This is a biopsy from a 50 year old woman who presented with tremor, sweating, heat intolerance, palpitations, anxiety, diarrhea, and inability to sleep. On exam, you note tachycardia, a wide pulse pressure, hypertension, a prominent stare and lid lag (but no proptosis). Surprised, you find a pelvic mass and ascites. There is no goiter and an iodine uptake test shows minimal uptake in the thyroid.Challenge: What's going on?
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Dermoid cyst of ovary producing Thyroxine.. Struma Ovarii
struma ovarii
Teratoma ?
struma ovarii
really well done! i definitely did not remember struma ovarii / teratoma. i'm impressed :) see you in a week!
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Goiter
Struma ovarii is the presence of thyroid tissue in an ovarian tumor, almost always a teratoma. Note, the histology shows cartilage, adipose, intestinal glands, as well as thyroid tissue.
Sources: UpToDate; library.med.utah.edu.
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