Malignant struma ovarii: An analysis of 88 cases, including 27 with extraovarian spread

Stanley J. Robboy, Ruthy Shaco-Levy, Ruth Y. Peng, Matthew J. Snyder, John Donahue, Rex C. Bentley, Sarah Bean, Hannah R. Krigman, Lawrence M. Roth, Robert H. Young

Research output: Contribution to journalArticle

85 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)405-422
Number of pages18
JournalInternational Journal of Gynecological Pathology
Volume28
Issue number5
DOIs
StatePublished - Sep 1 2009

Keywords

  • Malignant struma ovarii
  • Microfollicular adenoma
  • Papillary adenocarcinoma
  • Thyroid

Fingerprint Dive into the research topics of 'Malignant struma ovarii: An analysis of 88 cases, including 27 with extraovarian spread'. Together they form a unique fingerprint.

  • Cite this

    Robboy, S. J., Shaco-Levy, R., Peng, R. Y., Snyder, M. J., Donahue, J., Bentley, R. C., Bean, S., Krigman, H. R., Roth, L. M., & Young, R. H. (2009). Malignant struma ovarii: An analysis of 88 cases, including 27 with extraovarian spread. International Journal of Gynecological Pathology, 28(5), 405-422. https://doi.org/10.1097/PGP.0b013e3181a27777