT and MR imaging, immature teratomas characteristically have a large, irregular solid component containing coarse calcifications. Small foci of fat help identify these tumors. The US features of struma ovarii are also nonspecific, but a heterogeneous, predominantly solid mass may be seen. On T1- and T2-weighted images, the cystic spaces demonstrate both high and low signal intensity. Familiarity with the US, CT, and MR imaging features of ovarian teratomas can aid in differentiation and diagnosis.
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            Mature and immature ovarian teratomas: CT, US and MR imaging characteristics.

            Ovarian teratomas (OTs) are the most common germ cell neoplasm. They include mature cystic teratomas, monodermal teratomas (neural tumors, struma ovarii, carcinoid tumors) and immature teratomas. Teratomas are the most common benign ovarian neoplasms in women less than 45 years old. OTs are usually characterized by ultrasound (US) and magnetic resonance (MR) whereas they are usually an incidental finding on CT. The purpose of this paper is to review the most common types of teratomas and to describe CT, US and MR imaging features of the various types of mature and immature OTs.
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              Clinical characteristics of struma ovarii.

              To evaluate the clinical characteristics of struma ovarii. Twenty-five cases of struma ovarii were reviewed retrospectively from June 1994 to April 2007. The presenting clinical, radiologic, and pathologic features of the patients were reviewed. The mean age of the patients in this study was 45.3 years. The majority was of premenopausal status. Sixteen patients had clinical symptoms such as low abdominal pain, palpable abdominal mass and vaginal bleeding. Although one patient had an abnormal thyroid function test, the laboratory findings normalized after operative treatment. CA-125 levels were elevated in 6 cases. Diagnosis by preoperative imaging studies were 8 dermoid cysts, while only 3 cases were diagnosed as struma ovarii. There were 4 cases of malignant struma ovarii, and no patients with recurrent disease. Struma ovarii is a rare tumor. The presented clinical, laboratory and radiological findings of patients are very diverse. The diagnosis was confirmed by pathologic findings. The treatment of benign struma ovarii is surgical resection only. The cases of malignant struma ovarii may need adjuvant treatment, but recurrence is uncommon.
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                Author and article information

                Contributors
                +44-1482-674078 , +44-1482-320137 , martine.dujardin@gmail.com
                Priti.sekhri@hey.nhs.uk
                +44-1482-674078 , +44-1482-320137 , L.W.Turnbull@hull.ac.uk
                Journal
                Insights Imaging
                Insights Imaging
                Insights into Imaging
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                1869-4101
                20 December 2013
                20 December 2013
                February 2014
                : 5
                : 1
                : 41-51
                Affiliations
                [ ]Centre for MR Investigations, University of Hull in association with Hull York Medical School, Anlaby Road, Hull, HU3 2JZ East Yorkshire UK
                [ ]Hull and East Yorkshire Hospitals NHS Trust, Histopathology Department, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ UK
                [ ]Centre for MR Investigations, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ UK
                Article
                303
                10.1007/s13244-013-0303-3
                3948908
                24357453
                a00bb1d5-45c9-437d-bf9b-f9a450a2c65d
                © The Author(s) 2013

                Open Access This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

                History
                : 19 August 2013
                : 17 November 2013
                : 20 November 2013
                Categories
                Pictorial Review
                Custom metadata
                © The Author(s) 2014

                Radiology & Imaging
                struma-ovarian tumour,imaging,mri,cystic
                Radiology & Imaging
                struma-ovarian tumour, imaging, mri, cystic

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