LAUSR

malignant transformation of struma ovarii is rare (5% of all struma) [2]. It is diagnosed because of an abdominal mass and/or pelvic pain, as in our case. Rarely menstrual abnormalities and hyperthyroidism are present [2]. Generally it is a papillary carcinoma, rarely a follicular carcinoma. Metastases have been found in 5–23% of cases [2]. The rarity of the disease makes therapeutic management still debated [3]. The extension of pelvic surgery depends on the local extension and on patients’ age; in young women, unilateral oophorectomy is advocated, when tumor is confined to one ovary [3]. Some authors suggest a multimodal management of malignant struma ovarii as total thyroidectomy followed by radioiodine treatment to exclude any primitive thyroid carcinoma, local and distance metastasis and unable thyroglobulin dosage as biochemical marker for follow-up [3]. Because of the local extension of disease, thyroid histology, and TG, TGAb, and TSH levels, I-131 radioiodine treatment was not performed at the moment, according to 2015 ATA guidelines for thyroid cancer. Total body CT scan excluded any persistence of disease at 12 months after surgical treatment. These observations enforce the concept that the initial treatment and the subsequent management and follow-up depend on the features of the single patient such as the age of presentation and the extension of primary disease. Serum thyroglobulin and pelvic and abdominal imaging have a key role in the long-term follow-up of these patients.