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Malignant struma ovarii: surgical, histopathological and survival outcomes for thyroid-type carcinoma of struma ovarii with recommendations for standardising multi-modal management. A retrospective case series sharing the experience of a single institution over 10 years

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Abstract

Purpose

Struma ovarii is rare, accounting for 0.3–1% of ovarian tumours. Malignant transformation may occur, most often into papillary thyroid carcinoma. There is a paucity of data pertaining to malignant struma ovarii. This paper shares a decade of experience of a single institution in the management of this rare ovarian cancer, exploring the characteristics of this tumour and suggesting a standardised approach to treatment and follow-up.

Methods

All patients treated for malignant struma ovarii within a large cancer centre over one decade were identified and data collected retrospectively on presentation, diagnosis, management, follow-up and survival outcomes. A literature review was also undertaken.

Results

Eleven cases of malignant struma ovarii were managed in the Oxford Cancer Centre between 2010 and 2019, 6 of which were of papillary thyroid carcinoma sub-type. No cases were correctly diagnosed pre-operatively. All patients had stage I disease and were managed surgically—but with variation in radicality. Patients identified as high-risk based on final histopathology underwent additional thyroidectomy and radio-active iodine ablation therapy. One case of synchronous malignancy of the thyroid gland proper was identified. No disease recurrence occurred.

Conclusion

Malignant struma ovarii present a diagnostic challenge. Multi-disciplinary team (MDT) input is essential. Unilateral salpingo-oophrectomy may be adequate if stage I; reserving more radical surgery for advanced disease. Histopathological risk-stratification should be used to identify those most likely to benefit from adjuvant thyroid-targeting therapies. Patients require follow-up, anticipating an overall good prognosis.

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Data availability

Raw data collected from retrospective review of patient electronic and paper records and available for review.

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Acknowledgements

Dr Catherine Johnson—For provision of radiology images. Oxford University Hospitals NHS Foundation Trust, Department of Radiology, Churchill Hospital, Old Road, Headington, Oxford, OX3 7LE

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Authors and Affiliations

  1. Department of Gynaecology Oncology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Old Road, Headington, Oxford, OX3 7LE, UK

    Susan Addley, Moiad Alazzam & Hooman Soleymani majd

  2. Department of Endocrine Surgery, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Old Road, Headington, Oxford, OX3 7LE, UK

    Radu Mihai

  3. Department of Histopathology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Old Road, Headington, Oxford, OX3 7LE, UK

    Sunanda Dhar

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  1. Susan Addley
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Contributions

SA: Protocol/project development; data collection; data analysis; manuscript writing; RM: Data collection; manuscript editing; MA: Data collection; manuscript editing; SD: Data collection; manuscript editing; HSM: Protocol/project development; data collection; data analysis; manuscript writing/editing.

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Correspondence to Hooman Soleymani majd.

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Addley, S., Mihai, R., Alazzam, M. et al. Malignant struma ovarii: surgical, histopathological and survival outcomes for thyroid-type carcinoma of struma ovarii with recommendations for standardising multi-modal management. A retrospective case series sharing the experience of a single institution over 10 years. Arch Gynecol Obstet 303, 863–870 (2021). https://doi.org/10.1007/s00404-021-05969-0

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