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

• Ovarian Immature Teratoma

What is Immature Teratoma of Ovary? (Definition/Background Information)

• Teratoma of ovary is a rare type of ovarian tumor that arises from the germ cells in females. Most teratoma tumors are either mature or immature. A majority of benign teratomas are mature, while a majority of malignant teratomas are immature
• Immature Teratoma of Ovary is made up of cells that resemble an embryo, or a developing fertilized egg. These tumors are less commonly observed and tend to affect younger populations (age below 20 years)
• Immature teratoma consists of immature elements and is more often malignant. The cause of formation of Immature Teratoma of Ovary is unknown. Also, presently, the risk factors for the same are not well-established
• In many cases, no signs and symptoms of teratoma are observed and these tumors are diagnosed incidentally. Some tumors may grow to large sizes and cause obstructive signs and symptoms. Also, malignant ovarian teratomas may metastasize to distant organs
• The treatment of Immature Teratoma of Ovary involves surgery in most cases. Immature teratomas may be additionally treated using chemotherapy and/or radiation therapy, if necessary. The prognosis of Ovarian Immature Teratoma depends upon several factors and can be only assessed on a case-by-case basis

Who gets Immature Teratoma of Ovary? (Age and Sex Distribution)

• Immature Teratoma of Ovary is mostly observed in females below the age of 20 years (average age 18 years). These tumors are often seen in young girls and women
• However, when the immature teratoma is cystic, it is mostly observed in post-menopausal women
• No specific racial or ethnic group predilection is noted

What are the Risk Factors for Immature Teratoma of Ovary? (Predisposing Factors)

• Currently, no definite risk factors have been identified for Ovarian Immature 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 Immature Teratoma of Ovary? (Etiology)

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

• In general, it is known that cancers form when normal, healthy cells begin transforming into abnormal cells - these cancer cells grow and divide uncontrollably (and lose their ability to die), resulting in the formation of a mass or a tumor
• The transformation of normally healthy cells into cancerous cells may be the result of genetic mutations. Mutations allow the cancer cells to grow and multiply uncontrollably to form new cancer cells
• These tumors can invade nearby tissues and adjoining body organs, and even metastasize and spread to other regions of the body

What are the Signs and Symptoms of Immature Teratoma of Ovary?

The signs and symptoms of Immature Teratoma of Ovary can vary from one girl or women to another. In general, most (small) tumors are asymptomatic and no significant symptoms are observed, while large tumors are known to present symptoms.

The signs and symptoms of Immature Teratoma of Ovary include the following:

• Presence of a well-circumscribed tumor in the ovary; immature teratomas may be solid and locally invasive
• The tumors may be cystic (fluid-filled) or solid in nature; but, the tumor shape can vary from one individual to another
• Generally, only one ovary is affected; but, in nearly 10% of the cases, involvement of both ovaries may be seen (bilateral ovarian teratoma)
• The tumors may range in size from 14-25 cm
• Usually immature teratomas are larger in size than mature teratomas
• Immature teratoma can be associated with a mature cystic teratoma in the same ovary, in 1 in 4 cases
• Large tumors (size over 4 cm) can compress the surrounding structures or organs and give the sensation of an abdominal mass
• 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
• Frequent urination due to compression/pressure of the tumor
• When metastasis is noted, it may result in weight loss, fatigue, and other systemic symptoms

How is Immature Teratoma of Ovary Diagnosed?

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

• Physical examination and complete medical history screening
• Assessment of the symptoms observed
• Blood tests for various markers
• Alpha fetoprotein (AFP) blood test
• 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

A differential diagnosis to eliminate other tumor types may be necessary prior to establishing a definite diagnosis. The following tumors may be excluded:

• Hemorrhagic ovarian cyst
• Endometrioma of ovary

Note:

• A majority of ovarian teratoma tumors are discovered incidentally
• Some tumors may show tooth components and calcification
• Depending on the type of malignancy arising in immature teratoma, blood test may show elevation of certain enzymes such as alpha fetoprotein

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 Immature Teratoma of Ovary?

The complications of Immature Teratoma of Ovary may include the following:

• Stress and anxiety due to fear of cancer of the ovary
• Large tumor masses may get secondarily infected with bacteria or fungus
• Tumor rupture and torsion:
  • Rupture of tumor can cause peritonitis
  • Usually, larger tumors are more prone for torsion
  • Ovarian torsion can result in acute abdominal pain and a surgical emergency
• Some immature teratomas are known to rupture and cause associated complications
• A higher number of immature teratomas are known to transform to malignancies
• Metastasis of immature or malignant teratoma to distant sites
• Recurrence of the tumor following its incomplete surgical removal: Immature forms are more often likely to recur than mature forms
• Malignant teratomas are most commonly squamous cell carcinomas, sarcomas, or adenocarcinomas

There may be complications related to the methods used in treating the condition and may include:

• Side effects of radiation therapy that may include sunburn-like rashes, where radiation was targeted, red or dry skin, heaviness of the breasts, and general fatigue
• Side effects of chemotherapy, which may include nausea, vomiting, hair loss, decreased appetite, mouth sores, fatigue, low blood cell counts, and a higher chance of developing infections
• The treatment can also cause infertility in men and women. Hence, measures to protect the individual’s fertility must be considered, before starting chemotherapy
• Damage to the muscles, vital nerves, and blood vessels, during surgery
• Post-surgical infection at the wound site is a potential complication

How is Immature Teratoma of Ovary Treated?

The treatment of Immature Teratoma of Ovary 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
• However, while it is usually possible to surgically remove a mature teratoma, the complete removal of an immature teratoma may be challenging
• Additionally, chemotherapy and/or radiation therapy may be necessary for malignant teratomas
• Follow-up care with regular screening and check-ups are important and encouraged

How can Immature Teratoma of Ovary be Prevented?

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

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

• Immature Teratoma of Ovary may be aggressive, difficult to treat (complete tumor resection may not be possible), and can spread to other sites. The prognosis of these tumors is usually adjudged on a case-by-case basis
• If immature teratomas can be completely removed through surgery, then the prognosis is generally improved. The prognosis is also better, when an immature teratoma with treatment changes to a mature teratoma
• Occasionally, with chemotherapy, an immature teratoma can convert into a mature teratoma. Such mature teratomas can remain stable for prolonged periods - this is called retroconversion of an immature teratoma to a mature teratoma. A retroconverted teratoma can remain stable in size, but needs to be regularly monitored

Additional and Relevant Useful Information for Immature Teratoma of Ovary:

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

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