Unexpected diagnosis of struma ovarii in a patient with bilateral tubo-ovarian abscesses: a case report

Struma ovarii is a rare monodermal ovarian teratoma composed predominantly of thyroid tissue, accounting for approximately 1% of all ovarian tumors (J Clin Diagn Res 8:FD03–4, 2014, Pathology 39:139–46, 2007). Its nonspecific clinical presentation often complicates preoperative diagnosis. A 48-year-old woman with diabetes mellitus presented with acute lower abdominal pain and fever. Imaging suggested bilateral tubo-ovarian abscesses(TOAs). Emergency laparoscopy confirmed bilateral TOAs and revealed a distinct right ovarian cystic mass. Right salpingo-oophorectomy and left salpingostomy were performed. Histopathology identified struma ovarii in the right ovary. Postoperative thyroid function was normal, and the patient remained asymptomatic with no recurrence at six-month follow-up. This case highlights (reviewer 1 comment 7) the rare coexistence of struma ovarii and bilateral TOAs, emphasizing the importance of considering uncommon pathological entities when evaluating complex adnexal masses, particularly in acute infectious settings.