Department of Pathology, Soroka Medical Center, Beer-Sheva, Israel.
Arch Pathol Lab Med. 2012 Feb;136(2):172-8. doi: 10.5858/arpa.2011-0092-OA.
Struma ovarii exhibiting malignant histology are uncommon, and an aggressive clinical course in the form of initial extraovarian spread or recurrence is even more exceptional for these tumors.
To determine whether specific histologic features have predictive value in distinguishing clinically benign from clinically malignant struma ovarii.
Blinded analysis of 19 histologic characteristics of thyroid tumors was performed in 60 clinically benign and 26 clinically malignant struma ovarii cases, with long-term follow-up.
Except for lack of fibrosis and macrofollicular pattern, which were more common in biologically malignant tumors (P = .04 and P = .008, respectively), and trabecular pattern, which was associated with a benign clinical course (P = .03), none of the other histologic features was found to be correlated with clinical behavior. The presence of the following features was similar in the biologically benign and malignant tumors: papillae, pseudo-papillae, psammoma bodies, nuclear grooves, nuclear overlap, "orphan Annie" nuclei, nuclear pseudo-inclusions, prominent nucleoli, hypercellularity, colloid scalloping, eosinophilic cytoplasm, mitoses, vascular invasion, cytologic atypia, nuclear pleomorphism, and cell size and type. Trabecular pattern and absence of fibrosis were uncommon, and there was considerable overlap of macrofollicular pattern ratio between benign and malignant cases. Thus, their practical usefulness is uncertain.
The clinical outcome of struma ovarii cannot be predicted based on the microscopic diagnosis of the thyroid tissue or on specific histologic features. The lack of correlation between morphology and outcome in proliferative and histologically malignant struma ovarii is striking, making the behavior of these tumors particularly unpredictable.
表现出恶性组织学特征的卵巢甲状腺肿并不常见，而这些肿瘤初始卵巢外扩散或复发的侵袭性临床病程则更为罕见。
确定特定的组织学特征是否具有预测价值，可以区分临床上良性和恶性的卵巢甲状腺肿。
对 60 例临床上良性和 26 例临床上恶性卵巢甲状腺肿病例的 19 种甲状腺肿瘤的组织学特征进行了盲法分析，并进行了长期随访。
除了无纤维化和大滤泡模式（分别在生物学恶性肿瘤中更为常见，P ＝0.04 和 P ＝0.008）和小梁模式（与良性临床病程相关，P ＝0.03）外，其他组织学特征均与临床行为无关。在生物学上良性和恶性肿瘤中，以下特征的存在相似：乳头、假乳头、砂粒体、核沟、核重叠、“孤儿安妮”核、核假包涵体、突出的核仁、细胞丰富、胶样切迹、嗜酸性细胞质、有丝分裂、血管浸润、细胞学异型性、核多形性以及细胞大小和类型。小梁模式和无纤维化并不常见，并且良性和恶性病例之间的大滤泡模式比例有很大重叠。因此，它们的实际用途不确定。
不能根据甲状腺组织的显微镜诊断或特定的组织学特征来预测卵巢甲状腺肿的临床结果。在增生性和组织学恶性卵巢甲状腺肿中，形态与结果之间缺乏相关性，这使得这些肿瘤的行为特别不可预测。
