What Is an Ovarian Teratoma?

According to the type of histopathology, it is divided into mature teratoma, immature teratoma and ovarian goiter. The most common type of mature teratoma is a mature cystic teratoma, also known as a dermoid cyst. Immature teratoma has malignant biological behavior.

Zhu Lirong	(Chief physician)	Department of Obstetrics and Gynecology, Peking University First Hospital
Hu Jun	(Attending physician)	Department of Obstetrics and Gynecology, Peking University First Hospital

Ovarian teratoma is a common ovarian germ cell tumor. Occurs in women of childbearing age. About 15% of the total number of primary ovarian tumors, of which 95% -98% are benign mature teratomas, and only 2% -5% are malignant teratomas. Most mature cystic teratomas occur in women of childbearing age around the age of 30. The clinical symptoms are non-specific. The main manifestation is a pelvic mass. 25% of patients are found by accident. 10% of patients will have acute abdominal pain due to tumor rupture, twist or bleeding.

Western Medicine Name: Ovarian teratoma
Affiliated Department: Gynecology and Pediatrics-

Disease site: Ovary
Contagious: Non-contagious

Ovarian teratoma disease classification

Pathogenesis of ovarian teratoma

Parthenogenesis theory of ovarian teratoma

Parthenogenesis due to atypical division caused by stimulation of primitive germ cells is the most common etiology of immature teratoma.

Ovarian teratoma totipotent cytology

Early research suggests that teratomas come from primitive abnormal tissues in the early stages of the embryo and have a self-differentiation instinct. These leftover "totipotent cells" undergo uncoordinated growth and embryonic developmental abnormalities, thereby becoming detached from the whole and disordered, hyperproliferated, and eventually form teratoma.

Ovarian teratoma pathology

Ovarian teratoma usually consists of 2-3 germ layers. Mature cystic teratoma has a smooth surface and an intact capsule, with a diameter of about 10 cm. The capsule contains sebum and hair, and sometimes a head segment composed of teeth, bones and scalp is visible, which is characteristic of the head segment protruding into the cavity. Immature teratomas have different degrees of differentiation, showing that each germ layer has never matured and matured. The histological morphology is from cancer to sarcoma, and various components are mixed. Teratomas with neuronal components are classified as immature teratomas.

Clinical manifestations of ovarian teratoma

Most mature cystic teratomas occur in women of childbearing age around the age of 30. The clinical symptoms are non-specific. The main manifestation is a pelvic mass. 25% of patients are found by accident. 10% of patients will have acute abdominal pain due to tumor rupture, twist or bleeding. Ultrasound examination has a higher diagnosis rate, usually showing unilateral ovarian sac solid space. Typical sonograms have dough signs, wall nodules signs, disordered structure signs, lipid layer signs or waterfall signs. Serological examination may have a slight increase in CA199, AFP, etc. Complications include twists, ruptures and infections. Torsion of the cyst can cause perforation of necrosis and intra-abdominal bleeding, and rupture of the cyst can cause chemical peritonitis. Seborrhea into the abdominal cavity can form peritoneal oily granulomas. A mature teratoma containing glial components can be planted in the peritoneum after rupture, which is called peritoneal pseudoglioma disease. Immature teratomas grow rapidly, can penetrate the capsule at an early stage, and spread directly to the pelvic cavity for implantation. Lymph node metastases and extraperitoneal metastases can subsequently occur, and advanced hematogenous metastases to the lungs, liver, and other organs. ^[1]

Diagnosis and differential diagnosis of ovarian teratoma

The primary diagnosis of teratoma relies on imaging examinations such as ultrasound. Surgical pathology is the gold standard for diagnosis. Clinically, it should be distinguished from pelvic inflammatory mass, endometriosis, subserous myoma, luteal rupture, appendicitis and other diseases.

First aid measures for ovarian teratoma

Once the teratoma pedicle is diagnosed as twisted or ruptured, emergency surgery should be performed immediately.

Ovarian Teratoma Treatment

Patients with ovarian teratoma should choose surgery. The scope of the surgery can be selected from the removal of the ipsilateral appendage, the removal of the ipsilateral teratoma, and / or the contralateral ovarian biopsy. The choice of surgery is laparoscopic or open. The benign and malignant teratomas can be judged based on the findings during the operation. If a malignant tumor is suspected, a frozen pathological examination should be sent as soon as possible. Malignant teratoma should also be performed as completely as possible. Thoroughly explore the pelvic cavity, remove the omentum and peritoneal and lymph node biopsy during the operation to understand the extent of tumor invasion and the degree of involvement of various organs and tissues. For young, fertile patients with malignant teratoma, surgery to preserve fertility can be considered. The currently recommended chemotherapy regimen by WHO is the BEP regimen. ^[2]

Prognosis of ovarian teratoma disease

The recurrence rate of mature cystic teratoma is about 2%, and the recurrence interval is more than 10 years. It is more common in patients with bilateral lesions. The malignant rate of mature cystic teratoma is 2% -3%, and the malignant change is easy to occur near the head segment. Squamous carcinoma is the most common. Patients with squamous cell carcinoma have a poor prognosis, with a mortality rate of 75% -86%. The recurrence rate of immature teratomas is more than 50%, but recurrent immature teratomas have the characteristic of transforming from immature to mature. Over time, the degree of malignancy gradually decreased. ^[3]

Ovarian teratoma disease prevention

The cause of teratoma is unknown, and there is no effective prevention method. The key is to do regular pelvic examinations regularly to achieve early diagnosis and early treatment.

Ovarian teratoma disease care

Patients with teratoma should avoid strenuous exercise to prevent twisting and rupture. Should pay attention to rest after surgery, banned bathing in the same room for one month, regular review, watch out for recurrence.