Malignancy in struma ovarii is a rare form of ovarian germ cell tumour. Because of its rarity, the diagnosis and management of the tumour have not been clearly defined. We present a case of 67- year-old female with papillary carcinoma arising in struma ovarii and review the literature on malignancy in struma ovarii cases, focusing on management of these cases. 1. Introduction 15%–20% of ovarian tumours are teratoma. Struma ovarii is diagnosed when thyroid tissue is the predominant element (>50%) [1]. 5%–10% of these tumours are malignant, with papillary carcinoma and follicular carcinoma being the most common [1–3]. The percentage of papillary thyroid carcinoma within malignant struma ovarii is 70%, 44% of the tumours being classical type and 26% follicular variant of papillary thyroid carcinoma [4]. Recently, a new entity of follicular carcinoma, highly differentiated follicular carcinoma of ovarian origin (HDFCO), characterized by extraovarian dissemination of thyroid elements and histological resemblance to nonneoplastic thyroid tissue has been described [5]. Due to the rarity of the disease, its treatment is not uniform. Here we present a rare case of struma ovarii with papillary thyroid carcinoma, and we review the management and treatment option of this rare tumour. 2. Case report A 67-year-old female was admitted with abdominal distension and rapidly developing ascites. Ultrasound examination and CT scan of the abdomen and pelvis showed extensive abdominopelvic ascites of unknown cause. No intra-abdominal mass or pelvic abnormality was detected. Tumour marker CA125 was raised, 2000？KU/l (normal—less than 35？KU/l) but serum CEA levels were within normal limits. Clinically, ovarian cancer was suspected, however paracentesis demonstrated benign peritoneal effusion. A transvaginal scan showed solid/cystic mass in the pouch of douglas 8？×？6？×？4？cm. She underwent laparotomy which showed copious amount of benign ascitic fluid and a left ovarian mass. The possibility of a dermoid cyst was considered. A total abdominal hysterectomy with bilateral salpingo-oopherectomy was performed along with omental biopsy and peritoneal washing. On gross pathological examination, there was a left ovarian mass measuring 10？×？7？×？3.5？cm. The external surface of the cyst was mainly smooth with a small area of yellow/green discolouration. Cut section of the cyst showed haemorrhagic solid mass. Histology of the ovarian tumour showed thyroid tissue characteristic of struma ovarii (Figure 1). However, the thyroid tissue showed focal worrying features in the form of small and
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