Struma Ovarii Follow-up

  • Author: Jeannie Chen Kelly, MD; Chief Editor: Michel E Rivlin, MD   more...
 
Updated: Feb 23, 2012
 

Further Inpatient Care

For patients with a benign struma ovarii, standard surgical follow-up is sufficient.

For patients with malignant disease on surgical pathology, postoperative adjuvant therapy with radio-ablative iodine-131 is recommended. After surgical staging, a thyroidectomy is suggested before adjuvant treatment to potentiate the effects of radioablation. As normal thyroid cells preferentially uptake I-131, thyroidectomy would ensure delivery to the malignant cells. Additionally, a thyroidectomy would provide pathological confirmation that the struma is indeed ovarian in origin.

It is crucial for the surgeon to be aware of the intra- and postoperative complications of thyroidectomy (including hypocalcemia, damage to the recurrent laryngeal nerve, and/or need for postoperative thyroid replacement), and to be comfortable with their management. Radioactive I-131 ablation has been shown to treat malignant disease in both its initial presentation and any subsequent recurrence with excellent efficacy, although the rarity of the disease and lack of data surrounding its long-term management prove challenging to clinicians.[8]

Thyroglobulin is the preferred tumor marker followed in patients with malignant struma ovarii and should be followed sequentially after surgery and ablation. Increases in serum thyroglobulin should be followed up with total body scanning to detect recurrence, which is treated with subsequent radioablation.[10]

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Complications

Significant changes in thyroid function may occur in the immediate perioperative period.

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Prognosis

For the vast majority of patients, the struma is benign, and the prognosis is excellent. Even in malignant cases, adjuvant iodine-131 ablation with surgical extirpation has proven curative. Recurrences may be detected using iodine-123 scanning, and repeat iodine radioablation can lead to extended disease-free survival.

In an analysis of 88 patients with malignant struma ovarii, several factors were identified as being associated with recurrence or extraovarian spread. These include adhesions, peritoneal fluid of 1 liter or more, ovarian serosal rent, a papillary histology, or a struma component 12 cm or more. The overall survival rate for all patients is 89% at 10 years and 84% at 25 years.[12]

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Patient Education

For excellent patient education resources, visit eMedicine's Endocrine System Center. Also, see eMedicine's patient education article Thyroid Problems.

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Contributor Information and Disclosures
Author

Jeannie Chen Kelly, MD  Resident Physician, Department of Obstetrics and Gynecology, Tufts Medical Center

Disclosure: Nothing to disclose.

Coauthor(s)

Sarah H Hughes, MD  Assistant Professor, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Massachusetts Medical School

Sarah H Hughes, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists and Society of Gynecologist Oncologists

Disclosure: Nothing to disclose.

David Chelmow, MD  Leo J Dunn Distinguished Professor and Chair, Department of Obstetrics and Gynecology, Virginia Commonwealth University Medical Center

David Chelmow, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, American Society for Colposcopy and Cervical Pathology, Association of Professors of Gynecology and Obstetrics, Council of University Chairs of Obstetrics and Gynecology, Phi Beta Kappa, Sigma Xi, Society for Gynecologic Investigation, and Society for Medical Decision Making

Disclosure: Nothing to disclose.

Specialty Editor Board

Jordan G Pritzker, MD, MBA, FACOG  Assistant Professor of Obstetrics/Gynecology and Women's Health, Women's Comprehensive Health Center, Hofstra University School of Medicine; Attending Physician, Department of Obstetrics and Gynecology, Long Island Jewish Medical Center

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

A David Barnes, MD, PhD, MPH, FACOG  Consulting Staff, Department of Obstetrics and Gynecology, Mammoth Hospital (Mammoth Lakes, California), Pioneer Valley Hospital (Salt Lake City, Utah), Warren General Hospital (Warren, Pennsylvania), and Mountain West Hospital (Tooele, Utah)

A David Barnes, MD, PhD, MPH, FACOG is a member of the following medical societies: American College of Forensic Examiners, American College of Obstetricians and Gynecologists, American Medical Association, Association of Military Surgeons of the US, and Utah Medical Association

Disclosure: Nothing to disclose.

Frederick B Gaupp, MD  Consulting Staff, Department of Family Practice, Hancock Medical Center

Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians

Disclosure: Nothing to disclose.

Chief Editor

Michel E Rivlin, MD  Professor, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine

Michel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, and Royal College of Surgeons of Edinburgh

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Bradford W Fenton, MD, PhD, FACOG to the development and writing of this article.

References

  1. Utsunomiya D, Shiraishi S, Kawanaka K. Struma ovarii coexisting with mucinous cystadenoma detected by radioactive iodine. Clin Nucl Med. 2003;28(9):725-7. [Medline]. [Full Text].

  2. Yoo SC, Chang KH, Lyu MO, Chang SJ, Ryu HS, Kim HS. Clinical characteristics of struma ovarii. J Gynecol Oncol. Jun 2008;19(2):135-8. [Medline].

  3. Roth LM, Talerman A. The enigma of struma ovarii. Pathology. Feb 2007;39(1):139-46. [Medline].

  4. Bal A, Mohan H, Singh SB, Sehgal A. Malignant transformation in mature cystic teratoma of the ovary: report of five cases and review of the literature. Arch Gynecol Obstet. Mar 2007;275(3):179-82. [Medline].

  5. Kim D, Cho HC, Park JW, Lee WA, Kim YM, Chung PS. Struma ovarii and peritoneal strumosis with thyrotoxicosis. Thyroid. Mar 2009;19(3):305-8. [Medline].

  6. Mui MP, Tam KF, Tam FK, Ngan HY. Coexistence of struma ovarii with marked ascites and elevated CA-125 levels: case report and literature review. Arch Gynecol Obstet. May 2009;279(5):753-7. [Medline].

  7. Shen J, Xia X, Lin Y, Zhu W, Yuan J. Diagnosis of Struma ovarii with medical imaging. Abdom Imaging. Oct 2011;36(5):627-31. [Medline].

  8. Jung SI, Kim YJ, Lee MW, Jeon HJ, Choi JS, Moon MH. Struma ovarii: CT findings. Abdom Imaging. Nov-Dec 2008;33(6):740-3. [Medline].

  9. Shaco-Levy R, Peng RY, Snyder MJ, Osmond GW, Veras E, Bean SM, et al. Malignant struma ovarii: a blinded study of 86 cases assessing which histologic features correlate with aggressive clinical behavior. Arch Pathol Lab Med. Feb 2012;136(2):172-8. [Medline].

  10. Makani S, Kim W, Gaba AR. Struma Ovarii with a focus of papillary thyroid cancer: a case report and review of the literature. Gynecol Oncol. Sep 2004;94(3):835-9. [Medline].

  11. DeSimone CP, Lele SM, Modesitt SC. Malignant struma ovarii: a case report and analysis of cases reported in the literature with focus on survival and I131 therapy. Gynecol Oncol. Jun 2003;89(3):543-8. [Medline].

  12. Robboy SJ, Shaco-Levy R, Peng RY, Snyder MJ, Donahue J, Bentley RC. Malignant struma ovarii: an analysis of 88 cases, including 27 with extraovarian spread. Int J Gynecol Pathol. Sep 2009;28(5):405-22. [Medline].

 
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