Garg Karuna, Soslow Robert A, Rivera Michael, Tuttle Michael R, Ghossein Ronald A
Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
Int J Gynecol Pathol. 2009 May;28(3):222-30. doi: 10.1097/PGP.0b013e31818a2b99.
Struma ovarii (SO) infrequently harbor carcinomas that are histologically similar to those arising in the eutopic thyroid. We identified 10 such cases in our files. Eight patients presented with pelvic-related symptoms whereas 2 were incidentally discovered during pregnancy, all with disease confined to the ovary. There were 8 papillary thyroid carcinomas (PTCs) (2 classic and 6 follicular variant) and 2 poorly differentiated thyroid carcinomas. Two of the 10 thyroid carcinomas relapsed after an initial diagnosis of "benign" struma. Both occurred in young women with ovarian cysts discovered during pregnancy. The cystectomy from 1 patient showed thyroid follicles with nuclear features of the follicular variant of PTC whereas the cyst from the second patient showed thyroid follicles with subtle nuclear features, suggestive but not diagnostic of PTC. Both patients presented with disseminated PTC 3 and 4 years after the initial diagnosis, involving the pelvis in both cases and also the liver parenchyma in 1 case. The 2 patients received radioactive iodine therapy after thyroidectomy and are both alive with disease 6 years after diagnosis. The criteria separating hyperplastic nodules from well-differentiated follicular variant of PTC in the thyroid gland seem to be applicable to thyroid-type carcinomas arising in SO. The propensity for adverse clinical behavior does not seem to be related to the grade or histologic type of carcinoma in this small series. The hormonal milieu during pregnancy may lead to progression of malignant SO and such patients should be closely followed, particularly if their treatment consists of cystectomy alone.
卵巢甲状腺肿（SO）很少发生组织学上与正常甲状腺发生的癌相似的癌。我们在档案中发现了10例此类病例。8例患者出现盆腔相关症状，2例在孕期偶然发现，所有病例疾病均局限于卵巢。其中有8例乳头状甲状腺癌（PTC）（2例经典型和6例滤泡状变型）以及2例低分化甲状腺癌。10例甲状腺癌中有2例在最初诊断为“良性”卵巢甲状腺肿后复发。这两例均发生在孕期发现卵巢囊肿的年轻女性。1例患者的囊肿切除术标本显示甲状腺滤泡具有PTC滤泡状变型的核特征，而另1例患者的囊肿显示甲状腺滤泡具有细微核特征，提示但不能确诊为PTC。两名患者在最初诊断后3年和4年出现播散性PTC，两例均累及盆腔，1例还累及肝实质。这两名患者在甲状腺切除术后接受了放射性碘治疗，诊断后6年仍存活且伴有疾病。区分甲状腺腺体内增生性结节与PTC滤泡状高分化变型的标准似乎适用于SO中发生的甲状腺型癌。在这个小系列中，不良临床行为倾向似乎与癌的分级或组织学类型无关。孕期的激素环境可能导致恶性SO进展，此类患者应密切随访，尤其是如果其治疗仅包括囊肿切除术。
