1. How does teratoma occur?
Teratoma is an ovarian tumor that originates from ovarian germ cells. It does not evolve after a woman is pregnant with a strange fetus, but comes from the abnormal proliferation of germ cells, and is a tumor that grows in the ovarian tissue formed by the abnormal proliferation and aggregation of germ cells.
Because germ cells contain three types of tissue: ectodermal, mesodermal and endodermal, with ectodermal tissue being the most common, the tumor may contain ectodermal tissue such as hair, oil, skin, teeth and bone fragments, and may also contain mesodermal or endodermal tissue such as muscle, gastrointestinal and thyroid tissue. The cause of ovarian teratoma is not yet clear.
2. Is teratoma a benign tumor?
Ovarian teratomas are divided into mature teratomas (benign) and immature teratomas (malignant), 97% of which are cystic mature teratomas, also known as dermatomal cysts.
Cortical cysts are the most common ovarian tumors, accounting for 10%-20% of all ovarian tumors, 85%-97% of germ cell tumors, and over 95% of teratomas. Because it is not related to pregnancy, ovarian teratoma can occur at any age, newborns, adolescents, middle-aged or elderly, but 80%-90% are women of reproductive age between 20-40 years, accounting for about 1/4-1/3 of ovarian tumors. Most are unilateral, and about 10%-17% are bilateral.
Immature teratoma is a malignant tumor containing 2 to 3 germ layers. The tumor consists of immature embryonic tissue with different degrees of differentiation, mainly primitive neural tissue. They are prevalent in adolescents. The tumors are mostly solid, in which cystic areas may be present. The malignancy of the tumor depends on the proportion of immature tissue, the degree of differentiation and the neuroepithelial content. Recurrence and metastasis rates are high. However, after the surgery again after recurrence, it can be seen that the tumor tissue has the characteristic of transformation from immature to mature, that is, the phenomenon of reversal of malignancy degree.
3.What are the symptoms of teratoma?
Most of them are asymptomatic, but when the teratoma is too large, there will be abdominal distension, mild abdominal pain and pressure symptoms. When the teratoma is twisted, there will be lower abdominal cramps, nausea, vomiting and other symptoms. Infertility can result when compression of the fallopian tubes occurs. Most of the patients are found during health checkups or wedding and pregnancy tests with ultrasound.
4.What tests should be done for teratoma?
Ultrasound examination is the most economical, simple and specific method. The ultrasound image of teratoma is very specific. The typical image of teratoma is a cystic mass in the adnexal area on one side, with dough and lipid separation signs. X-ray, CT examination and MRI of the pelvis may reveal calcified spots within the pelvic mass. Blood sampling to determine tumor markers such as CA-125, AFP, CEA, hCG, etc. are meaningful for diagnosis and differential diagnosis.
5.How should teratoma be treated?
Once ovarian teratoma is formed, it is impossible to disappear. It cannot be eliminated by medication or injection, but it does not mean that surgery is needed immediately. When the diameter of the teratoma is less than 3cm, we recommend dynamic observation and regular ultrasound examination. Because the teratoma is too small, one is afraid of wrong diagnosis, and the other is that the tumor is too small, making it difficult to find the tumor during surgical treatment and damaging the normal ovarian tissue too much. If it is larger than 3cm, early surgery should be performed.
6.What is the best surgical method?
Laparoscopic treatment is the best way to treat teratoma, which not only removes the tumor completely, but also minimally invasive and leaves no surgical scars on the abdomen. Laparoscopic teratoma removal is not a major operation, but it requires a high level of technical skill. The level of skill and delicacy of the operation is closely related to the subsequent pregnancy.
If the laparoscopic debridement ruptures, there is a risk of peritoneal implantation and chemical peritonitis, so patients are advised to choose their hospital and surgeon carefully in a responsible manner. In most cases, ovarian teratoma surgery can preserve the normal ovarian tissue on the affected side (resection of the affected adnexa is recommended in menopausal patients), and the contralateral ovary is not dissected in principle if no abnormality is seen on preoperative ultrasound and intraoperative probing.
For teratoma in perimenopausal women, resection of the affected adnexa or the uterus plus bilateral adnexa is recommended. The youngest patient treated by laparoscopic surgery in our medical group was 7 years old, and the largest number of patients with bilateral ovarian teratomas peeled laparoscopically was 11. Some patients with very large teratomas, larger than 13 cm in diameter and with a very high solid component, may be better treated with open surgery.
7. Can ovarian teratoma become malignant? Is it likely to recur? What are the consequences of untimely treatment?
Benign ovarian mature teratoma has the possibility of malignancy, and the malignancy rate is about 2-3%. The rate of malignancy is about 2-3%. Very few patients have teratomas that reappear on the same or opposite side after surgery. Ovarian teratoma is prone to tumor reversal because of the heterogeneity of the tumor. Once reversed, emergency surgical treatment is necessary, in most cases requiring removal of the adnexa on the reversed side, resulting in irreversible damage to the body. Most of the clinical cases of ovarian cyst torsion are caused by teratoma.
8.How to manage teratoma in pregnancy?
If ovarian teratoma is found during pregnancy, it should be temporarily observed during the first 3 months of pregnancy and then treated with laparoscopic surgery after 12 weeks. Teratoma is most likely to be reversed and acute abdomen occurs, so in principle, laparoscopic surgery should be performed to treat teratoma in pregnancy. Teratoma found in the middle and late pregnancy can wait to be treated together at the end of delivery. Teratoma found before pregnancy is best treated surgically first to avoid tumor growth during pregnancy and the need for surgery. Contraception is not required after teratoma surgery.