Malignant Struma Ovarii: An Analysis of 88 Cases, Including 27 With Extraovarian Spread
- 1 September 2009
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in International Journal of Gynecological Pathology
- Vol. 28 (5), 405-422
- https://doi.org/10.1097/pgp.0b013e3181a27777
Abstract
Struma ovarii that display extraovarian spread or later recurrence is exceedingly rare. Among 88 patients with “malignant” struma ovarii followed for prolonged periods, several features helped to predict the adverse clinical course. Adhesions (graded 2 to 4+), peritoneal fluid (≥1 L) or ovarian serosal rent were worrisome features, occurring in 74% of 27 biologically malignant tumors but only 10% of 61 clinically benign tumors. The size of the strumal component rather than the overall size of the ovarian teratoma also had some predictive value. Tumors with a strumal component ≤6 cm recurred rarely (7%), whereas 33% of the consult and 88% of the literature cases ≥12 cm were clinically malignant. Except for a papillary pattern or poorly differentiated cancer, no microscopic feature reliably predicted the clinical outcome, including those typically associated with malignancy in primary thyroid tumors. Among the consult cases, 7% with histologic follicular adenomas and 29% with papillary carcinomas were clinically malignant. Unequivocal vascular invasion was rare, precluding assessment of its effect. Optically clear nuclei, when extensive, were useful to diagnose papillary carcinoma, but were present nevertheless in smaller numbers in both macrofollicular and microfollicular adenomas. Eight tumors confined initially to the ovary (stage 1) recurred. Papillary carcinomas recurred earlier (average 4 y) than follicular adenomatous neoplasms (average 11 y, range: 1-29 y). Overall, the survival rate for all patients was 89% at 10 years and 84% at 25 years, indicating the need for routine long-term follow-up.Keywords
This publication has 65 references indexed in Scilit:
- Peritoneal strumosisEuropean Journal of Nuclear Medicine and Molecular Imaging, 2004
- Metastatic thyroid carcinoma in the presence of struma ovariiThe Medical Journal of Australia, 2001
- Malignant Struma Ovarii: Two Case Reports and a Review of the LiteratureGynecologic Oncology, 1999
- Peritoneal StrumosisPathology - Research and Practice, 1994
- A Case of Malignant Strumal CarcinoidGynecologic Oncology, 1993
- Proliferative and Histologically Malignant Struma OvariiInternational Journal of Gynecological Pathology, 1993
- Functioning Ovarian Tumors with Peripheral Steroid Cell ProliferationInternational Journal of Gynecological Pathology, 1986
- Strumal carcinoid of the ovary: An analysis of 50 cases of a distinctive tumor composed of thyroid tissue and carcinoidCancer, 1980
- Struma OvariiActa Obstetricia et Gynecologica Scandinavica, 1964
- Functional and Growth Characteristics of Struma OvariiAmerican Journal of Obstetrics and Gynecology, 1940