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Table 1 Case studies of malignant Struma Ovarii

From: The largest reported papillary thyroid carcinoma arising in struma ovarii and metastasis to opposite ovary: case report and review of literature

Study*

Country

Tumor

Type of Gynecological Surgery

Thyroid Workup

Thyroid Nodule

Thyroid Management

Follow up

Recurrence

Type

Size (mm)

Middelbeek 2017 [29]

USA

PTCF

12

LBSO

a

a

HT then TT

a

a

Pineyro 2017 [30]

Uruguay

PTCF

4

Right ovarian cystectomy, left adnexectomy

TFT Normal

U/S

4x2x4 mm

FNA NC

Conservative

Lost follow up

Lost follow up

Fernández 2016 [35]

Spain

PTC

25

UO

U/S HN

1.5 cm

FNA BFN

TT, HP PTC, RAI, LT

6 y

Nil

Wei 2015 [44]

USA

PTCF (8 cases)

1–42

–

–

–

TC

1 m-11 y

–

PTC (2 cases)

4–30

–

–

–

–

8–15 y

–

HDFCO

–

–

–

–

–

17 y

Nil

PTCT and OM (2 cases)

–

–

–

–

–

NC

–

Monti 2015 [45], Goffredo 2015 [8]

Italy

USA

PTC

68 (HP NC)

–

mean 52.8 (1–200)

UO

UO, BO,oophorectomy and omentectomy, debulking surgery

U/S, TFT, TgAb

NC

Nil

NR

Prophylactic TC, RAI

TT

NC

2 m- 34 y (mean 8 y)

–

–

Kumar 2014 [27]

India

PTCF

–

UO,TAH, omentectomy, appendectomy

TFT, U/S

Nil

TT, HP lymphocytic thyroiditis

1 y

Nil

Mardi 2013 [46]

India

PTCT

–

Cystectomy

–

–

–

6 m

Nil

Leite 2013 [31]

Portugal

PTC

–

USO

–

–

Complete thyroidectomy, HP PTCF

2 y

Nil

Meringolo 2012 [47]

Italy

PTC

3

Monolateral annessectomy

TFT, TgAb, TPO ab

Yes, FNA benign

LT

–

–

Barrera 2012 [24]

Philippines

PTC

–

TAH BSO

TFT, U/S, HNs

No FNA done

RIA, LT

6 m

Nil

Stanojevic 2012 [32]

Japan

PTCF

10

USO, contralateral cystectomy(HP benign)

TFT, Tg, TgAb U/S

6 × 4 mm

Patient planned for FNA and TT

–

–

O’Neill 2012 [33]

Ireland

PTC

–

USO

NC

–

TT, HP normal, RAI

–

–

Jean 2012 [28]

USA

PTC

25

BSO, peritoneal biopsy, lymph node sampling

TFT, U/S

2.7 cm nodule

TT (HP benign), RAI

2y

Nil

Tanaka 2011 [26]

Japan

PTCF

30

Total hysterectomy + USO

–

–

–

14 m

Nil

Shaco-Levy 2010 [48]

USA

FTC

–

–

–

–

–

–

Yes in 15 patientsb

PTC (24 cases, 4 re classified as AC)

All NR except one (2)

–

–

–

RAI

–

 

FA (60)

 

–

–

–

RAI

–

 

Sibio 2010 [25]

Italy

PTC

1

Hysterectomy, UA, peritoneal implants removal, LL

Patient had previous Total Thyroidectomy

7 y

Nil

Coyne 2010 [36]

USA

PTCF

–

Unilateral ovarian cystectomy

TFT, U/S, CT

Patient planned for final pregnancy followed by TT + RAI

–

–

Robboy 2009 [18]

USA

FTC (3 cases)

–

UO /TAH BSO/tumor debulking

–

–

Thyroidectomy/ biopsy in 14 patients

25 y; 10 y survival 89, 84% at 25 y

Yes in 10 patientsc

PTC (20 cases)

–

“

“

“

“

  

PTCF (1 case)

–

“

“

“

“

  

PTC + MA (4 cases)

–

“

“

“

“

  

Adenomatous patterns (58)

–

“

“

“

“

  

Garg 2009 [22]

USA

PTC (2 cases)

PTCF(4 cases)

PTCF and PTC

Bilateral PTCF

Poorly differentiated carcinoma (2 cases)

1.1–80

Cystectomy, USO, TAH BSO, hysterectomy with USO

Radioactive iodine scan, thyroglobulin

–

TT(HP benign) and RAI in two patients,

1 to 14 y

2 casesd

Roth 2008 [34]

USA

PTC (3 case)

–

e

e

e

e

e

e

FTC poorly differentiated (1 case)

–

e

e

e

e

e

e

Salvatori 2008 [37]

Italy

PTCF

–

f

f

f

f

f

f

Yassa 2008 [3]

USA

PTC

9

–

TSH, TG, TG ab, U/S

1 cm FNA benign

Thyroxine therapy

1 y

none

  1. AC Anaplastic carcinoma, BFN Benign follicular nodule, CT Computerized tomography, FA Follicular adenoma, FTC Follicular thyroid carcinoma, HDFCO (Highly differentiated follicular carcinoma of ovarian origin): tumor involved extra ovarian tissues without nuclear features of PTC, HN Hypoechoic nodule, HP Histopathology, HT Hemithyroidectomy, LBSO Laparoscopic bilateral salpingo-oophorectomy, LL Locoregional lymphadenectomy, LT Levothyroxine, m months, MNS Microcarcinoma focus size not specific, MA Mucinous adenocarcinoma, PTC + OM Primary papillary thyroid carcinoma + ovarian metastasis, PTC Papillary thyroid cancer, PTCF PTC follicular variant, PTCT Tall cell variant, RAI Radioactive iodine, SO struma ovarii, TAH BSO Total abdominal hysterectomy and bilateral salpingo-oophrectomy, TAH Total abdominal hysterectomy, TFT Thyroid function tests, TgAb Anti-thyroglobulin antibody, TPO ab: thyroperoxidase antibody, TT Total thyroidectomy, U/S Ultrasound, UA Unilateral adnexectomy, UO Unilateral oophorectomy, USO Unilateral salpingo-oophorectomy, y years
  2. *Due to space considerations, only first author is cited; “: same as above; –: not reported, cannot be inferred
  3. aPatient diagnosed initially as thyroid PTCF, had HT followed by TT, thyroid scan and SPECT (right adnexal mass uptake), histopathology: PTCF within SO suggestive of primary disease not metastatic, radio iodine treatment given postoperative, no recurrence features over 5 years
  4. b15 patients with recurrences (11 FA, 4 PTC)
  5. c10 patients with recurrences, initial gynecological operation for each is not clear
  6. dFirst patient had left ovarian cystectomy, HP later found to be SO + PTCF. On 3 years follow up right ovarian tumor 2.4 cm detected, during surgery cul de sac and omentum implants found, HP was PTC. Patient then had RAI scan (diffuse uptake in abdomen), TT done, then RAI therapy given. Second patient had left ovarian cyst, ovarian cystectomy done. Caesarian section four years later (uterus, pelvis, cul-de-sac lesions found, TAH BSO done, PTCF lesions), RAI scan done (diffuse uptake in chest/ abdomen), patient had TT + RAI. Also had metastatic liver mass 8 cm (PTCF) that was resected. It is noted that recurrences in both patients occurred with well-differentiated and small foci of their primary tumors
  7. eOne PTC case had unilateral adnexal excision, paraortic LNs dissection + radiation therapy postoperative. Thyroid workup/ management NC. Follow up/ recurrence NC. One PTC case had right oophorectomy, left ovarian cystectomy and uterine curettage. Thyroid workup/ management NC. Follow up 25 years and patient is well. One PTC case had TAH BSO and pelvic node dissection, died soon after surgery. One poorly differentiated FTC had TAH BSO and peritoneal biopsies, then total TT, RAI and chemotherapy. Died 3years after primary operation
  8. fInitial operation was right salpingo-oopherectomy for right ovarian cyst, HP was SO with mature cystic teratoma, patient then had enucleation of left ovarian cyst (HP: PTCF) and multiple biopsies from pink nodules in abdomen and pelvis (HP: endometriosis). Then patient had TT and RAI scan (multiple liver, abdominal, pelvic uptakes), CT and MRI (multiple abdominal/ pelvic nodules). Patient underwent debulking of nodular mass, partial omentectomy and partial excision of ovarian cortex (due to patient’s wish), followed by RAI therapy
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Thyroid Research

ISSN: 1756-6614