TITLE:
Intra-operative consult for cystic struma ovarii—An experience in an academic medical center: A study of 53 cases over 21 years
AUTHORS:
M. Ruhul Quddus, Jinjun Xiong, S. M. K. Nahar Begum, Michele Lomme, Katrine Hansen, C. James Sung, W. Dwayne Lawrence
KEYWORDS:
Struma Ovarii; Intraoperative Consult; Ovarian Cyst
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.3 No.7A,
September
5,
2013
ABSTRACT: Struma ovarii often escapes recognition during intraoperative consultation because of
its rarity, subtle characteristic gross appearance, and lack of clinical
suspicion. An intraoperative diagnosis of benign struma ovarii enables the
general gynecologic surgeon to continue the planned surgery. However, a
diagnosis of malignnancy in a struma ovarii would alter the course of surgery
with the involvement of a gynecologic oncology surgeon. We present here that our
experience with intraoperative consultation for preoperatively undiagnosed
struma ovarii presenting as an adnexal cystic or solid mass at our teaching
hospital. Fifty-three cases of struma ovarii, 5.2% of all cystic teratoma of the
same period, were diagnosed between January 1991 and March 2011. All intraoperative
consultation reports, gross descriptions and final pathology reports were
reviewed. The H&E stained slides and in selected cases, immunohistochemistry
stained slides, were reviewed. Of the 53 cases of struma ovarii, intraoperative
consultation was requested on 48 cases. Frozen section was done on 24 cases and
only gross examination was felt appropriate in remaining 24 cases. 83% cases
were diagnosed when a frozen section was done. None of the remaining 24 cases
were recognized as struma by gross inspection. Our findings reveal that in a
large number of cases the diagnosis of struma ovarii remained unrecognized
during intraoperative consultation, indicating its often subtle/deceptive gross
morphologic appearance. However, the purpose of the intraoperative consultation
was served, as appropriate information was provided to the surgeon to guide the
surgical management.