What are the dangers of ovarian teratoma?

Ovarian teratoma is a relatively common germ cell tumor that often occurs in women of childbearing age. Most of them are benign tumors, with 2% to 52% being teratomas. This is quite harmful to patients. About 10% of patients will experience tumor rupture, which can easily lead to torsion or even bleeding symptoms, and chemical peritonitis. Once lymph node metastasis occurs, it can easily lead to metastasis to organs such as the liver and lungs.

Mature cystic teratomas mostly occur in women of childbearing age around 30 years old. The clinical symptoms are nonspecific, the main manifestation is a pelvic mass, which is discovered incidentally in 25% of patients, and 10% of patients experience acute abdominal pain due to tumor rupture, torsion or bleeding. Ultrasonography has a high diagnostic rate and usually reveals a unilateral ovarian cystic solid mass.

Typical sonograms include dough sign, wall nodule sign, chaotic structure sign, fat-fluid stratification sign or waterfall sign. Serological examination may show slight elevation of CA199, AFP, etc. Complications include torsion, rupture, and infection. Cyst torsion can cause necrosis, perforation and intra-abdominal hemorrhage, and cyst rupture can cause chemical peritonitis.

Sebum overflowing into the abdominal cavity can form peritoneal oil granuloma. Mature teratomas containing glial components may form implants in the peritoneum after rupture, which is called pseudoglioma peritonei. Immature teratomas grow rapidly and can penetrate the capsule in the early stages, spreading directly to the pelvic and abdominal cavities 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.

Patients with ovarian teratoma should choose surgical treatment. The scope of surgery can include ipsilateral oophorectomy, ipsilateral teratoma removal and/or contralateral ovarian biopsy. The surgical method can be laparoscopic or open. The benign or malignant nature of the teratoma can be preliminarily determined based on what is found during the operation. If a malignant tumor is suspected, the teratoma should be sent for frozen pathology examination as soon as possible.

Malignant teratomas should also undergo complete staged surgery as much as possible. During the operation, the pelvis is fully explored, the greater omentum and peritoneum are removed, and lymph node biopsy is performed to understand the scope of tumor infiltration and the degree of involvement of various organs and tissues. For young patients with malignant teratoma who want to have children, surgery to preserve fertility can be considered. The chemotherapy regimen currently recommended by WHO is the BEP regimen.