Malignant struma ovarii: presentation and management

Abstract

Struma ovarii are rare tumours and just over 400 cases are reported in the world literature (Gould et al, 1983). The incidence of malignancy is reported as 5–10% of all cases of struma ovarii (Marcus & Marcus, 1961) but has been reported as less (Gould et al, 1983). The metastasis rate is estimated to be 5–6% (Emge, 1940) and only 21 cases with metastases have so far been reported (Dalley, 1970; Pardo-Mindan & Vazquez, 1983; Willemse et al, 1987; Rosenblum et al, 1989). Owing to their rarity, there is no universal agreement as to management. Surgical excision continues to remain the initial definitive primary treatment. However, metastatic and recurrent malignant struma ovarii have been treated with radioactive 131I (Woodruff et al, 1966; Kempers et al, 1970; Willemse et al, 1987). Intra-peritoneal radiocolloids (Woodruff et al, 1966; Rosenblum et al, 1989) and external beam radiotherapy (Gonzalez-Angulo et al, 1963; Woodruff et al, 1966; Pardo-Mindan & Vazquez, 1983) have also found a useful role in palliation. This paper describes the presentation and management of two patients with malignant struma ovarii referred to the Royal Marsden Hospital between 1945 and 1989, during which time nearly 3000 other ovarian tumours were recorded. A 35-year-old married woman with no previous or family history of thyroid disease presented in 1951 with severe recurrent abdominal pain. Laparotomy was performed and both ovaries were found to be cystic.