Question:

Concerning the differential diagnosis of struma ovarii, only one of the following answers is true
1. Struma ovarii can occur in association with mature cystic teratomas, mucinous cystadenomas and carcinoid tumors
2. Mature cystic teratomas can present as a cystic lesion with a Rokitansky nodule, which is more commonly vascular
3. The chemical shift artifact has no added value in the diagnosis of mature cystic teratomas without demonstrable fat, in comparison with fat-saturation techniques
4. Mucinous tumors usually exhibit a "stained glass appearance" due to different colloid concentrations within locules
5. Mucinous cystadenomas have usually small solid vegetations





Answer:

The correct answer for the question "Concerning the differential diagnosis of struma ovarii, only one of the following answers is true" is:

1. Struma ovarii can occur in association with mature cystic teratomas, mucinous cystadenomas and carcinoid tumors



Explanation
[However, the radiologist should be aware that 50-60% of struma ovarii cases are associated with mature cystic teratomas and, in smaller percentages, with mucinous cystadenomas and carcinoid tumors]

[Mature cystic teratomas may resemble struma ovarii on ultrasound scans, particularly when they present as a cystic lesion with an echogenic solid component (Rokitansky nodule). However, in opposition to struma ovarii, the blood flow is usually only detected at the periphery of the lesion and the Rokitansky nodule is usually avascular; if the presence of Doppler color is ever detected, the possibility of malignancy transformation should be raised

[The chemical shift artifact can also be particularly helpful in the diagnosis of teratomas without demonstrable fat (described as 15% of cases), by demonstrating a drop in signal intensity in the out-of-phase images]

[The distinction between struma ovarii and mucinous tumors is also very difficult, because both most commonly present as multiloculated cystic masses with different attenuation or signal intensity between locules, on CT and MR imaging, respectively. In the case of mucinous tumors, the "stained glass appearance" is related to different mucin concentration: thick mucin shows high signal intensity on T1-weighted images and low signal intensity on T2-weighted images, while watery mucin usually shows high signal intensity on T2-weighted images and low signal intensity on T1-weighted images]

[A malignant cystadenocarcinoma is suspected when solid components or thick and irregular wall and septa are identified, in opposite to benign cystadenomas, which usually have thin and regular wall and septa]



From the manuscript:
Papillary carcinoma arising in struma ovarii versus ovarian metastasis from primary thyroid carcinoma: a case report and review of the literature
Radiology Case. 2013 Oct; 7(10):24-33


This article belongs to the GU section.




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From the manuscript

Papillary carcinoma arising in struma ovarii versus ovarian metastasis from primary thyroid carcinoma: a case report and review of the literature

Free full text article: Papillary carcinoma arising in struma ovarii versus ovarian metastasis from primary thyroid carcinoma:  a case report and review of the literature

Abstract
We present a case of a postmenopausal woman diagnosed with an ovarian mass containing thyroid follicles and foci of papillary thyroid carcinoma during pathological examination. This patient referred having had a metachronous thyroid malignancy 10 years before. The differential diagnosis between a thyroid malignancy arising from a struma ovarii and a metastatic ovarian tumor originating from thyroid-cancer is challenging. Struma ovarii should be considered when thyroid components are the predominant element or when thyroid malignant tissue is identified within an ovarian lesion. Thyroid carcinoma arising from a struma ovarii is reported to occur in a minority of cases. Of these, papillary carcinoma is the most frequent subtype encountered. Regarding primary thyroid carcinomas, papillary carcinomas have a lower metastatic potential when compared to follicular carcinomas, and most of the metastases occur in the cervical lymph nodes. Ovarian metastases are exceedingly rare and generally associated with widespread disease. However, they must be considered in the presence of previous history of malignant thyroid carcinoma. The authors review the main clinical, imaging and therapeutic aspects of both these entities and present the most likely diagnosis.






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1. Urogenital System

2. Ovarian Neoplasms

3. Papillary thyroid carcinoma

4. Ovarian metastasis

5. Struma ovarii

6. Thyroid neoplasms


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