What are the other Names for this Condition? (Also known as/Symptoms)

• Homunculus
• Ovarian Fetiform Teratoma

What is Fetiform Teratoma? (Definition/Background Information)

• Fetiform Teratoma is a highly uncommon form of tumor that arises from the germ cells in the ovary. In this type of teratoma, the tumor components form a highly-organized mass, to the point of resembling a malformed fetus
• Fetiform Teratoma is only observed in adult women. However, to diagnose Fetiform Teratoma, the following two conditions must be ruled-out:
  • Ectopic pregnancy; when the fertilised egg is found outside the uterus
  • Fetus inside fetus (or fetus in fetu); when a tissue mass resembling a fetus usually develops inside the body of a newborn
• The cause of formation of Fetiform Teratoma is unknown. Also, presently, the risk factors for the same are not well-established. Fetiform Teratomas are not usually observed to be malignant
• The signs and symptoms of Fetiform Teratoma depend on the size and nature of the tumor (if benign or malignant). Large tumors may cause symptoms such as pelvic pain and abdominal discomfort
• The treatment of Fetiform Teratoma involves surgery in most cases. In a majority, the prognosis of the condition is good with early appropriate treatment

Who gets Fetiform Teratoma? (Age and Sex Distribution)

• Fetiform Teratoma is mostly observed in young and middle-aged (adult) women
• No specific racial or ethnic group predilection is noted

What are the Risk Factors for Fetiform Teratoma? (Predisposing Factors)

• Currently, no definite risk factors have been identified for Fetiform Teratomas

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Fetiform Teratoma? (Etiology)

The cause of development of Fetiform Teratoma is generally unknown. It is believed that abnormal differentiation of germ cells gives rise to the formation of this tumor.

What are the Signs and Symptoms of Fetiform Teratoma?

The signs and symptoms of Fetiform Teratoma may vary from one individual to another. In general, small tumors may be asymptomatic and large tumors can cause signs and symptoms that may include the following:

• Presence of a well-circumscribed solitary tumor in the ovary
• The tumor size may range from 4 to 13 cm
• The tumors are usually mature and cystic in nature; currently, almost all tumors reported in the scientific literature are benign
• Large tumors (size over 4 cm) can compress the surrounding structures or organs and give the sensation of an abdominal mass
• Nausea and vomiting
• Abdominal pain from large-sized ovarian tumors
• Abdominal discomfort, heaviness, and tenderness (especially at the iliac fossa, which is an area near to the hip bone)
• Pelvic discomfort and pain; lower back pain

How is Fetiform Teratoma Diagnosed?

There are a variety of tests the healthcare provider may employ to diagnose Fetiform Teratoma, which may include:

• Physical examination and complete medical history screening
• Assessment of the symptoms observed
• Ultrasound scan of the pelvis: It is a non-invasive procedure that uses high frequency sound waves to produce real-time images
• Transvaginal ultrasound: An ultrasound is inserted into the vagina and the mass is examined using sound waves
• Abdominal and pelvic CT scan: It is a non-invasive procedure that provides more details of soft tissues, blood vessels, and internal organs
• Pelvic MRI scan: It is a non-invasive medical test that uses a powerful magnetic field to produce images of soft tissues, bones, organs, and all other internal structures of the abdomen and pelvis
• Hysteroscopy: This procedure involves placing a probe through the cervix to examine the cavity of the uterus

Invasive diagnostic procedures such as:

• Laparoscopy: A special device is inserted through a small hole into the abdomen, to visually examine it. If necessary, a tissue sample is obtained for further analysis. Exploration of the abdomen using a laparoscope is called ‘exploratory laparoscopy’
• Laparotomy: The abdomen is opened through an incision for examination, and if required, a biopsy sample obtained. Exploration of the abdomen using laparotomy procedure is called ‘exploratory laparotomy’

Although the above modalities can be used to make an initial diagnosis, a tissue biopsy of the tumor is necessary to make a definitive diagnosis to begin treatment. The tissue for diagnosis can be procured in multiple different ways which include:

• Fine needle aspiration (FNA) biopsy of the tumor: A FNA biopsy may not be helpful, because one may not be able to visualize the different morphological areas of the tumor. Hence, a FNA biopsy as a diagnostic tool has certain limitations, and an open surgical biopsy is preferred
• Core biopsy of the tumor
• Open biopsy of the tumor

Tissue biopsy:

• A tissue biopsy of the tumor is performed and sent to a laboratory for a pathological examination. A pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. Examination of the biopsy under a microscope by a pathologist is considered to be gold standard in arriving at a conclusive diagnosis
• Biopsy specimens are studied initially using Hematoxylin and Eosin staining. The pathologist then decides on additional studies depending on the clinical situation
• The tumors may have varying proportions of blood vessels, smooth muscle, and fat cells, when examined by a pathologist under a microscope
• Sometimes, the pathologist may perform special studies, which may include immunohistochemical stains, molecular testing, and very rarely, electron microscopic studies to assist in the diagnosis

Note: A differential diagnosis to eliminate other tumor types may be necessary prior to establishing a definite diagnosis.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Fetiform Teratoma?

The complications of Fetiform Teratoma may include the following:

• Stress and anxiety due to fear of ovarian cancer
• Large tumor masses may get secondarily infected with bacteria or fungus
• Tumor rupture and torsion:
  • Rupture of tumor can cause peritonitis; it can also cause shock and internal bleeding
  • Usually, larger tumors are more prone for torsion
  • Torsion can result in acute abdominal pain and a surgical emergency
• Recurrence of the tumor following its incomplete surgical removal may occur
• Damage to the muscles, vital nerves, and blood vessels, during surgery
• Post-surgical infection at the wound site is a potential complication

How is Fetiform Teratoma Treated?

The treatment of Fetiform Teratoma may involve the following:

• Generally, the treatment of choice is complete surgical excision for all teratomas (mature or immature). The following surgical procedures may be considered:
  • Operative laparoscopy
  • Cystectomy or surgical removal of the ovarian cyst
  • Oophorectomy or removal of the affected ovary
  • Ovarian tissue sparing techniques
• Additionally, chemotherapy and/or radiation therapy may be necessary for malignant teratomas (if any observed)
• Follow-up care with regular screening and check-ups are important and encouraged

How can Fetiform Teratoma be Prevented?

Currently, there are no known methods to prevent the development of Fetiform Teratoma.

What is the Prognosis of Fetiform Teratoma? (Outcomes/Resolutions)

The prognosis of Fetiform Teratoma is typically good with complete surgical removal of the tumor, since almost all such teratomas are known to be mature and benign.

Additional and Relevant Useful Information for Fetiform Teratoma:

The following article link will help you understand other cancers and benign tumors:

http://www.dovemed.com/diseases-conditions/cancer/