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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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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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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DOI: https://doi.org/10.1007/s00404-021-05969-0