甲状腺外科视角认识恶性卵巢甲状腺肿

Malignant struma ovarii:from a perspective of thyroid surgery

卵巢甲状腺肿(struma ovarii,SO)是一种高度分化单胚层畸胎瘤,其中甲状腺组织已超过所有其他组织或仅有甲状腺组织。恶性卵巢甲状腺肿(malignant struma ovarii,MSO)是一种非常罕见的疾病,研究证实其发病机制与原发性甲状腺癌基本一致;但因术前诊断较困难,确诊需依据术后石蜡病理;需强调组织学恶性并不代表恶性行为。MSO原发病灶手术方式多样,以经腹子宫切除术+双侧输卵管卵巢切除术预后比较理想而占主流。甲状腺的处理观点不一,大多切除甲状腺,然后再选择行化疗、放疗及131I治疗。术后随访按照原发性甲状腺癌原则进行。

Struma ovarii is a highly specialized form of monoderal ovarian teratoma,in which thyroid tissue has exceeded all other tissues or only thyroid tissue malignant struma ovarii is a very rare disease.Studies have confirmed that the pathogenesis is basically consistent with primary thyroid cancer.Preoperative diagnosis is difficult and the diagnosis should be based on postoperative paraffin pathology.It’s important to emphasize that the histologic malignance does not represent malignant ovarian behavior.Transabdominal hysterectomy+bilateral salpingo-oophorectomy has a better prognosis,and there are different opinions on the management of the mainstream thyroid.Most patients take active thyroid excision followed by chemotherapy and radiotherapy and 131I for postoperative follow-up in accordance with the principle of primary thyroid cancer.