Do you know about ovarian teratoma

Ovarian teratoma is a common ovarian germ cell tumor. It is common in women of childbearing age. It accounts for about 15% of the total number of primary ovarian tumors, of which 95% to 98% are benign mature teratomas and only 2% to 5% are malignant teratomas. Mature cystic teratomas mostly occur in women of childbearing age around 30 years old. The clinical symptoms are non-specific, mainly manifested as pelvic masses. Twenty-five percent of patients are discovered accidentally, and ten percent of patients will experience acute abdominal pain due to tumor rupture, torsion or bleeding.

According to the pathological histological type, it is divided into mature teratoma, immature teratoma and ovarian goiter. The most common mature teratoma is mature cystic teratoma, also known as dermoid cyst. Immature teratoma has malignant biological behavior.

Pathogenesis

Theory of parthenogenesis

The most common etiology of immature teratoma is parthenogenesis caused by atypical division of primordial germ cells.

Totipotent cell theory

Early studies believed that teratomas come from primitive abnormal tissues in the early embryonic stage, which have the instinct of self-differentiation. These left-behind "totipotent cells" grow uncoordinatedly and develop abnormal embryos, thus becoming separated from the whole and causing disordered differentiation and excessive proliferation, eventually forming teratomas.

pathology

Ovarian teratomas are usually composed of 2-3 germ layers. Mature cystic teratomas have a smooth surface, intact capsule, and a diameter of about 10 cm. The cyst contains sebum and hair, and sometimes teeth, bones, and scalp head sections can be seen, with the head section protruding into the cavity as its characteristic. The degree of differentiation of immature teratomas varies, showing the process of each germ layer evolving from immature to mature stage. The histological morphology ranges from cancer to sarcoma, with various components mixed. Teratomas containing neural components are classified as immature teratomas.

Clinical manifestations

Mature cystic teratomas mostly occur in women of childbearing age around 30 years old. The clinical symptoms are non-specific, mainly manifested as pelvic masses. Twenty-five percent of patients are discovered accidentally, and ten percent of patients will experience acute abdominal pain due to tumor rupture, torsion or bleeding. Ultrasound examination has a high diagnostic rate, and unilateral ovarian cystic solid mass can usually be seen. The typical sonogram has dough sign, wall nodule sign, chaotic structure sign, lipid layering sign or waterfall sign. Serological examination may show a slight increase in CA199, AFP, etc. Complications include torsion, rupture and infection. Cyst torsion can cause necrosis, perforation and intraperitoneal hemorrhage, and cyst rupture can cause chemical peritonitis. Sebum overflowing into the abdominal cavity can form peritoneal oil granulomas. Mature teratomas containing glial components can form implants in the peritoneum after rupture, which is called peritoneal pseudogliomatosis. Immature teratomas grow rapidly and can penetrate the capsule in the early stage and spread directly to the pelvic and abdominal cavity for implantation. Lymph node metastasis and extraperitoneal metastasis may occur subsequently, and in the late stage, hematogenous metastasis to the lungs, liver and other organs may occur.