Many people are misled by the name teratoma, but is ovarian teratoma really a “freak”? Teratoma can occur at any age, it is not a result of fertilization of the egg and is not related to pregnancy. Teratoma is a tumor formed by the mutation of infantile germ cells in the body, and it occurs most often in the ovaries, followed by the testes. In other words, men can also develop teratomas. In addition, they can also grow in the mediastinum, sacrococcygeal region, retroperitoneum, pineal gland and other parts. 1. What is a teratoma? Let’s bite the bullet. The term “teratoma” refers to an unattractive, oddly shaped tumor; the term “fetus” refers to a tumor that contains components similar to those of a fetus. The source of the tumor is indeed the germ cells in the female ovaries or male testicles, but it should be clarified that teratoma is not a tumor that evolves after a woman has conceived a strange fetus and has nothing to do with marriage or sexual life. We know that the primordial germ cells mature into an egg, and after fertilization with sperm, they differentiate towards an embryo. After the fertilized egg is divided into two, two and four, and four and eight …… gathered into a mass to form an embryo, it initially differentiates into three major types of tissues: ectoderm, mesoderm and endoderm, and then each differentiates into the corresponding organ and eventually matures into a fetus. In the absence of fertilization, the body’s primordial germ cells may also undergo abnormal differentiation, also into three types of tissues: ectodermal, mesodermal and endodermal, but ultimately fail to differentiate into complete organs, thus forming a tumor, which is a teratoma. The tumor will have ectodermal components such as hair, grease, skin, teeth, bone fragments, etc. It may also have mesodermal or endodermal tissues such as muscle, gastrointestinal, and thyroid tissues. 2.Who will teratoma find? In terms of gender, teratoma is mostly found in women. Teratoma can also occur in men, but it is very rare …… In terms of location, ovaries are the most common site of occurrence. However, teratomas can also occur in the midline areas of the body, such as the mediastinum, the front of the spine, and the pelvis, but of course they are very rare. In terms of age, teratoma can occur in both young girls and older women, but most of them occur in women between 20 and 30 years old. 3.Is there any difference between good and bad teratoma? Of course! About 97% of teratomas are benign teratomas. Most benign teratomas that occur in the ovaries are cystic in nature, also known as dermatomal cysts. The shape of the tumor is round or oval with a smooth envelope on the outside. The cystic cavity is most often filled with hair masses and oil. The grease is runny at human body temperature (or thickened to a cheese-like substance), and the tumor condenses to a semisolid at room temperature shortly after cutting it down. The tubercle also often contains teeth and bone fragments, which can number in the dozens. The tumor can also have solid portions within it that become cephalic segments. The tissue within the tumor is well differentiated, so the tumor is benign. If the differentiation is immature, it is malignant. 4. What are the oddities of teratoma? In some teratomas, the differentiated mature hair-covered head segments resemble the fetal scalp, which really looks like a headache. Some of the bone fragments differentiate into irregular bone fragments, while others differentiate into something almost identical to a child’s teeth. The bone fragment-like material has poor light transmission. If a high-density image is found on ultrasonography or X-ray, it is a good thing, indicating that the tumor is mostly benign. However, only about half of the benign teratomas will have this kind of reassuring test result. 5. What is the problem with malignant teratoma? If the tissue within the tumor is poorly differentiated and even has undifferentiated embryonal cancer cells, it is an immature teratoma. It is a malignant germ cell tumor. The most common immature tissues are neural tissues, and the percentage of immature tissues or cells determines the malignancy of the tumor. It has been recognized that the malignancy of immature teratoma has a pattern of transformation to benign. If repeated surgery, chemotherapy and supportive treatment make the patient survive for more than 1 year, the tumor may reverse to mature type and become benign tumor. 6.Can you tell us more about mature cystic teratoma of the ovary? Yes. It is one of the most common benign tumors of the female reproductive system, accounting for almost half of all benign tumors of the female reproductive system. Moreover, it is also the most common benign tumor found in pregnant women, especially those who have not had a physical examination prior to pregnancy. A small mature cystic teratoma of the ovary does not cause any trouble, it is just a small tumor found on the ovary during an ultrasound, or one feels uncomfortable in the lower abdomen after learning that there is a tumor in the ovary. If the tumor is large and the patient is slim at the same time, it can sometimes be felt in the shower. Mature cystic teratoma of the ovary is very good natured, but it can easily cause a big problem, cyst torsion, leading to abdominal pain and nausea, which is a gynecological emergency that needs urgent treatment. 7. What is teratoma torsion? Because teratomas are mostly of medium size (fist size, 5-10 cm), and the contents are of different density, the center of gravity is usually to one side, heavy, and will follow the movement when the position changes such as movement and sex, sometimes the movement is too much and twisting will occur. It can be twisted half a turn or several turns. The consequences of cyst torsion are serious, equivalent to ovarian suicide! Because the blood supply to the ovaries and the teratoma is blocked after torsion, if you don’t believe in twisting a cucumber on a melon shelf several times from the tip, see if it can still live. Severe abdominal pain and nausea will occur after the cyst is twisted. If not treated in time, the ovary will be necrotic and the tumor may rupture when the tension increases. The contents of the tumor (mainly grease) will break into the abdominal cavity and cause chemical peritonitis, which in addition to being very painful, may also lead to future abdominal adhesions. 8.When do I need surgery? Once the diagnosis of mature cystic teratoma of the ovary is established, surgery is most likely required, it is just a matter of time. As for the specific size of the diameter to warrant surgery, it is still being studied in depth. Generally speaking, if the tumor is not more than 5 cm in diameter, surgery can be withheld for the time being and reviewed regularly. However, if the patient has a need for fertility in the near future, the threshold should be lowered a bit, and a diameter of more than 4 cm is worth surgery. 9. Do teratomas require removal of the ovaries? Once yes, now no. Everything used to be done whenever there was a tumor on the ovary, but then thanks to a gynecologist who promoted ovarian cyst removal. If the patient is not too old, the tumor can be removed and the normal ovarian tissue can be preserved. After the surgery, one can still have normal menstruation and normal fertility. Since about 25% of dermatomal cysts are bilateral, the surgeon will carefully examine the other ovary during surgery. If necessary, the ovary will be dissected to look for small cysts that may be found. 10. What is the best way to perform the surgery? There used to be controversy over whether to perform traditional open surgery or minimally invasive laparoscopic surgery, but the dust has recently settled. Previously, teratoma was considered a contraindication to laparoscopic surgery for fear of contaminating the pelvis after tumor rupture during surgery, but in recent years, it is believed that laparoscopy is the best surgical approach after paying attention to some details during surgery.