Yongxue Wang1, Lingya Pan2, Huifang Huang1, Keng Shen1, Ming Wu1, Jinghe Lang1. 1. Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China. 2. Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China. Email: lingyapan@hotmail.com.
Abstract
OBJECTIVE: To study the clinical features, treatment and prognosis of struma ovarii. METHODS: From January 1990 to January 2012, a total of 68 patients were diagnosed struma ovarii at the Department of Obstetrics and Gynecology, Peking Union Medical College Hospital. Clinical data of these patients were studied retrospectively. RESULTS: (1) Characteristics of patients: the median age of patients was 42 years old (17-81 years). Of those patients, 64 cases (94%) were diagnosed begin struma ovarii and 4 (6%) were malignant struma ovarii. (2) CLINICAL FEATURE: 32(47%, 32/68) patients were identified with pelvic mass by ultrasonic test, 28 cases(41%) had clinical abdominal pain, 8 (12%) touched a mass from abdominal wall. Preoperative CA(125) were tested in 54 patients, but only 8 cases (15%) had moderate elevation. All patients receive ultrasound examination, and 51 cases (75%) were mulitcystic lesions with many septi, 3 (4%) solid lesions and 14 (21%) solid-cystic tumors. The mean diameter of tumors was (8 ± 3) cm. Ascites was present in 4 (6%, 4/68) patients. Sixty-seven patients had unilateral lesions, and 1 patient had bilateral lesions. No patient had hyperthyroidism presentation. Nineteen cases underwent thyroid function test after operation, and the results were normal. (3) TREATMENT: all patients underwent surgical treatment. Among patients with begin struma ovarii, 25 cases underwent cystectomy, 15 cases unilateral, 2 bilateral salpingo-oophorectomy, 22 cases hysterectomy + unilateral or bilateral salpingo-oophorectomy. Four malignant struma ovarii, 1 patient underwent fertility-sparing staging surgery, 2 patients unilateral salpingo-oophorectomy, 1 case hysterectomy + bilateral salpingo-oophorectomy. Two patients received chemotherapy after surgery. (4) PROGNOSIS: all patients were followed up in Peking Union Medical College Hospital. The median follow-up time of benign struma ovarii was 5.4 years (6 months-21 years) and there were no recurrence. The median follow-up time of malignant struma ovarii was 11.5 years (9-20 years). Three cases had long-term recurrence at 2, 7 and 16 years respectively after surgery. They were received surgical treatment after recurrence and all were alive. Two cases were given by thyroidectomy and ¹³¹I treatment. CONCLUSIONS: Struma ovarii is a rare ovarian monodermal teratoma. Tumorectomy or salpingo-oophorectomy is the appropriate therapeutic treatment for benign struma ovarii. The incidence of malignant struma ovarii is low, and there are no standard treatments. Because of higher long-term recurrence rate, these patients need close follow-up.
OBJECTIVE: To study the clinical features, treatment and prognosis of struma ovarii. METHODS: From January 1990 to January 2012, a total of 68 patients were diagnosed struma ovarii at the Department of Obstetrics and Gynecology, Peking Union Medical College Hospital. Clinical data of these patients were studied retrospectively. RESULTS: (1) Characteristics of patients: the median age of patients was 42 years old (17-81 years). Of those patients, 64 cases (94%) were diagnosed begin struma ovarii and 4 (6%) were malignant struma ovarii. (2) CLINICAL FEATURE: 32(47%, 32/68) patients were identified with pelvic mass by ultrasonic test, 28 cases(41%) had clinical abdominal pain, 8 (12%) touched a mass from abdominal wall. Preoperative CA(125) were tested in 54 patients, but only 8 cases (15%) had moderate elevation. All patients receive ultrasound examination, and 51 cases (75%) were mulitcystic lesions with many septi, 3 (4%) solid lesions and 14 (21%) solid-cystic tumors. The mean diameter of tumors was (8 ± 3) cm. Ascites was present in 4 (6%, 4/68) patients. Sixty-seven patients had unilateral lesions, and 1 patient had bilateral lesions. No patient had hyperthyroidism presentation. Nineteen cases underwent thyroid function test after operation, and the results were normal. (3) TREATMENT: all patients underwent surgical treatment. Among patients with begin struma ovarii, 25 cases underwent cystectomy, 15 cases unilateral, 2 bilateral salpingo-oophorectomy, 22 cases hysterectomy + unilateral or bilateral salpingo-oophorectomy. Four malignant struma ovarii, 1 patient underwent fertility-sparing staging surgery, 2 patients unilateral salpingo-oophorectomy, 1 case hysterectomy + bilateral salpingo-oophorectomy. Two patients received chemotherapy after surgery. (4) PROGNOSIS: all patients were followed up in Peking Union Medical College Hospital. The median follow-up time of benign struma ovarii was 5.4 years (6 months-21 years) and there were no recurrence. The median follow-up time of malignant struma ovarii was 11.5 years (9-20 years). Three cases had long-term recurrence at 2, 7 and 16 years respectively after surgery. They were received surgical treatment after recurrence and all were alive. Two cases were given by thyroidectomy and ¹³¹I treatment. CONCLUSIONS:Struma ovarii is a rare ovarian monodermal teratoma. Tumorectomy or salpingo-oophorectomy is the appropriate therapeutic treatment for benign struma ovarii. The incidence of malignant struma ovarii is low, and there are no standard treatments. Because of higher long-term recurrence rate, these patients need close follow-up.