Malignant Struma Ovarii: Two Case Reports and a Review of the Literature

Struma ovarii consists of thyroid tissue derived from germ cells in a mature teratoma. Malignant transformation is very rare, with clinically evident metastatic disease reported in approximately 20 cases. The rarity of this disease renders evaluation of treatment modalities difficult. There is evidence that these tumors behave like their thyroid counterparts, and cytoreductive surgery followed by ablation with radioactive iodine has been advocated. We report the diagnosis and treatment of 2 patients with metastatic malignant struma ovarii treated with a combination of surgery and radiation therapy.     

卵巢甲状腺肿MRI和CT表现

目的 分析卵巢甲状腺肿的MRI、CT表现。方法 回顾性分析14例经手术病理证实的单发卵巢甲状腺肿患者的MRI及CT表现,观察其形态、大小、密度/信号、强化特点等。结果 14例病变均表现为包膜完整的囊实性肿块,其中分叶状11例,类圆形3例;多囊状13例,单囊1例;11例实性成分为明显厚壁或分隔,3例呈结节状。肿瘤最大径为3~34 cm,平均（11.34±2.24） cm。7例MR T2WI囊性部分均可见极低信号区,增强后无强化,实性成分明显强化。7例CT囊性部分均可见高密度区,CT值57~90 HU,增强扫描未见强化;实性成分明显强化,CT值为145~270 HU;4例囊壁或实性结节中见斑片状钙化。结论 卵巢甲状腺肿的MRI、CT表现具有一定特征性,有助于诊断及鉴别诊断。     

恶性卵巢甲状腺肿发病机制和诊疗的研究进展

卵巢甲状腺肿是具有高度特异性的单胚层分化的成熟畸胎瘤,其主要由甲状腺组织构成。良性卵巢甲状腺肿的恶变率低,为0.5%~5%。恶性卵巢甲状腺肿(MSO)与起源于甲状腺的恶性肿瘤具有相似的分子发病机制,如BRAF(B-Raf proto-oncogene)、RAS(retrovirus-associated DNA sequence)基因点突变,RET/PTC(RET proto-oncogen/papillary thyroid carcinoma)基因重排等。因MSO临床罕见,目前仍缺乏明确的诊断标准及处理原则。一些肿瘤专家主张用原发性甲状腺癌的病理标准作为MSO的诊断依据。MSO一旦确诊后,应行全面的手术分期和术后的辅助治疗,辅助治疗包括全甲状腺切除或甲状腺素抑制治疗、放射性碘治疗、体外照射等。临床观察发现MSO预后均较好,且术后辅助治疗起重要作用。术后需要长期随访,血清甲状腺球蛋白、131I全身扫描是检测肿瘤转移和复发的特异性指标。     

Struma ovarii: management and follow-up of a rare ovarian tumour

INTRODUCTION

Struma ovarii represents about 1.0% of all ovarian tumours. While management involves surgery, there is a paucity of data regarding the extent and approach of surgery, and postoperative management. This study aimed to delineate the management of struma ovarii, its associated complications, and postoperative follow-up and investigations.

METHODS

We retrospectively reviewed cases of benign struma ovarii treated at KK Women’s and Children’s Hospital, Singapore, between January 2000 and May 2011.

RESULTS

A total of 68 patients underwent surgical removal of ovarian cyst or mass (24 cystectomy, 20 salpingo-oopherectomy and 24 total hysterectomy and bilateral salpingo-oopherectomy). Of the 68 surgeries, 39 (57.4%) included intraoperative frozen section sampling or procedures for staging of ovarian malignancy. The majority (73.5%) of surgeries were laparotomies. Histology revealed benign struma ovarii in all (98.5%) but one patient. Only 7 (10.3%) patients had postoperative complications – 3 wound-related, 2 thyroid-related, 1 incisional hernia and 1 nonspecific. The mean length of hospital stay was 4.2 days. During follow-up, 45 (66.2%) patients required no additional investigations. The most common investigation done was ultrasonography (n = 18, 26.5%). While no recurrences were diagnosed histologically, two patients were subsequently found to have complex/dermoid ovarian cysts on the ipsilateral side of the previous struma ovarii on ultrasonography.

CONCLUSION

Simple surgery is recommended for patients with struma ovarii, especially if they have fertility potential. Laparoscopic surgery is the recommended approach due to its shorter recovery time and lower morbidity. Most patients do not require extended periods of follow-up or postoperative investigations.     

卵巢甲状腺肿超声诊断与误诊分析

目的 探讨卵巢甲状腺肿(SO)的超声声像学表现特征,以提高超声对SO临床诊断价值。方法 回顾性分析我院2010年1月～2019年10月经手术病理证实7例SO超声声像图资料,并结合病理分析误诊的原因。结果6例表现为多房囊实性混合回声包块,1例为单囊性肿块。囊性部分各房腔回声不均匀,部分囊腔透声比膀胱内液体透声差;实性部分位于各囊腔之间,实性部分呈蜂窝状稍高回声并可探及较丰富血流回声。结论 SO超声表现具有一定特征,如囊性部分透声比膀胱内液体差;实性部分位于各囊腔之间,且呈蜂窝状稍高回声并探及丰富血流回声等,有助于提高诊断准确性。     

Uncommon ovarian epithelial tumours

Epithelial ovarian tumours represent the most common type of ovarian tumour. Most of malignant cases represent high-grade serous, clear cell and endometrioid carcinomas; borderline serous and mucinous tumours of intestinal type are less common. This review focuses on the uncommon or rare epithelial tumours of the ovary which include borderline and malignant Brenner tumours, the recently-described mesonephric-like carcinoma of the ovary, and primary ovarian neuroendocrine tumours, with emphasis on helpful and diagnostic features.     

低位小切口甲状腺切除术探讨

目的总结低位小切口甲状腺切除术治疗甲状腺良性肿瘤的经验体会。方法回顾分析我院2004年7月～2008年10月取低位小切口为128例甲状腺良性肿瘤患者行甲状腺切除术,颈丛麻醉或气管插管全麻,取胸骨切迹上0.5cm横纹处弧形切口,长3.5～4.3cm,平均4.0cm。结果手术顺利,术后均恢复良好,无声音嘶哑、饮水呛咳和低钙性抽搐。结论低位小切口甲状腺切除术可以满足常规甲状腺手术所需要的切口暴露,能达到不影响甲状腺手术疗效的同时满足患者美容要求的目的。     

胸骨后甲状腺肿的外科治疗

目的:探讨胸骨后甲状腺肿的临床特点、诊断与外科治疗.方法:回顾分析经术后病理证实为胸骨后甲状腺肿14例的临床资料.结果:14例胸骨后甲状腺肿均为坠入性,良性病变12例,甲状腺癌2例,9例颈部低位领式切口;5例颈部低位领式切口辅以正中切口,其中2例仅胸骨上段劈开;3例胸骨全劈开.喉返神经损伤1例.结论:胸骨后甲状腺肿一经确诊,均应手术治疗,只要正确选择手术入路,术中仔细操作,都可避免严重手术并发症,取得良好的治疗效果.     

2004年临朐县部分中小学生健康状况调查

[目的]了解临朐县中小学生的健康状况，为制定有效的预防保健措施提供依据。[方法]2004年3～12月对临朐县部分中小学生67036人进行健康查体。[结果]调查学生67036人，视力不良20433人，患病率30、48％；龋齿患病人数11887人，龋患率17．73％；生理性甲状腺肿大14715人，肿大率21.95％；色弱1811人，患病率2．70％；扁桃体炎488人，患病率0．73％。城区与乡村、男生与女生、小学生、初中生和高中生间各种患病率的差异均有统计学意义。[结论]临朐县中小学生视力不良、生理性甲状腺肿大、龋齿患病率仍然较高，预防视力不良、生理性甲状腺肿大是当地学校卫生工作的重点。