Ovarian teratoma is a tumor that can contain hair but also bones, teeth, etc.
A benign or malignant tumor, teratoma develops in the ovary in women (or in the testicles in men). Its discovery is often made during a routine visit to the gynecologist or during a surgical operation. “It is during a pelvic ultrasound or an MRI that the ovarian teratoma is discovered accidentally” specifies Dr Elisabeth Paganelli, obstetrician gynecologist, member of the Syngof.
What is an ovarian teratoma?
Etymologically, the term teratoma from the Greek “teras” means “monstrous tumor” due to the appearance of a wide variety of cells in the tumor. As Doctor Elisabeth Paganelli explains, “a teratoma is a tumor that develops from primitive germ cells, it is therefore called a “complex” tumor. It appears in the ovary in women And in the testicles of men”. Testicular or ovarian, teratoma is characterized by its bulky mass. As astonishing as it may seem, “teratomas can produce hair or teeth” underlines Doctor Paganelli. “Teratomas are composed of tissues from the three embryonic layers called the endoderm, the ectoderm and the mesoderm” explains Dr. Paganelli. These three layers are at the origin of all the organs and tissues of the body. Teratomas can thus contain various types of fabrics.
What is a mature teratoma?
Mature teratoma also called dermoid cystmost frequently “is a slowly growing benign tumor”, explains Elisabeth Paganelli. Indeed, these are benign lesions, originating from initially totipotent germ cells but having evolved towards their “definitive” mature cell stage, which can be by definition very variable: hair, tooth, skin, cartilage, etc. cells. thyroid… “In a very rare (approximately 1% of cases of mature teratomas), these cells making up the mature teratoma can sometimes become cancerous and turn into cancer“, adds Nicolas Carrabin.
What is an immature teratoma?
Immature teratoma is a rapidly growing malignant tumor who meets especially in young women and presents several grades of aggressiveness described after an anatomopathological examination. It consists of studying tissues or cells taken from a patient to identify and analyze abnormalities linked to a disease. However, as Nicolas Carrabin points out, “immature teratomas are very rare (less than 5% of teratomas) and are immediately malignant lesions that can endanger the vital prognosis. They are composed of initially totipotent germ cells but by definition still immature (or embryonic), that is to say which have not yet reached their terminal mature stage of tooth or hair cell.
What causes an ovarian teratoma?
Patients who develop teratoma have abnormal tissue development. However, it remains difficult to know the cause of an ovarian teratoma, “often of unknown origin” recognizes Doctor Paganelli. Which makes preventing the formation of this tumor impossible.
What are the symptoms of an ovarian teratoma?
“These are the classic symptoms of an ovarian cyst, usually present in cases of a large cyst. The patient complains of pelvic heaviness linked to the mass, which can sometimes compress nearby organs such as the bladder ( and cause a frequent urge to pee) or the rectum (and cause a false need to have a bowel movement or transit disorders)” replies Doctor Nicolas Carrabin, gynecological surgeon and president of the Rhône-Alpes college of gynecology. “During palpation of the abdomen, it is also possible to perceive a mass if the teratoma is large” adds Elisabeth Paganelli. Endocrine disorders “such as hyperthyroidism if the teratoma secretes thyroxine” must also warn, continues the latter.
Examinations: mandatory MRI
The diagnosis of teratoma is most often suspected duringPelvic ultrasoundand is confirmed by a heavier imaging examination such as to scan or ideally thePelvic MRI. “The presence of a fatty component within the lesion is almost a “signature” of the teratomatous nature of the lesion. This MRI very often makes it possible to direct the diagnosis towards a mature or immature teratoma lesion depending on its appearance, on the part of solid versus liquid tissue, the nature of the tissues composing it and the extent of absorption of the contrast product which is injected” explains Nicolas Carrabin. The definitive diagnosis remains provided by microscopic analysis of the lesion, which can only be made in the event of surgical removal. It is not recommended to perform biopsies of these lesions.
Depending on the diagnosis, benign or malignant, the treatments will differ. “If the teratoma is mature and does not cause symptoms, simple imaging monitoring may be offered. If the cyst becomes bothersome then a cystectomy can be considered under general anesthesia, either by laparoscopy or by laparotomy depending on the size and location of the teratoma.explains the specialist. “Sometimes it becomes necessary to remove the ovary, always depending on the size of the teratoma. But this operation presents itself as a surgery with low risk of complications. In the case of immature and therefore malignant teratomas, surgical treatment is essential. “It is based on surgical excision of the tumor requiring an adnexectomy (removal of an ovary and the fallopian tube) only in advanced teratomas, if the tumor exceeds the ovary or there is tumor rupture..” Depending on the results carried out under the microscope, it may sometimes be necessary to supplement surgical treatment with chemotherapy. “Regular monitoring is then fundamental to prevent recurrences and is based on clinical examination, biology and imaging” concludes Doctor Elisabeth Paganelli.
The survival prognosis depends on the type of teratoma
“In case of benign teratoma, the vital prognosis is not engaged. The growth of the lesion is most often very slow and a simple monitoring can be adapted. There is then a small risk of ovarian torsion which may require emergency surgery. underlines Doctor Nicolas Carrabin. However, it is advisable tooperate on mature teratomas in cases of large size due to a small risk of cancerization, “that is to say, for example, that a mature skin cell making up the teratoma transforms into a skin cancer cell. The prognosis is then linked to the nature of the cancer depending on the cell of origin: skin cancer, thyroid…” continues the specialist. THE immature teratoma is a much rarer lesion whose prognosis also depends on the grade of the lesionthat is to say his aggressiveness. “Generally speaking, the prognosis remains rather good with a high cure rate in cases of immature teratoma”explains Nicolas Carrabin.
Thanks to Doctor Elisabeth Paganelli, obstetrician gynecologist in Tours and member of the Syngof board of directors, and Doctor Nicolas Carrabin, gynecological surgeon at the Charcot clinic and president of the Rhône-Alpes gynecology college.