What is ovarian immature teratoma

What is ovarian immature teratoma? Ovarian immature teratoma is a malignant germ cell tumor of the ovary with a high degree of malignancy. The cause of this disease is unknown. Common clinical manifestations include abdominal mass and abdominal pain, and the incidence of abdominal implantation is high. After treatment with postoperative adjuvant combined chemotherapy, the survival rate has increased from 10% to 20% to more than 95%.

Common clinical manifestations include abdominal mass and abdominal pain. The incidence of abdominal implantation is high. Sixty percent of patients have peritoneal effusion, which consumes physical fitness and causes weight loss. Most patients have normal menstruation and reproductive functions. The incidence of metastasis is high. The metastasis spreads along the peritoneum. Common metastatic sites include pelvic and abdominal peritoneum, greater omentum, liver surface, diaphragm, intestines and mesentery. Most metastatic lesions are surface implants. Lymph node metastasis is not uncommon.

Serum alpha-fetoprotein (AFP) The AFP in the patient's serum is lower than that in ovarian yolk sac tumor. This may be because the endoderm tissue of immature teratoma can also secrete a small amount of AFP. Another possibility is that many germ cell malignant tumors are mixed types. Immature teratoma may be mixed with a small amount of yolk sac tumor components, which can synthesize trace amounts of AFP. Nerve cell-specific enolase (NSE) Ovarian immature teratoma contains mature or immature nerve cells. Sometimes NSE can be detected in the serum, which is of reference significance for the diagnosis of this disease. B-ultrasound, CT, MRI, laparoscopy, and histopathological examination. Differential diagnosis of ovarian immature teratoma should be differentiated from yolk sac tumor and choriocarcinoma. Yolk sac tumor is often accompanied by elevated serum AFP, and choriocarcinoma is often accompanied by elevated β-hCG, which is helpful for differential diagnosis.

Treatment principles for immature ovarian teratoma:

(1) The scope of surgery should first be explored in detail, especially the diaphragm, liver surface and retroperitoneal lymph nodes, to correctly stage the tumor. The vast majority of tumors are unilateral, and the patients are often very young. It is often recommended to perform unilateral adnexectomy to preserve fertility. If the patient has no fertility requirements and the tumor is stage II or III, bilateral adnexes and hysterectomy can be performed. The greater omentum is a common site of metastasis, and it is performed regardless of the early or late stage of the tumor. There is no consensus on whether the retroperitoneal lymph nodes should be routinely removed. For patients with extensive abdominal implants and metastases, tumor cell reduction surgery should be performed as much as possible to achieve basic tumor removal. Tumors are mostly surface implants with little parenchymal infiltration, so surgical removal is not difficult.

(2) Surgical treatment of recurrent tumors Recurrent tumors of immature teratomas are still mainly treated by surgical resection, supplemented by effective combined chemotherapy. Recurrent tumors are often large or medium-sized tumors that are widely distributed in the abdominal and pelvic cavities. They are located in the liver or between the liver and diaphragms. From the appearance, surgical resection is difficult, but do not give up easily. It is still possible to remove the tumor. If the adhesion is severe and cannot be completely removed, a small amount of tumor tissue can be left, and postoperative chemotherapy can also achieve good results.

(3) Surgical treatment for residual tumors that have been transformed into pathological grade 0 and have not been completely removed ① If the tumor is large and involves organs and produces symptoms, such as being close to the liver or diaphragm, causing compression symptoms and even affecting breathing and producing a large amount of abdominal effusion; the tumor is located in the mesentery, affecting intestinal peristalsis; the tumor is close to the pelvic wall, compressing the ureter, etc., surgery must be performed as soon as possible to relieve symptoms. ② If the patient has undergone multiple major surgical traumas in the recent period, although there are still pathological grade 0 tumors in the abdominal cavity, the tumor is not large (less than or equal to 6 cm in diameter) and is asymptomatic, follow-up observation can be performed and surgery can be performed at a later date after the physical condition improves. ③ In some patients, pathological grade 0 tumors that remain in the abdominal cavity may still become malignant after a certain time interval. Although the chance of mature teratomas turning into adenocarcinomas or carcinoids is low, once they become malignant, they are highly malignant and have a poor prognosis. If the patient's general condition recovers well, the remaining mature teratomas that have been transformed into grade 0 should be removed.