A Report on

Ovarian Teratomas
Kristoffer S. Escleto
Ovarian Teratomas
Definition:
These belong to the germ cell* family o
ovarian neoplasms. Teratomas arise from a
single germ cell, and therefore may contain
any of the three germ layers—ectoderm,
mesoderm, or endoderm.
These layers are typically disorganized.

*A cell that develops into a reproductive cell, which is an

egg in females and a sperm in males.
Classification
Teratomas are classified as:
1. Immature teratoma: This neoplasm is malignant. Immature tissues from one,
two, or all three germ cell layers are found and often coexist with mature
elements.
2. Mature teratoma—This benign tumor contains mature forms of the three
germ cell layers:
● Mature cystic teratoma develops into a cyst, is common, and is also
called benign cystic teratoma or dermoid cyst.
● Mature solid teratoma has elements formed into a solid mass.
● Fetiform teratoma or homunculus forms a doll-shape, as the germ cell
layers display considerable normal spatial differentiation.
Fetiform or homunculus teratoma
Monodermal teratoma

This benign tumor is

composed either solely or
predominantly of only one
highly specialized tissue
type. Of the monodermal
teratomas, those
composed dominantly of
thyroid tissue are termed
struma ovarii.
Mature Cystic Teratomas
● Of these teratoma types, mature cystic teratoma is by far the most
common.
● These benign tumors comprise approximately 10% to 25% of all ovarian
neoplasms and 60% of all benign ovarian neoplasms.
● These cystic tumors are typically slow growing, and most measure
between 5 and 10 cm. They are bilateral in approximately 10 percent
of cases.
Mature Cystic Teratomas
Microscopically, endodermal or mesodermal derivatives
may be found, but ectodermal elements usually
predominate. The cyst is typically lined with keratinized
squamous epithelium and contains abundant sebaceous
and sweat glands. Hair and fatty secretions are often found
within.

At times, bone and teeth are also identified. The Rokitansky

protuberance is usually the site where the most varied
tissue types are found and is also a common location of
malignant transformation.

Malignant transformation develops in 0.06 to 2 percent of

cases and typically in older women. Most malignant cases
are squamous cell carcinoma.
Mature Cystic Teratomas
The diverse tissues found within teratomas do not arise by fertilization of an ovum
by sperm. Instead, they are thought to develop from genetic material
contained within a single oocyte by asexual parthenogenesis*. As a result,
almost all mature cystic teratomas have a 46,XX karyotype.

*is a natural form of asexual reproduction in which growth and development of an embryo can occur
directly from an egg without fertilization.
Mature Cystic Teratomas
● can often undergo torsion, but cyst rupture is rare. Presumably, their thick cyst
wall resists rupture compared with other ovarian neoplasms.
● If cysts do spill, acute peritonitis is common, peritonitis is attributed to the
sebum and hair contents.
● intraoperative lavage is beneficial to prevent peritonitis and adhesion
formation.
● chronic leakage of teratoma contents is rare but can lead to granulomatous
peritonitis
Diagnosis:

Sonography is
the main
imaging tool
Management:

surgical excision provides a definitive

diagnosis, affords relief of symptoms,and
prevents torsion, rupture, and malignant
degeneration
Immature Teratomas
Three features distinguish malignant germ cell tumors from epithelial ovarian
cancers.

1. individuals typically present at a younger age, usually in their teens or early

20s.
2. Most have stage I disease at diagnosis.
3. prognosis is excellent—even or those with advanced disease—due to
exquisite tumor chemosensitivity.
Immature Teratomas
Due to a 60% increased incidence during the past few decades, immature
teratomas are now the most common variant and account or 40% to 50% o all
malignant ovarian germ cell tumors
Immature Teratomas
Clinical Features:

● Subacute abdominal pain is the presenting symptom in 85%

● In 10 % of cases, cyst rupture, torsion, or intraperitoneal hemorrhage leads to

an acute abdomen
Immature Teratomas
Clinical Features:

● ascites may develop and cause abdominal distention

● menses can become heavy or irregular.
● ¼ of individuals are asymptomatic, and a pelvic mass is noted unexpectedly
during physical or sonographic examination
Laboratory Testing:
In patients with a suspected
immature teratomas, , serum
human chorionic gonadotropin
(hCG) and alpha- fetoprotein
(AFP) tumor markers,
complete blood count, and
liver function tests are drawn
before treatment.
Imaging:

● Sonography
● Computed tomography (CT)
● Color flow Doppler sonography and s
● Magnetic Resonance Imaging(MRI)
● Chest radiography
Diagnostic Procedures

● Surgical resection with frozen

section analysis
 Immature Teratomas
● these tumors are
large, rounded or
lobulated, soft or
firm masses
● Microscopic
examination
reveals a
disorderly mixture
of tissues.
Immature Teratomas
Tumors are graded 1 to 3 primarily by the amount of immature neural tissue they contain.
O’Connor and Norris (1994) analyzed 244 immature teratomas and noted significant
inconsistencies in grade assignment by different observers. For this reason, they proposed
changing the system to two grades: low (previous grades 1 and 2) and high (previous grade
3). This practice, however, has not been universally accepted.

In general, survival is predicted most accurately by stage and by histologic grade of the
tumor. For example, almost ¾ of immature teratomas are stage I at diagnosis and have a
5-year survival rate of 98%. Those with stage IA grade 1 immature teratomas have an
excellent prognosis and do not require adjuvant chemotherapy Patients with stage II-IV
disease have a 5-year survival rate ranging from 73 to 88%.
Management
● Unilateral salpingo-oophorectomy (Standard)

● Ovarian cystectomy and adjuvant chemotherapy

Malignant Transformation of Mature Cystic Teratomas (Dermoid Cysts)

● are the only germ cell variants that typically develop in postmenopausal women

● malignant areas are usually found as small nodules in the cyst wall or a polypoid mass within the lumen a
ter removal of the entire mature cystic teratoma

● Squamous cell carcinoma is most common and is found in approximately 1% of mature cystic teratomas

● Platinum-based chemotherapy with or without pelvic radiation is most often used or adjuvant treatment on
early-stage disease
Thank you for Listening!!!