## 3 Results  
The patients' age ranged between 24 and 71 years, with the highest age of incidence occurring in the fifth decade of life. The tumor was unilateral in 24 cases--(13 cases on the left ovary and 11 on the right side), and bilateral involvement was present in 1 case. Tumor sizes varied between 1 and 20 cm. For 9 patients, tumor size was under 6 cm (Table 1). \begin{table}
\begin{tabular}{c c c c c c} \hline \hline \begin{tabular}{c} **Patient** \\ **Nr** \\ \end{tabular} & \begin{tabular}{c} **Age of** \\ **Patients** \\ **(Years)** \\ \end{tabular} & \begin{tabular}{c} **Ovary** \\ **(Years)** \\ \end{tabular} & \begin{tabular}{c} **The Largest** \\ **Tumor Size** \\ **(cm)** \\ \end{tabular} & \begin{tabular}{c} **Year of** \\ **Diagnosis** \\ \end{tabular} & **Additional Conditions to Struma Ovarii** & \begin{tabular}{c} **CA-125** \\ **(Ul/mL)** \\ \end{tabular} \\ \hline \hline \(1\) & 43 & left & 18 & 2001 & Serous cystadenoma & 4.94 \\ \hline \(2\) & 28 & right & 4.5 & 2001 & Uterin leiomatosis & \\ \hline \(3\) & 41 & right & 8 & 2003 & Mucinous cystadenoma & 10.7 \\ \hline \(4\) & 71 & right & 6 & 2004 & Mucinous cystadenoma & 14.6 \\ \hline \(5\) & 49 & left & 8 & 2004 & - & 3.7 \\ \hline \(6\) & 51 & right & 10 & 2005 & \begin{tabular}{c} Serous cystadenoma \\ Ascites \\ \end{tabular} & 45 \\ \hline \(7\) & 35 & left & 2.5 & 2005 & \begin{tabular}{c} Ovarian torsion \\ Hyperhyroidism \\ \end{tabular} & 5.2 \\ \hline \(8\) & 42 & left & 1 & 2005 & - & 3.1 \\ \hline \(9\) & 26 & left & 7 & 2006 & Ovarian torsion & 4.2 \\ \hline \(10\) & 32 & left & 5 & 2006 & Thyroid papillary carcinoma & 22.6 \\ \hline \(11\) & 45 & left & 3.5 & 2007 & Uterin leiomatosis & 9.4 \\ \hline \(12\) & 33 & right & 9 & 2007 & \
\begin{tabular}{c} Cyctic teratoma \\ Chronic inflammation \\ \end{tabular} & 15.9 \\ \hline \(13\) & 68 & left & 9 & 2007 &
\begin{tabular}{c} Surface papillatosis \\ Peritoneal implants \\ \end{tabular} & 18.4 \\ \hline \(14\) & 42 & left & 4 & 2008 & Teratoma & 8.9 \\ \hline \hline \end{tabular}
\end{table} 
Table 1: Main epidemiological and clinico-morphological data of the study population. Patients with struma ovarii are usually asymptomatic or have non-specific symptoms comparable to those of other ovarian neoplasms. In our investigation, 4 women did not have any symptoms. Lower abdominal pain (n = 10 cases), palpable lower abdominal mass (n = 7 cases), ascites (n = 1 case), and pregnancy with symptoms suggestive of emetic disgravidia and iliac fossa pain (n = 3 cases) were the most prevalent symptoms at the time of diagnosis. Two patients had a history of thyroid disease, including symptoms and signs of hyperhydroxism, such as weight loss, shaking, palpitations, and sweating. Unfortunately, thyroid function profiles were not carried out before surgery. In four cases, surgery was performed for reasons other than an ovarian tumor (two cases during C-section), and struma ovarii was discovered by coincidence during laparotomy. Pre-operative US raised the suspicion of a malignant ovarian tumor in 5 patients: 1 case was a 51 years old woman with ovarian mass and ascites (Figure 1a,b and Figure 2a,b); 2 cases with many vessels in the core area of the tumor on  
Figure 4: Doppler exam—intense vascularization in the core area of the tumor. Figure 5: Intra-operative aspect. Figure 3: Ultrasonography showing a predominantly hyperechoic heterogenous ovarian mass. (**a**) Longitudinal view; (**b**) Transverse view. Figure 2: (**a**) Gross appearance of the ovarian tumor; (**b**) Longitudinal section of the ovarian mass showing a polycystic aspect. The extent of surgical procedures varied depending on the case: from simple cystectomy unilateral or salpingo-oophorectomy to a total hysterectomy and bilateral salpingo-oophoreectomy. Usually, the gross examination showed a unilateral and solid mass, with a gelatinous, red-brown to green cut surface; goiter-like multinodular or cystic alterations were also seen.