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Clinical Presentation: The patients are usually peri- or post-menopausal women. Most cases are asymptomatic and discovered incidentally. Some patients present with symptoms related to mass-effect, ascites (one-third of cases) or hyperthyroidism (<10% of cases).

Gross Pathology: Struma ovarii is unilateral, usually solid with small cystic areas, and measures under 10 cm in most cases. The cut surface is soft, waxy or gelatinous, with a golden yellow to beefy, reddish-brown color resembling normal thyroid or a goiter. Uncommonly, the cystic changes are dominant and it appears as a multiloculated cyst, which may be mistaken for serous cystadenoma.

Image courtesy of: Jian-Hua Qiao, MD, Los Angeles, California, USA. Used with permission.

Image 126 of 183