A Challenging Case of Fertility Preservation in Metastatic Struma Ovarii in a 29-Year Old With Successful Delivery.

Introduction: Struma ovarii is a rare ovarian teratoma characterised by the unusual presence of thyroid tissue. Even though usually benign, malignant transformation is sometimes detected. We report such a case of malignant struma ovarii in a 29-year-old nulliparous woman who was managed systematically with fertility preservation and followed up to have a successful delivery.

Patient Intervention: The patient was diagnosed to have bilateral complex ovarian cyst when evaluated for pain abdomen. She underwent bilateral ovarian cystectomy with frozen section biopsy as initial management. On diagnosing as malignant epithelial ovarian tumour in frozen, definitive treatment was planned after final histopathology report and fertility preservation. Her histopathology showed stage 3 malignant struma ovarii. Multidisciplinary team was convened. After further detailed evaluation, she had embryo freezing by controlled ovarian stimulation with antagonist protocol. Two good quality embryos were vitrified on day 2 post-intra-cytoplasmic sperm insemination (ICSI). She underwent staging laparotomy that included uterus conserving surgery with bilateral oophorectomy, omentectomy, peritonectomy, appendicectomy with total thyroidectomy and iodine ablation. After 1 year of follow-up, embryo transfer was done which resulted in a successful delivery. This is, to our knowledge, the first case of fertility preservation after stimulation with gonadotropins in a case of malignant struma ovarii.

Conclusion: Poor ovarian reserve due to bilateral ovarian cystectomy, time constraint as she had to undergo a definitive surgery and residual complex ovarian cystic lesions made this a challenging case.