Immature teratoma prognosis. Teratoma: what is it, signs and treatment methods

This formation contains several types of tissues formed from one, two, three rudiments, the presence of which does not belong to those parts of the body where the tumor is formed. It comes from gonocytes (mature sex cells of men and women), usually manifests itself in the gonads in men, in the ovaries in women, in the coccygeal-sacral area and in the brain in children.

Teratoma is a tumor-like neoplasm consisting of one, two or three embryonic buds. The cause of teratoma is the abnormal behavior of chromosomal cells. Therefore, the contents of the formation are unpredictable; the gap contains fragments of hair, teeth, cartilage tissue, brain, muscles, and sometimes pieces of the embryo’s body. Scientists have not yet discovered the true causes of teratoma, but according to some data they have classified it as a type of embryonic cancer.

Etiology of the disease

Teratoma belongs to the germ cell tumor type embryonic cancer. A germ cell tumor is produced from the pluripotent (stem tissues involved in the formation of all cells in the human body), germ cell epithelium of a specialized gonad, which can be amenable to somatic and trophoblastic differentiation and serves the appearance of multicellular tumors of different structure and construction, in particular testicular seminoma, ovarian dysgerminoma, embryonal cancer.

Teratoma in most cases is located in the gonads; the appearance of a tumor outside the gonads is determined by the slow movement of the germinal epithelium as it moves from the yolk sac shell to the area where the gonads are formed. Teratoma is divided into mature (dermoid formations) and immature (teratoblastoma). Mature and immature tumors differ in composition and structure. The mature one consists of standard cells natural for an adult.

If the cells cannot be distinguished, it is an immature tumor. In profile, the formation resembles a sac filled with secretion, a greasy liquefied substance with fragments of hair follicles, teeth, and sebaceous glands. Under a microscope you can see the formation of the germ layer. Ectodermal: skin, parts of nerve cells and fibers such as ganglia. Mesodermal: bone, cartilage, fibrous and adipose tissue.

Endoderm is found less frequently; as a rule, it is respiratory epithelium, fragments of the thyroid and salivary glands. Mature cystic teratoma is one of the most well-known tumors of childhood and adolescence; if the generating property is increased, then newborns are included in the risk group. There is a high probability of tumor appearance during puberty and postmenopause. Teratoma most often appears as a benign formation.

Symptoms of the disease

The scenario depends entirely on the size and location of the tumor. In newborns with teratoma, deformations of the skeleton and internal organs are visible at birth. In adults, the pathology remains hidden for a long time until it begins to compress or move the organs from which it grows. With a malignant tumor, symptoms of a different nature appear, a feeling of squeezing, suffocation, heaviness and pain in the abdomen, fever, sharp pain, depending on the location of the pathology.

Teratoma usually manifests itself during puberty and hormonal changes. Acute pain occurs when the base of the tumor is twisted, this leads to its rupture; untimely assistance can cause peritonitis. If a teratoma has formed in the testicles, swelling of the scrotum is observed; the swelling accompanied by pain indicates a malignant tumor. Revealed over the years.

The presence of the formation can be detected immediately at birth and removed by two months. If a tumor is not detected, this leads to an unfavorable prognosis, since by adolescence, hormonal changes have already occurred in the body, and there is a risk of the cell turning into a malignant tumor. A sacrococcygeal teratoma located in the groin area contributes to the disorder of defecation and urination.

A sacrococcygeal tumor can be recognized immediately at birth or during an ultrasound scan inside the womb. The tumor is located behind the sacrum and can be round or enormous in size. This prevents the correct course of labor; in this case, doctors perform a caesarean section. Teratomas of ENT organs are extremely rare; they can be detected in fetal development.

Ovarian teratoma

This pathology is a tumor arising from embryonic tissues, flattened in thickness with an uneven surface. Also divided into two types: mature and immature teratoma.

Immature in most cases transforms into a malignant tumor in addition to metastases and has an unfavorable prognosis.

Teratoma is often mistaken for teratoblastoma - a tumor of undifferentiated tissue.

The transformation of the original non-malignant tumor into a malignant one occurs quickly, developing into teratoblastoma.

The main location of the tumor is on the anterior wall of the uterus, leading to hemorrhages and tissue necrosis. These types of tumors are transported by lymphatic drainage and blood vessels.

The structure of metastases coincides with the main source, or one of the constituent elements may dominate. Main symptoms: anemia, increased fatigue, weight loss, pain occurs when the form is advanced. Timely diagnosis and treatment will help avoid consequences.

A mature teratoma is considered benign and is called a dermoid cyst.

The structure is heterogeneous, with a large number of cystic blisters filled with colorless secretion. It has a dense shell, contains cartilaginous, bone and sebaceous fragments, and may consist of one or more depressions.

Not prone to metastases, but there is a risk of torsion due to the size and extent of the base. Can develop from uterine to adulthood. It opens up as it ages. During the development of a teratoma, it is impossible to predict.

Having reached its final size, it no longer increases.

Treatment is carried out using laparoscopy.

Diagnosis of pathology

To recognize this type of tumor, ultrasound and screening are used. Using ultrasound, the size, location and structure of the tumor are determined to determine the presence of metastases. In cases where the tumor is located in the sacrococcygeal zone and mediastinum, X-ray examinations are performed.

Infected areas, diagnosis of size, structure of the tumor, the presence of metastases and their foci are well revealed by computed tomography. To determine the presence of malignant cells in a tumor, a histological examination is performed. Blood tests for alpha photoprotein and human chorionic ganadotropin are performed as prescribed if the presence of a teratoma is determined.

If ovarian teratoma is suspected, an examination is performed by palpation. With the help of palpation, tumors ranging in size from 5-15 cm are felt. Echography is used for a more accurate prognosis; during the study, pronounced sound diversity is noted.

Teratoma has clear contours, a hypoechoic structure, and a solitary echogenic inclusion. When switched on, the sound shadow is perfectly monitored. A Doppler apparatus is used as an additional measure.

Treatment of the disease

Therapy for mature and immature tumors is carried out using surgery. For teratoma combined with another malignant germ cell tumor, and for malignant tumors capable of modification, systematic therapy is used.

Patients with an immature tumor require constant monitoring, the scenario entirely depends on the size and location of the tumor.

In case of an ovarian tumor, it is removed; in the postmenopausal period, all reproductive organs are removed. For mature teratoma, laparoscopy is performed; the woman will be able to become pregnant in the future.

In general, the prognosis is always good; in case of repeated outbreaks, a drastic method is used - chemotherapy. Children are also treated surgically, with complete removal of the tumor.

In case of coccygeal teratoma, it is eliminated along with the coccyx. Immature testicular teratoma with metastases requires surgical treatment in addition to chemotherapy; the prognosis is not always favorable.

If you notice symptoms of teratoma, consult your doctor immediately.

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Teratoma

A tumor containing various tissues, sometimes atypical for a given organ, is called a teratoma, which translated from Greek means “monstrous tumor.” The disease owes this terrifying name to the fact that inside the tumor there may be teeth, hair, eyes, bone, connective, muscle, nervous, epithelial and other tissues, as well as other organs.

This happens for the reason that teratoma develops from germ cells that can degenerate into any tissue of the human body. The most complex structure is found in those teratomas that form at the very beginning of embryonic development. If the tumor arises later, when the rudiment of an organ or tissue has already formed, it is more homogeneous in its composition.

The disease usually manifests itself in childhood or adolescence. Most often, teratoma forms in the gonads: in the ovaries - in women, in the testicles - in men. Children develop mainly coccygeal teratoma in the sacrococcygeal spine. Much less often, the tumor is localized in other organs. In all cases, removal of the teratoma is indicated.

Teratomas can have both a benign and malignant course.

Types of teratoma

A chromosomal abnormality of cells leads to the formation of a tumor. Depending on what constitutes a deviation from the norm, immature and mature teratomas are distinguished.

The immaturity of a teratoma is indicated by the presence in the tumor of tissues, the type of which is difficult to determine. Most often the tumor has a malignant course. In a mature teratoma, elements of tissues characteristic of humans are clearly visible: nervous, muscle, connective or fatty.

Mature teratomas differ from immature ones not only in appearance, but also in different growth characteristics. For example, a mature testicular teratoma in men can sometimes become malignant, while an ovarian teratoma of the same type in a woman is mostly a benign tumor.

In turn, mature teratomas are divided into cystic and solid. Cystic is a large tumor, under the smooth surface of which there are one or more cavities filled with turbid contents. There may be fragments of cartilage, teeth or hair inside them.

A solid mature teratoma is a dense tumor-like formation of different sizes, the surface of which can be either smooth or bumpy. The teratoma is heterogeneous in structure; inside there may be tissue of unknown origin and small cysts with mucus or liquid.

According to their consistency, there are dense teratomas, consisting only of tissue, and cystoteratomas, where there is also liquid.

Symptoms of teratoma

As a rule, obvious symptoms of teratoma appear with a malignant course or significant tumor growth. In other cases, the condition of the patients is not particularly affected; the teratoma remains “silent” for a long time. When the tumor-like formation becomes large, symptoms characteristic of displacement or compression of organs appear. For example, with a mediastinal teratoma, unpleasant sensations appear behind the sternum, and a tumor in the lungs causes shortness of breath.

With ovarian teratoma, complaints of a feeling of heaviness in the lower abdomen may periodically appear. If there is torsion of the cyst leg, then the symptoms are similar to the clinical picture of an “acute abdomen.” A teratoma in the testicle is visible to the eye as an enlargement of the scrotum on the side of the formed tumor. The addition of pain indicates that the process is becoming malignant.

In children, the tumor is most often localized in the sacrum, coccyx or perineum. Pilonidal teratoma can come in different sizes and shapes. Large formations interfere with the normal functioning of the child, as it makes it difficult for him to urinate and defecate. Congenital teratomas are common. The intrauterine development of the child is disrupted the more strongly the earlier the formation of the coccygeal teratoma occurs. After birth, soft tissue defects and skeletal damage become noticeable.

Treatment of teratoma

Treatment of teratoma of any form is only surgical; in case of torsion of the pedicle of a cystic teratoma of the ovary, the operation is performed as an emergency. The extent of surgical intervention is determined by the size of the tumor, the age of the patient, the location of the teratoma and concomitant diseases.

In girls and young women, removal of teratoma with lesions of the pelvic organs is carried out against the background of partial resection of the ovaries. Whereas in women during menopause, complete removal of the uterus with both appendages is indicated.

Due to the tendency to become malignant and metastasize to the lymph nodes, treatment of testicular teratoma consists not only of tumor removal, but also of the use of radiation therapy simultaneously with the prescription of antitumor drugs. The same comprehensive approach is also practiced for other localizations of teratomas, if they are combined with other tumors or are prone to malignant degeneration.

In most cases, the prognosis is favorable, but to a large extent it depends on where the tumor formed and how timely and adequate the treatment was. Teratoma, the course of which is complicated by some types of cancer, proceeds less well. In such cases, even removal of teratoma and other formations does not guarantee complete recovery.

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Teratoma - what kind of disease is it?

The high prevalence of tumor diseases leads to a constant increase in interest regarding etiology, prognosis and treatment methods. Teratoma is one of the most common pathologies. This tumor can be either malignant or benign.

The rarest large teratomas

Often, without showing its presence, it is discovered during examination for associated symptoms. There are various forms, localization and associated complaints - from mild frequent coughing to the inability to have children or the appearance of neurological symptoms. What kind of disease this is will be discussed in more detail below.

Definition

Teratoma is a tumor growth that has components of one or more germ layers, the presence of which is not typical for the location of the tumor. It takes its name from the Greek root “teratos”, which means “ugly”.

This is due to contents that may seem frightening or disgusting - often inside the tumor capsule, in addition to cloudy liquid, the rudiments of teeth, bone or cartilage tissue, hair or even nails are found.

The development of large dermoids can affect many body functions, including the ability to bear a fetus. This pathology occupies approximately a third of the total number of all tumor formations in children and approximately seven percent in adults.

It is believed that most often they are benign in nature and are removed only for certain indications, such as the occurrence of secondary complications or in the presence of a negative cosmetic effect.

Pathophysiology of development

Teratoma most often originates during intrauterine development of a person. The most acceptable theory of its development believes that the primary focus of teratoma development is a violation in the genesis of primordial germ cells.

Three germ layers are formed from them: exo-, meso- and endoderm. Due to a violation of tissue differentiation, some of the cells, which subsequently should become an organ of another system, remain in an uncharacteristic place. Then they continue to grow and develop together with the host organism.

In the photo: Histological specimen of a mature teratoma

The subsequent development process depends on the magnitude of changes in the genetic code, which ultimately leads to the presence of a mature (dermoid) or immature (teratoblastoma) tumor. The difference between them lies in the internal content.

In the first case, a mature teratoma is differentiated tissue that is normally found in various organs or systems of an adult. In the second case, an immature teratoma is tissue that cannot be differentiated by microscopy.

Mature cystic teratoma is considered the most common pathology of childhood and adolescence. Sometimes the intensity of its growth increases due to pregnancy or the onset of menopause. This is due to hormonal changes that accompany these conditions.

Reasons for development

The etiology of teratoblastoma is a rather unstudied issue. There are many theories about the reasons for its development. It is believed that due to the influence of various pathogenic factors, a failure occurs in the process of organogenesis and some cells simply stop moving and remain in place, while the surrounding cells form tissues, and tissues form organs and systems. Unfortunately, modern medicine is still unable to give a clear answer as to why this happens.

Many clinical studies in this area highlight the main pathogens:

Presence of a family history of teratoma.

Abuse of alcohol or tobacco products during early pregnancy.

Treatment with hormonal drugs or cytostatics.

Chronic exposure to radiation, toxic substances and occupational hazards.

Certain types of embryocytomas

Below we will separately consider some types of teratomas, differing in their localization:

Ovarian teratoma

This disease is a fairly common form of teratoma. Due to its specific localization, it requires separate consideration. We have a detailed article about this.

Fetal teratoma

This serious pathology is becoming more common every year. Read a separate article about the causes, types and methods of treatment of fetal teratoma.

Caudal teratoma

Caudal teratoma is, as a rule, a congenital tumor with a benign course, which is located in the peri-rectal tissue. It occurs in one in forty thousand newborns.

Its dimensions rarely exceed twenty centimeters. The danger lies in the possibility of fistula formation with the intestines or skin. Diagnosis consists of radiography or the use of MRI. Treatment is surgical.

Sacrococcygeal teratoma

It is also a congenital tumor that occurs in one in thirty-five thousand newborns. Most often it occurs in female children. It can grow both forward and backward, often leading to deformation of adjacent organs, namely the intestines, bladder or vagina.

Diagnosis of such teratomas consists of conducting an ultrasound examination at the twenty-second to thirty-fourth week of pregnancy. As a therapeutic measure, prenatal puncture is performed, which makes it possible to reduce the size of the teratoma and reduce the likelihood of complications during childbirth. After childbirth, surgical correction is performed.

Teratoma of the brain

This is a rather rare type of intracranial tumor, which in almost half of cases is characterized by a malignant course. A typical site of localization is the base of the skull; due to the wide vascular network, frequent metastasis is observed in the lungs, bones of the spinal column, and liver.

Brain teratoma MRI

In the presence of a benign course, there remains a high probability of malignant degeneration of the tumor. Histologically, it is a dermoid cyst, which originates during fetal development and is associated with the presence of unexplained chromosomal abnormalities.

Characteristic symptoms include dizziness, headache and nausea. Hormonal disorders are also often observed, which is why boys experience early puberty. The treatment that is used in this case is surgical removal of the tumor. The outcome depends on the location, size and histological characteristics.

Lung teratoma

This is a dermoid cyst, the cells of which, during organogenesis, moved to the site of future lung formation. As a rule, morphologically it is a cavity, inside of which there are sebaceous glands with the corresponding secretion, hair, cartilage and teeth. The presence of a dense capsule allows it to grow up to ten centimeters in diameter without the presence of pathological mucus during expectoration.

Lung teratoma - radiography

Lung teratoma accounts for less than two percent of all tumors in this area. Most often it is detected in adults during fluorography. The favorite site of localization is the upper lobes of the lungs, and therefore it is often confused with tuberculosis.

Violent symptoms can develop when a cyst ruptures, and therefore such patients are urgently admitted for treatment to the pulmonology department, and then to the thoracic surgery department. Immature teratoma of this localization often tends to develop into sarcoma and, as a result, does not have a very favorable prognosis.

Mediastinal teratoma

This is an anomaly of intrauterine development in which tumor cells develop in an atypical area. The main site in this situation is the pericardium or great vessels. An enlarged mediastinal teratoma can lead to pressure on the pleural cavity or difficulty in the passage of blood through the aorta and vena cava.

Mediastinal teratoma – radiography

The size of such a cyst can reach twenty centimeters, which has a strong effect on the saturation of tissues with oxygen. This leads to shortness of breath, tachycardia, and hypertrophy of the heart chambers. Suppuration is possible, which will lead to general inflammatory syndrome. Diagnosis consists of radiography, treatment is surgical.

The prognosis for mediastinal teratoma depends on the site of its growth and the presence of invasion into the pleural cavity or vessels. In almost nine out of ten cases, benign tumors arise, which increases the chance of a positive effect from surgery.

Testicular teratoma in men

This tumor occupies approximately 40% of all germ cell tumors of this organ. Its increase begins during puberty, which is why, most often before this period, no one suspects its existence.

The discovery of testicular teratoma in an adult male is extremely rare and occurs in only five percent of cases. There is a mature teratoma and an immature one. The treatment tactics that are used have a fairly high efficiency; this allows more than ninety percent of patients to be cured without relapse after dermoid removal.

Teratoma of the neck

This is a dermoid tumor that is usually diagnosed in the postpartum period. It is quite small in size, and therefore it can only be detected over time by the presence of pain symptoms or problems associated with eating.

The characteristic dimensions do not exceed ten centimeters, it is located along the anterior or posterior triangle of the neck. Most often, this is a dense formation, easily mobile and characterized by slow growth.

In connection with a neck teratoma, symptoms such as noisy breathing, discoloration of the skin, choking and difficulty swallowing may occur. History contains no more than two hundred cases of this condition.

Teratoma on the face

Teratoma on the face requires careful differential diagnosis with other types of tumors. Pathology with such localization occurs quite rarely.

Symptoms and diagnosis

The clinical picture of embryocytoma can be quite varied; it depends on its location, size and growth pattern. For quite a long time, this tumor can exist without growth. After the addition of a growth factor, and it can be anything, for example, puberty or pregnancy, it will rapidly begin to increase and give corresponding complaints.

In the presence of teratoblastoma on the main vessels - their compression and the occurrence of cardiac hypertrophy, congestion in the lungs or chronic tissue hypoxia. Most often, teratoma is found in children on the testicle, in the lungs or sacrococcygeal teratoma.

MRI is the most informative non-invasive method for diagnosing teratoma

The occurrence of sharp abdominal pain during adolescence may indicate torsion of the pedicle of a cystic teratoma on the ovary. This condition is life-threatening, because necrotic tissue will lead to an inflammatory process in the abdominal cavity, and without proper treatment, death.

If various symptoms occur, accompanied by pain or dysfunction of the organ, you should consult a specialist.

Visual inspection of the affected area.

Treatment

Basically, the treatment strategy consists of surgical removal of the tumor body and preventing the development of metastases. These measures must be carried out as soon as possible after the final diagnosis has been established. The extent of intervention and prognosis depend on the location of the tumor, its stage and size.

Mature cystic embryocytomas are usually removed laparoscopically. It is preferable to remove sacrococcygeal dermoids using mini-incisions in the abdominal cavity; this type of intervention is more effective. Lung teratoma can be removed either laparoscopically or openly.

in the photo: Laparoscopic treatment of teratoma

The probability of relapse after removal of a teratoma is quite high. This depends on the qualifications of the surgeons and the histological structure.

Teratoma: causes, types and locations, how to treat, prognosis

Nature sometimes presents unexpected surprises, which not only give rise to scientific research, debate and discussion, but also surprise both scientists and ordinary people a lot. Possible congenital malformations of the fetus always frighten expectant mothers and force them to undergo numerous examinations, and illustrations of such diseases in the medical literature rarely leave anyone indifferent. Meanwhile, not all disorders that occur in the embryonic period can be diagnosed in utero, so some of their types are detected after the birth of the baby. Similar defects in the formation and formation of organs include teratoma - a tumor that is as diverse as it is unpredictable.

Teratoma appears as a result of disorders of embryonic development. This means that such neoplasms are already present at the birth of a child, and are not always detected immediately; sometimes years or decades pass before a diagnosis is made. The name comes from the Greek word "τέρατος", which literally means "monster". Indeed, the appearance of many teratomas is disconcerting, but inside the most unexpected findings can await, ranging from skin derivatives (hair, sebaceous gland secretions) to formed teeth, fragments of liver tissue, thyroid gland or bone. If with other tumors the doctor has a rough idea of ​​their structure, then in the case of teratomas it is extremely difficult to predict exactly what formations or tissues it consists of.

typical localizations of teratomas

The favorite localization sites for teratomas are the ovaries, testicles, sacrococcygeal region, neck, but they can also appear in the mediastinum, retroperitoneum, and brain. If ovarian teratoma is more often found in teenage girls or young women, then a tumor of the sacrococcygeal region is visible at birth and requires mandatory surgical treatment already in infancy.

Teratoma is not always malignant; most cases of tumor do not pose a serious threat if removed in a timely manner, but aggressive and metastasizing varieties are also recorded. Among all neoplasms of early childhood, teratoma occurs in a quarter of cases, and in adults it accounts for no more than 5-7%.

Causes of teratomas

The causes of teratomas have not been fully studied to this day, but scientists have expressed two main versions:

As the embryo grows, spontaneous genetic mutations may appear, leading to various types of deformities and tumors. At the same time, it is impossible to exclude chromosomal abnormalities that arose in the germ cells even before fertilization. If sperm undergo regular renewal during a man’s life, then eggs are laid before the birth of a girl, therefore it is so necessary for the expectant mother to lead a healthy lifestyle in order not only to avoid mutations in her child, but also to ensure healthy genetic material and offspring for the girl, also future moms.

It is difficult to name the exact cause of mutations in chromosomes, but probably all sorts of external unfavorable factors, such as smoking, carcinogens in food, water and everyday life, and occupational hazards contribute to this process.

The tumor can be quite large by the time the child is born, or grow during life (for example, in the ovaries), sometimes reaching enormous sizes.

In order to understand how a combination of very different structures and tissues is possible in one neoplasm, you need to remember the development of the human embryo, which is studied in biology lessons at school. After fertilization of the egg, a zygote is formed, carrying a full set of chromosomes, then it is fragmented with an increase in cell mass, implanted (immersed) in the mucous membrane of the uterus and the formation of three germ layers, which will subsequently give rise to all organs and systems of the body. Thus, the ectoderm (outer germ layer) gives rise to nervous tissue, skin, tooth enamel, and the receptor apparatus of the sensory organs. From the endoderm (inner layer) the liver, pancreas and other organs of the gastrointestinal tract develop. The middle layer - mesoderm - turns into muscles, bone, connective tissue, blood vessels, kidneys, etc.

If the movement of cells is disrupted, skin rudiments from the ectoderm can enter the developing ovaries, then in the teratoma we will see hair, fragments of the integumentary epithelium, and the secretion of the sebaceous glands. In some cases, even formed limbs, head or torso are found in the tumor, the reason for which is the arrest of the development of one of the twins due to chromosomal abnormalities.

Very important processes of cell division, tissue differentiation and organ formation occur in the first trimester of pregnancy, so during this period you should not only be attentive to the health of the expectant mother, but also ensure timely visits to the doctor with ultrasound, genetic counseling, etc.

Types of teratoid tumors

Depending on the degree of differentiation (development) of the tissues forming the tumor, teratoma can be:

1. Immature – malignant, teratoblastoma.
2. Mature – benign, can be solid or cystic.

Immature teratoma (teratoblastoma) consists of poorly differentiated embryonic tissues, papillary growths from trophoblast elements, which were later to become part of the placenta. The combination of rudiments is very diverse. Teratoblastomas tend to metastasize, grow rapidly, and have a poor prognosis.

A mature teratoma consists of well-differentiated elements of all germ layers, but, as a rule, derivatives of the ectoderm (covering epithelium, similar to that in the skin, hair, sebaceous and sweat glands) predominate. If a mature teratoma has a cavity, then it is called a dermoid cyst. Such cysts are characteristic of the ovarian localization of the pathological process.

various forms of teratomas

In some cases, a teratoid tumor is represented by highly specialized tissue belonging to any one organ (monodermal teratoma). Thus, the detection of areas of thyroid parenchyma in the ovary is called struma.

Teratoma can be located both inside the body (in the tissues of the testicle, lung, ovarian dermoid cyst) and outside (in the sacrococcygeal region in newborns). A tumor of external localization is quite easy to diagnose when examining the baby.

The behavior of teratoblastomas (malignant varieties) is not much different from other malignant tumors. They are characterized by infiltrative growth, characterized by germination of surrounding tissues and organs, they metastasize to lymph nodes and parenchymal organs, spread through the serous membranes, and can bleed, ulcerate, and suppurate. The prognosis for such neoplasms is very serious, and treatment is not always effective due to the lack of a clear boundary with healthy tissues and their involvement in the pathological process.

Symptoms and signs of teratomas of different locations

Teratoma of the sacrococcygeal region

Teratoma of the sacrococcygeal region is detected in children already at birth and more often in girls. The tumor is benign in most cases, but tends to reach large sizes, occupying almost the entire volume of the small pelvis when localized internally, without damaging the bones. With external growth, the formation is located in the area of ​​the sacrum, perineum, and hangs between the child’s thighs, displacing the anus. The mass of the tumor can even exceed the weight of a newborn, and the appearance is quite frightening.

A teratoma of the sacrococcygeal region may include areas of liver tissue, intestinal loops, and limbs of an underdeveloped twin, but in all cases elements of ectodermal origin are always found - hair, skin. The presence of embryonic tissue in a benign teratoma makes it dangerous in terms of malignancy, which is especially pronounced after six months of a child’s life as the tumor grows.

Externally, the tumor looks like a spherical formation of heterogeneous consistency: dense areas (fragments of cartilage, bone) alternate with soft ones (cystic cavities). Feeling it is usually painless. With the external or external-internal type of location of such a teratoma, certain difficulties in delivery are possible, so it is important to decide on a cesarean section in a timely manner.

various forms of sacrococcygeal teratomas

Malignant variants of sacrococcygeal teratoma contain cancer-like structures, papillary growths, and immature tissue of all three germ layers. Such a tumor grows rapidly already in the first days and months of the baby’s life, leading to damage to the tissue of the perineum, squeezing the opening of the urethra and the rectum, which can manifest itself as a violation of emptying the bladder and intestines.

The danger with this pathology is associated with the development of heart failure in children, since a large volume of the tumor is well supplied with blood, creating additional stress on the small heart. In utero, during or after childbirth, tumor rupture and bleeding may occur, the volume of which can be compared with all the blood available in the baby.

Signs of sacrococcygeal teratoma are already detected in a pregnant woman in the form of polyhydramnios, severe late toxicosis (preeclampsia), discrepancy between the volume of the uterus and the gestational age, and premature birth. Approximately half of the fetuses with this pathology die before birth, and born children require surgical treatment.

Teratoma of the neck

Fetal neck teratoma is very rare, in most cases it is benign, but the involvement of blood vessels, nervous tissue, and respiratory organs in the pathological process makes it deadly in% of cases, both in utero and after the birth of a baby with such a pathology without surgical treatment.

Nervous tissue and areas of thyroid parenchyma are most often found in fetal neck teratoid tumors. It is located both on the front and back surfaces of the neck. When the tumor reaches a large size, it can obstruct the airways, leading to death from suffocation.

Testicular teratoma

Testicular teratoma is diagnosed mainly in young children (under two years of age), manifesting itself as a benign neoplasm. In adolescents and young men, on the contrary, this tumor is more often malignant. Manifestations of the disease in children are reduced to asymmetry and the presence of a space-occupying lesion in the scrotum. In adults, testicular teratoma can occur for a long time without any symptoms, but at a certain moment it begins to grow, pain appears, and an increase in the size of the scrotum on the affected side. Epithelial elements and glandular tissue are found in the tumor.

Ovarian teratoma

Ovarian teratoma is the most common type of tumor in this group. It can be found in girls and women of reproductive age, but it also occurs in infants and in old age. Like other similar neoplasms, ovarian teratoma can be benign or malignant.

The causes of ovarian teratoma are the same as in the case of other similar tumors, that is, disturbances in the process of embryonic development and organ formation. There have been suggestions about the role of hormonal imbalance in a woman’s body, but scientific justification and evidence for this theory have not yet been presented.

Depending on the structure of the tumor, there are solid variants (without the formation of cavities) and cystic ones. Cystic teratoma, or dermoid cyst, is considered the most common tumor in girls and young women. It is formed by elements of all three germ layers, but ectoderm derivatives predominate. Externally, the tumor resembles a bag with thick walls, filled with sebaceous contents, hair; it is also possible to detect areas of bone or cartilage tissue and even formed teeth.

Solid teratoma does not contain cysts and is formed by well-developed tissues; it is benign and has a good prognosis. Malignant variants of cystic teratoma may contain embryonic tissue and even fragments of other tumors, for example, melanoma.

Teratoma of the left ovary occurs as often as the right one, the symptoms will be similar, but a tumor located on the right side can simulate an attack of acute appendicitis or other intestinal pathology.

Signs of ovarian teratoma are often absent for a long time, but as its size increases, pain in the lower abdomen of a pulling nature and difficulty urinating due to compression of the urinary tract appear.

Sometimes dermoid cysts are located on a thin stalk, which creates a risk of torsion of the tumor, poor circulation and the development of an “acute abdomen” with intense sharp pain. In these cases, patients require emergency surgical care.

Diagnosis and treatment of teratomas

To suspect the presence of a teratoma, it is necessary to conduct a series of examinations, but sometimes one glance is enough to determine the diagnosis.

Among the most common diagnostic methods are:

• X-ray examination, including computed tomography (CT);
• Angiography;
• Laboratory determination of tumor markers, hormones and other biologically active substances;
• Morphological study of areas of tumor tissue.

With a teratoma of the neck or sacrococcygeal region in a newborn, an examination is enough to suspect a tumor, but it is important to make a timely diagnosis before birth. In such cases, ultrasound comes to the rescue, which can also be used during pregnancy.

In addition to examining fetuses, ultrasound is very informative for ovarian dermoid cysts and testicular tumors. The method is accessible and safe, allowing us to predict the structure of both the teratoma itself and its effect on surrounding organs and tissues.

X-ray examination is carried out not only to exclude metastases in the lungs in malignant teratomas. It can also be used to detect bone fragments in ovarian teratomas, as well as to distinguish a sacrococcygeal cyst from a spina bifida, which occurs as a result of impaired development of the sacral vertebrae in the fetus.

Angiography is rarely used, but with its help the doctor evaluates the blood flow in the tumor and also finds out from which vessels the tumor is supplied with blood, which is important for subsequent surgical treatment.

The most informative diagnostic method is morphological examination of tumor areas. In most cases, it is carried out after its removal, but it allows one to resolve one of the most important questions - whether the tumor is benign or not.

To clarify the nature of the spread of teratoma into surrounding tissues, patients undergo CT and MRI.

Laboratory diagnostic methods have not been widely used for teratoid tumors, and there are no characteristic changes in a general blood or urine test. However, it is worth noting that most teratomas are capable of synthesizing alpha-fetoprotein or human chorionic gonadotropin, which reflect the presence of embryonic tissue in the tumor. A neck teratoma containing areas of thyroid tissue secretes thyroid-stimulating hormone. These indicators show the activity of the tumor, its growth rate, metastasis and the effectiveness of the therapy.

Teratoma is a special tumor, and therefore traditional methods of treating cancer patients are not always applicable to it. One thing remains unchanged: radical surgical removal of teratoma is the most effective way to combat the disease.

Laprascopic removal of ovarian teratoma

Benign tumors of the testicle, ovaries, and sacrococcygeal region are subject to total removal as early as possible after their detection. If technically possible, dermoid cysts of the right or left ovary in young women and girls are removed laparoscopically. Certain difficulties arise in the surgical treatment of malignant teratomas that grow into other organs and tissues and do not have clear boundaries, which can result in leaving tumor areas that will subsequently become a source of relapse (resumption) of the disease, as well as metastasis.

In addition to surgery, radiation treatment and chemotherapy are possible, but teratoma is poorly sensitive to both methods, so they are used mainly when radical surgery is not possible.

In addition to those described, there are ways to reduce tumors during fetal development. Thus, for teratoma of the sacrococcygeal region containing large cysts, a good effect can be obtained by puncturing them under ultrasound control. Reducing the volume of tumor tissue after such a procedure reduces the risk of premature birth and teratoma rupture in case of natural delivery, and also reduces the load on the uterine wall. In any case, with sacrococcygeal teratoma, an early cesarean section is indicated to help avoid dangerous complications. Caesarean section can be performed when the fetal lungs can independently perform the respiratory function.

There are no specific methods for preventing teratomas, and the reason for them is not completely clear. At the same time, it would be unfair to assert that lifestyle, nature of work activity and heredity have no influence. In order to reduce the risk of genetic mutations leading to tumors, you need to try to lead a healthy lifestyle, eliminate bad habits, and eat right. This is especially true for expectant mothers, who are responsible not only for themselves, but also for the little person who is beginning to develop “under their hearts.” Future dads shouldn't be left out either. Their role is to support the woman they love and take care of their health already at the stage of pregnancy planning.

Regular visits to the doctor by a pregnant woman make it possible to timely detect possible abnormalities in the development of the fetus, organ defects and the presence of teratomas, and correct and timely delivery helps to avoid dangerous complications in the case of a teratoid tumor.

Teratoma is a benign tumor that forms at the stage of human embryonic development. It is believed that it occurs during multiple pregnancy if the development of one of the embryos is interrupted. Particles of tissue from which it should have been formed are found in the body of a stronger fetus in the form of a tumor. In women, it is localized mainly in the ovary. A teratoma can exist for a long time in its infancy, and then begins to develop. This happens at any age. Due to the risk of complications, it is removed.

Content:

What is a teratoma

Teratoma is a genetic abnormality in the development of the embryo. It is a capsule with a durable shell located on the body of the ovary. Inside there are particles of various body tissues. Hair, elements of sebaceous glands, muscle and nerve fibers, fragments of bones, cartilage and teeth are detected.

There are 2 types of teratomas: mature and immature (teratoblastoma).

Mature teratoma

This is a benign tumor in which particles of individual tissues (bones, teeth, hair) are clearly visible. As a rule, it begins to grow after the onset of puberty, when the ovaries increase in size and the production of sex hormones increases sharply. Teratoma is most often found in women aged 14-40 years. The peculiarity is that it is impossible to predict when the tumor will begin to grow. After it grows to a certain size (matures), its growth stops. The tumor is found in the right or left ovary and may consist of 1 or 2 chambers. In addition to tissue particles, small capsules containing mucus are found in it.

There are 2 types of such neoplasms:

1. Mature teratoma of “solid structure”. Has a bumpy surface. The section reveals dense grayish tissue of heterogeneous composition, in which there are pieces of cartilage, bones, and small cavities with mucus.
2. Mature teratoma of “cystic structure”. It is called a dermoid cyst. It is a single-chamber or two-chamber cavity filled with turbid liquid or mushy fat, in which fragments of organic tissue are located.

Immature ovarian teratoma (cystoma)

As a rule, it degenerates into a malignant tumor. It differs in that inside the capsule there is a mixture of elements of various tissues that cannot be distinguished from each other. In cross section, the contents are a variegated brown mass with many cysts. Such a tumor quickly increases in size, its cells grow through the walls of the capsule into the peritoneum, forming metastases in the lymph nodes, lungs and other organs. The size of the tumor can be 5-40 cm.

Video: What is ovarian teratoma. How is it discovered?

Possible complications and symptoms

Symptoms appear when the tumor reaches a size of 3 cm or more. A nagging pain appears in the part of the abdomen where it is located. A growing teratoma puts pressure on the bladder and intestines, interfering with their normal functioning. This leads to impaired and painful urination, diarrhea, constipation, and bloating. In thin women, you may notice an enlarged abdomen. There are no menstrual irregularities.

Why is a mature teratoma dangerous?

It does not grow into other organs, but a dangerous complication is the twisting of the thin long stalk with which the tumor is attached to the body of the ovary. In this case, the blood supply to the tumor stops and tissue death occurs. The consequence may be peritonitis and blood poisoning. Sometimes a cyst ruptures, releasing its contents into the abdominal cavity, which also leads to peritonitis.

If the ovarian teratoma capsule is damaged, severe internal bleeding occurs. Signs of anemia appear (dizziness, weakness, nausea, headache). With such complications, a woman experiences severe abdominal pain, fever, and loss of consciousness. Such complications are life-threatening and require urgent medical attention.

Complications during pregnancy

If the teratoma is small (no more than 5 cm), it does not interfere with the onset of pregnancy, its course and the development of the fetus. But due to the increase in size of the uterus, neighboring organs often become displaced and the tumor stalk becomes twisted. This can cause miscarriage or premature birth. Doctors recommend that when planning a pregnancy, you undergo an examination in advance; if a teratoma is detected, then remove it.

If an ovarian teratoma is discovered during pregnancy, and its diameter is no more than 3 cm, then the development is constantly monitored. Under the influence of sudden hormonal changes characteristic of this period, it can quickly increase. In this case, it is removed at approximately 17 weeks of pregnancy.

If it does not increase, it is eliminated during childbirth, which is performed by caesarean section. In the case of natural childbirth, the teratoma is removed 2-3 months after the birth, when the woman’s body gets stronger.

Symptoms and complications of immature teratoma

The main danger is that, with its small size, teratoblastoma is practically no different from a dermoid cyst. Symptoms of malignant degeneration appear at a later stage of tumor development. In addition to weakness, fatigue, anemia, nagging pain in the lower abdomen, painful manifestations occur in other organs (liver, lungs, brain) affected by metastases.

That is why it is important, when the first symptoms of neoplasms appear in the ovaries, to undergo a thorough examination in order to promptly determine the nature of the ovarian teratoma.

Teratoma of the right and left ovaries

Bilateral teratoma is rare, in about 7-10 cases out of 100. Such a tumor is more often found on the right ovary, since various processes occur more actively in it due to the advantages of its blood supply (blood enters it from a larger vessel). Sometimes the growth of right-sided teratoma is provoked by inflammation of the appendix.

Note: The symptoms that occur when the tumor stalk is twisted resemble those of acute appendicitis, so an erroneous diagnosis may be made.

The left ovary functions less actively, so neoplasms appear in it less frequently.

Diagnostics

A doctor can diagnose the presence of a neoplasm in the ovary by external palpation. The following methods are used during the examination:

1. X-ray examination of the abdominal cavity. It allows you to detect a tumor by the presence of bone tissue elements in the ovary.
2. Ultrasound. It allows not only to determine the presence of a tumor on the side of the uterus or in front of it, but also to determine its internal structure, the degree of heterogeneity of the contents, and to detect disturbances in the development of the vascular network. Based on the nature of the pathologies, the type of teratoma can be determined. The size of the tumor is determined.
3. CT, MRI of organs located in the pelvis. It is carried out if it is necessary to clarify the structure of the tumor, its location relative to other organs, and detect metastases.
4. Diagnostic laparoscopy. It is carried out when there is a suspicion of malignant degeneration. In this case, a biopsy is performed - sampling the contents of the ovarian teratoma for cell examination.

A blood test for tumor markers is required. It is necessary to confirm the nature of the tumor.

Video: Symptoms and treatment of ovarian dermoid cyst

Treatment

Considering the possibility of complications and malignant degeneration of the tumor, it is removed surgically. The technique and volume of intervention depend on the size of the tumor and the degree of risk of complications. This takes into account the patient’s age and the presence of concomitant diseases.

Surgical intervention

The following methods of operations are used:

1. Laparoscopic enucleation is the removal of a small tumor without involving healthy surrounding tissue. This operation is the least traumatic and is performed through small punctures. The manipulations are controlled using ultrasound. There is rapid healing of wounds and restoration of ability to work.
2. Partial ovarian resection is an operation in which the tumor and the layer of unaffected tissue closest to it are excised. Such intervention is performed when teratoma is detected in girls and young women and the tumor is small and clearly benign. This allows the patient to maintain her fertility.
3. Removal of the ovary (oophorectomy).
4. Amputation of the ovary along with part of the uterus. During an adnexectomy, the ovaries and fallopian tubes are removed. In some cases, the entire uterus except the cervix is ​​amputated (subtotal hysterectomy). Such operations are usually performed on women of menopausal age.
5. Complete removal of the ovaries along with the entire uterus, as well as the omentum (an element of the peritoneum that protects the internal organs from accidental damage).

The ovarian teratoma is removed through an incision in the abdomen. The operation is performed under general anesthesia. Before the procedure, a blood test is carried out for coagulability, composition, sugar content, the presence of hepatitis, HIV, and sexually transmitted infections. The blood type and Rh factor are determined.

An electrocardiogram is taken, and a vaginal smear is analyzed to determine the composition of the bacterial microflora.

Chemotherapy

After removal of the immature teratoma (cystoma), 6 courses of chemotherapy are prescribed to prevent the formation of metastases. Drugs based on platinum salts (carboplatin, cisplatin) or other antitumor agents (Erbitux, Nexavar and others) are used.

– a tumor that forms from embryonic cells.

Teratoma begins to develop before a person is born, and manifestations of the disease can occur at any age. This tumor is benign, but in one percent of cases it can become malignant and grow into nearby tissues.

Causes of teratoma.

The cause of tumor development is a violation of the proper development of embryonic tissue. This leads to the tumor containing the rudiments of several organs that are uncharacteristic for a certain anatomical region. For example, an ovarian teratoma may contain muscle or lymphatic tissue that is adjacent to hair follicles or tooth buds.

The cause of tumor progression is a chromosomal abnormality of teratoma cells. According to the type of this anomaly, teratomas are divided into mature and immature, the difference between which lies in the differentiation of the tissues that make up the tumor. If a teratoma consists of elements of normal tissues that are characteristic of an adult, then this indicates a mature form of teratoma. But if the type of tissue in the tumor cannot be determined, then this indicates an immature teratoma.

Teratomas, in addition to their appearance and set of chromosomes, can differ in growth characteristics. In women, mature forms of ovarian teratoma have a benign course, and in men, testicular teratoma has a malignant course.

The malignancy of the tumor manifests itself in the form of more aggressive growth of the teratoma with organ destruction, bleeding and the release of antigens and hormones into the blood, which can lead to death.

Based on their structure, these tumors are divided into cysto-teratomas and dense teratomas. Along with tissue rudiments, cysto-teratomas contain liquid masses.

Symptoms and signs of teratoma.

The manifestations of teratoma depend on the time of its occurrence in human embryogenesis and the location of its location. The earlier the formation of tumor cells occurs in the life of the embryo, the more the correct development of the child will be disrupted. Manifestations of the tumor in these cases are noticeable at birth in the form of pathology of soft tissues and skeleton.

In an adult, a teratoma may not manifest itself for a long time, however, signs of compression or displacement of the affected organ may occur.

Mediastinum and pulmonary teratoma may present with signs of shortness of breath and chest pain. Testicular teratoma is characterized by the occurrence of a formation in the scrotum. With ovarian teratoma, torsion of the ovarian ligaments may occur, which provokes pain in the pelvic area.

Treatment of teratoma.

Treatment of teratoma is carried out only by surgery. Typically, the ovary or testicle is removed. Considering the likelihood of malignancy of the teratoma, an audit of regional lymph nodes is carried out to exclude metastasis. As a rule, this tumor secretes biologically active substances (beta-chorionic gonadotropin, alpha-fetoprotein), the presence of which in high doses in the blood is a sign of teratoma activity, thereby making it possible to determine the rate of tumor growth, the effectiveness of treatment and the likelihood of metastasis.

Every person should understand that monitoring their health is in their interests. Any doctor will tell you that the effectiveness of treatment often depends on how quickly the correct diagnosis is made, therefore, for women in a delicate situation, it is especially important to follow all the doctor’s recommendations and regularly conduct routine ultrasound examinations.

Teratoma - what is it?

When they talk about such a nuisance as a teratoma, we are talking about a tumor that forms during the prenatal development of organs and tissues. Inside this neoplasm there are tissues that are atypical for this organ. Nervous tissue, muscle, epithelial, bone, hair can be found inside the teratoma; in rare cases, more complex organs can be found, such as eyes, parts of the torso, limbs, and teeth.

Thanks to such unusual contents of the tumor, it received its name, which translated from Greek means “monstrous tumor.”

Causes

Most often, teratoma is found in the testicles of men, and in women, respectively, in the ovaries; it is also often found in the brain, and in children it is found in the sacrococcygeal region.

The formation of this tumor occurs due to improper development of embryonic tissue. The growth of teratoma begins long before the birth of the child itself; it is formed from germ cells. During the life of the body, they are able to degenerate into any tissue of the human body.

Most often, this problem begins to form in the body of a small person even during a woman’s pregnancy, so scientists are studying with special care the adverse effects that can become risk factors for the occurrence of teratoma. These include:

• ecology, or more precisely, the environment in which the future mother of the child lives. The presence of nearby factories that emit harmful substances into the air that a pregnant woman breathes has a negative impact;
• long-term effects on the body of a pregnant woman from low or, conversely, high temperatures;
• irradiation;
• self-administration of medications that may be contraindicated in this situation;
• drinking alcoholic beverages and nicotine (smoking);
• illnesses suffered during gestation of a viral or bacterial nature;
• intense physical activity.

Symptoms and how they manifest themselves

The insidiousness of this disease also lies in the fact that teratoma is often asymptomatic. At the moment when the tumor reaches its critical size, unpleasant sensations appear that a person cannot help but notice.

Everything also depends on the location of the problem; for example, when it comes to cervical teratoma, patients report discomfort while eating, difficulty breathing, and sometimes even attacks of suffocation.

With mediastinal teratoma, you may notice a slight curvature in the chest area, increased temperature, severe cough (in rare cases, even mixed with blood), shortness of breath, and a change in heartbeat.

If we talk about children, then in this case everything depends on at what stage of embryo development in the mother’s womb the formation of tumor cells occurred. Unfortunately, this determines the degree of complexity of the disease and the scale of the problem, which could affect the generally normal development of the child and his ability to adapt socially.

In most cases, teratoma in children is noticeable at birth and manifests itself as a pathology of the skeleton and soft tissues. If it is a sacrococcygeal teratoma, then a noticeable neoplasm is visualized in the perineal area.

Types of teratoma

Doctors distinguish between mature and immature teratomas in humans.

Mature include those whose study revealed tissue elements that are characteristic of an adult (fat, muscle, connective, nervous). If it is difficult, and sometimes even impossible, to determine the type of tissue, then we are talking about an immature teratoma.

Depending on the content, mature teratomas can be divided into solid and cystic.

The type of teratoma can be accurately determined by microscopic examination of its structure.

Liquid masses contain cystic teratomas, while dense formations have the appearance of a homogeneous, smooth node.

Diagnostics

Teratoma can be detected using ultrasound, especially when it comes to determining fetal development. As a rule, this disease is considered a congenital disease, but still not all types of tumors can be diagnosed and seen in this way. Some teratomas appear after the birth of a child, sometimes immediately, and sometimes in the first years of the baby’s life.

When it comes to diagnosing older patients, we can talk about the following actions:

• conduct an MRI to identify or exclude the presence of metastases;
• take a biochemical and general blood test;
• take an x-ray of the problem area;
• perform a biopsy (a piece of tissue is taken from the problem area for microscopic analysis);
• A qualified specialist should conduct a gynecological examination and perform a pregnancy test.

Additionally, in such cases, you may need to consult an oncologist who can determine whether the neoplasm is malignant or not.

Treatment

Any form of teratoma requires exclusively surgical intervention. This tumor is usually completely excised within healthy tissue. The only exception in such cases is ovarian teratoma. In cases where the patient is of reproductive age, partial resection of the ovaries is performed. For women in the climatic period, complete amputation of the uterus and appendages is possible.

The treatment tactics and the extent of surgical intervention depend on the location and nature of the tumor, as well as the patient’s overall health condition.

If you listen to the clues sent by our body, you can notice changes that may indicate the presence of serious problems. Timely seeking qualified medical help will help avoid complications.

Mature teratoma belongs to germ cell tumors. Depending on tissue differentiation, teratomas are divided into mature (dermoid cyst) and immature (teratoblastoma).

Mature teratoma is divided into solid (without cysts) and cystic (dermoid cyst). There are also monodermal (highly specialized) teratomas - ovarian struma and ovarian carcinoid, their structure is identical to ordinary thyroid tissue and intestinal carcinoids.

Mature cystic teratoma is one of the most common tumors in childhood and adolescence; the tumor can occur even in newborns, which indirectly indicates its teratogenic origin. Mature teratoma occurs in reproductive age, in the postmenopausal period (as an accidental finding). A mature teratoma consists of well-differentiated derivatives of all three germ layers with a predominance of ectodermal elements. This defines the term "dermoid cyst". The tumor is a single-chamber cyst (a multi-chamber structure is rarely observed), is always benign and only rarely shows signs of malignancy. The structure of dermoid cysts includes the so-called dermoid tubercle.

The capsule of a dermoid cyst is dense, fibrous, of varying thickness, the surface is smooth and shiny. A teratoma on a cut resembles a bag containing a thick mass consisting of fat and hair, and well-formed teeth are often found. The inner surface of the wall is lined with columnar or cubic epithelium. Microscopic examination reveals tissues of ectodermal origin - skin, elements of neural tissue - glia, neurocytes, ganglia. Mesodermal derivatives are represented by bone, cartilage, smooth muscle, fibrous and adipose tissue. Endoderm derivatives are less common and usually include bronchial and gastrointestinal epithelium, thyroid and salivary gland tissue. The object of particularly careful histological examination should be the dermoid tubercle in order to exclude malignancy.

Teratoma symptoms:

The symptoms of dermoid cysts differ little from the symptoms of benign ovarian tumors. A dermoid cyst does not have hormonal activity and rarely causes complaints. Pain syndrome is observed in a small number of observations. The general condition of the woman, as a rule, does not suffer. Sometimes dysuric phenomena appear, a feeling of heaviness in the lower abdomen. In some cases, the pedicle of the dermoid cyst becomes torsed, causing symptoms of an “acute abdomen” that require emergency surgical intervention.

Anemia is a relatively rare autoimmune complication of mature ovarian teratomas. Its development is associated with hematopoietic tissue in the tumor structure, which produces antigenically altered red blood cells. In such cases, after removal of the tumor, complete recovery occurs.

A dermoid cyst is often combined with other tumors and tumor-like formations of the ovaries. It is extremely rare for a mature teratoma to develop a malignant process, mainly squamous cell carcinoma.

Mature solid teratoma is a relatively rare ovarian tumor, found mainly in children and young women. Most mature teratomas contain tumor elements of immature tissues, and for this reason they are classified as malignant tumors. Solid teratomas consist entirely of mature tissue, are benign and have a favorable prognosis. Only extensive histological examination allows differentiation of the tumor.

Diagnosis of Teratoma:

The diagnosis is established on the basis of the clinical course of the disease, two-manual gynecological examination, the use of ultrasound with colorectal dosage, and laparoscopy.

During gynecological examination, the tumor is located mainly anterior to the uterus, round in shape, with a smooth surface, has a long stalk, mobile, painless, and dense consistency. The diameter of a mature teratoma ranges from 5 to 15 cm.

A dermoid cyst involving bone tissue is the only tumor that can be identified on a plain X-ray of the abdominal cavity.

Echography helps to clarify the diagnosis of mature teratomas (pronounced acoustic polymorphism).

Mature teratomas have a hypoechoic structure with a solitary echogenic inclusion, with clear contours. Directly behind the echogenic inclusion is an acoustic shadow. Mature teratomas may have an atypical internal structure. Multiple small hyperechoic inclusions are visualized inside the tumor. In some cases, the tumor has a dense internal structure, sometimes completely homogeneous, although small hyperechoic streak inclusions, less often thin long linear inclusions, are often visualized inside the tumor. In some cases, a weak enhancement effect is visualized behind small-streak inclusions - a “comet tail”. Possibly a cystic-solid structure with a dense component with high echogenicity, round or oval shape, with smooth contours. Polymorphism of the internal structure of the tumor often creates difficulties in the interpretation of echographic images.

With CDK, vascularization is almost always absent in mature teratomas; blood flow can be visualized in the ovarian tissue adjacent to the tumor; IR is within the usual values ​​of 0.4.

As an additional method in the diagnosis of mature teratomas after the use of ultrasound, it is possible to use RCT.

During laparoscopy, the dermoid cyst has an uneven yellowish-whitish color; when palpated with a manipulator, the consistency is dense. The location of the cyst in the anterior fornix, in contrast to tumors of other types, usually located in the utero-rectal space, has a certain differential diagnostic significance. The stalk of a dermoid cyst is usually long and thin, and there may be small hemorrhages on the capsule.

Teratoma Treatment:

Treatment of mature teratomas is surgical. The volume and access of surgical intervention depend on the size of the space-occupying lesion, the age of the patient and concomitant genital and extragenital pathology. In young women and girls, partial resection of the ovary within healthy tissue (cystectomy) should be limited, if possible. It is preferable to use a laparoscopic approach using an evacuation bag. In perimenopausal patients, supravaginal amputation of the uterus with appendages on both sides is indicated. It is permissible to remove the uterine appendages from the affected side if the uterus is not changed.

The prognosis is favorable.

Which doctors should you contact if you have Teratoma:

Gynecologist

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