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Ovarian teratomas are a rare type of germ cell tumor that can contain immature or fully formed tissue, including teeth, hair, bones and muscles. Teratomas can be cancerous or non-cancerous and can affect people of all ages. Treatment includes surgical removal. Cancerous teratomas may require chemotherapy, radiation therapy, or other cancer treatments. In women under the age of 20, ovarian teratomas account for 10 to 20 percent of all ovarian malignancies. About half of all immature ovarian teratomas may occur even earlier, between the ages of 10 and 20. Ovarian teratomas are rare in postmenopausal women.
What are ovarian teratomas?
Ovarian teratomas are a rare type of ovarian tumor that consists of developed tissues and organs such as hair, teeth, muscles, and bones. When viewed under a microscope, ovarian teratomas look like three layers of a developing embryo.
Teratomas can occur in newborns, children and adults, and are most common in women in their 20s. They are usually benign, although some may be cancerous and require surgical removal and / or chemotherapy.
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What causes ovarian teratomas?
Ovarian teratomas develop in germ cells that are produced in the early stages of fetal development and are capable of differentiating into specialized cells for a variety of functions. Ovarian teratomas are caused by a problem with the cell differentiation process. Therefore, teratoma contains tissue that belongs to other parts of the body. But why this is happening has yet to be clarified.
Also read: Fetal development stages – the first, second and third trimesters of pregnancy
Ovarian teratomas – types
In the case of ovarian teratomas, there are usually two types, i.e. mature and immature teratomas.
Mature teratomas
Mature teratomas (lat. mature teratoma) these start as benign, but can become malignant if not treated. Mature teratomas are often diagnosed before birth or in newborns. They can be found in the testes or ovaries of adolescents or young adults. Teratomas differ from other cancer cells in that although they can grow large, they do not spread throughout the body. They usually occur in women of childbearing age.
Mature teratomas vary greatly in appearance and can be further classified as follows:
- cystic – one or more fluid-filled cysts in a self-contained bag with a thin outer edge.
- solid – consists of hard tissue containing blood vessels.
- mixed – they have both cystic and solid parts.
Mature cystic teratomas, also called dermoid cysts, contain structures characteristic of normal skin, along with other tissues such as hair follicles, hair (sometimes abundant clumps of long hair), sweat glands with pockets of sebum, blood, fat (93%), bones , nails, teeth, eyes, cartilage, and thyroid tissue. Their diameter is usually less than 10 centimeters and rarely greater than 15 centimeters.
Immature teratomas
Immature teratomas (lat. premature teratoma), constitute 1% of all teratomas. They are most likely to develop into a malignant tumor and consist of tissues from the three germ layers. In women under the age of 20, these tumors account for 10 to 20 percent of all ovarian malignancies. About half of all immature teratomas can occur even earlier, between the ages of 10 and 20. They rarely occur in postmenopausal women.
There is also a third type of teratoma, that is, the extremely rare monolithic teratoma (Latin. monodermal teratoma), which mainly consists of only one type of tissue. The main subtypes are:
- ovarian goiter (lat. goiter ovarii) – a rare form of monocellular teratoma that mainly contains thyroid tissue, which can cause an overactive thyroid gland. Despite its name, it is not limited to the ovary.
- carcinoid (Latin argentaffinoma, carcinoid) – a slowly growing type of neuroendocrine tumor derived from cells of the neuroendocrine system. Sometimes it leads to metastases.
Ovarian teratomas – symptoms
Ovarian teratomas are usually asymptomatic initially. As they develop, symptoms may include:
- abdominal swelling;
- dilated veins on the skin;
- severe pelvic or abdominal pain caused by ovarian torsion due to the growing mass of the teratoma.
Occasionally, ovarian teratomas are associated with N-methyl-D-aspartate (NMDA) receptor-associated encephalitis, which is a rare condition that can cause intense headaches and mental symptoms such as confusion, violent behavior and psychosis.
Ovarian teratomas – diagnosis
Ovarian teratomas are often diagnosed during routine gynecological examinations.
In the case of mature teratomas, they are diagnosed by ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI). On the other hand, immature and monolary teratomas can be diagnosed on the basis of a combination of clinical features and imaging tests.
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Ovarian teratomas – treatment
Treatment depends on whether ovarian teratoma is cancerous or non-cancerous. Almost all teratomas should be removed upon discovery. Even if they’re not cancerous, they can grow or break quickly, leading to other problems. If the teratoma is cancerous, a specialist may recommend chemotherapy, radiation therapy, or a combination of the two in addition to surgical removal.
Treatment will also depend on the severity of ovarian teratoma. In the case of immature teratoma in stage 1, the treatment will be only surgical due to the excellent prognosis. When cancer progresses to stage 2 or 3, chemotherapy is usually recommended. The degree of immature teratoma refers to the proportion of tissue containing immature nerve components. According to the American Cancer Society, Grade 1 immature teratoma consists mainly of non-cancerous tissue and only a few areas of cancerous tissue that can be seen under a microscope. The stage of immature teratoma refers to how far it has spread – a stage I tumor means that its growth is limited to the ovaries.
Ovarian teratomas – surgical treatment
For women of childbearing age who wish to maintain fertility, surgery may be performed to remove the diseased ovary and leave the uterus and the other ovary undisturbed. The second ovary is assumed to be rarely involved, but a staging assessment is still required to ensure that the cancer has not spread. If it metastases, the tumor spreads to organs inside and around the peritoneal cavity. It can also sometimes spread to the lymph nodes and metastasize to distant areas such as the lungs and liver through the bloodstream, but this is very rare.
In the case of surgical treatment of ovarian teratomas, laparoscopy is used. It involves making a small incision in the abdomen through which a laparoscope with a small cutting tool is inserted to remove the ovarian teratoma. If the ovarian teratoma is large, the surgeon may remove some or all of the ovary. The remaining ovary will continue to ovulate and the secretion of hormones will continue from the remaining ovary.
If ovarian teratoma ruptures during removal and leaks waxy material from it, it can cause an inflammatory reaction known as chemical peritonitis. At this point it should be added that even after surgical removal, ovarian teratomas may grow back.
Ovarian teratomas – chemotherapy
Malignant teratomas are treated with a combination of surgery and chemotherapy, with chemotherapy after surgical removal.
At the start of chemotherapy, the usual combination of three drugs is bleomycin, etoposide and cisplatin. Sometimes a second combination is also used (especially in case of relapse), namely vincristine, adriamycin (doxorubicin) and cyclophosphamide.
Ovarian teratomas – prognosis
The main factor in the early stage of the disease is the severity of ovarian teratoma. If the teratoma is benign and quickly removed when detected, a permanent cure is achieved. In the case of malignant ovarian teratomas, it all depends on the severity and general condition of the woman.
The five-year survival rate for Stage 1 ovarian teratoma is estimated to be around 82 percent, and drops to around 30 percent when the tumor progresses to Stage 3. The five-year survival rate for stage 1 teratoma ranges from 90 percent to 95 percent, while the advanced stage survival drops to about 50 percent for grade 1 to 2 cancers and to 25 percent or less when the tumors are grade 3.