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

• Germ Cell Tumor, Teratoma subtype

What is Teratoma? (Definition/Background Information)

• Teratoma is a tumor that arises from the germ cells. It can originate from the ectoderm, mesoderm, and endoderm, which are 3 types of tissues of a developing embryo
  • Endoderm: Inner layer that forms the lungs, thyroid, pancreas, and intestines
  • Mesoderm: Middle layer that forms the heart, muscles, and kidneys
  • Ectoderm: Outer layer that forms the skin and nervous system
• Teratomas usually affect children and young adults. It can occur in many parts of the body including in the testes in males and ovaries in females (common sites with 37% of the cases), the sacrococcygeal region (in almost 40% of the cases), the brain (5% of the tumors), chest, abdominal cavity, etc. 
• The following forms of Teratomas have been described: 
  • Mature Teratoma: It is made up of cells that resemble adult tissue cells. Most Teratomas belong to the mature type
  • Immature Teratoma: It is made up of cells that resemble an embryo, or developing fertilized egg
• Teratomas may be cancerous or benign. A majority of benign teratomas are mature teratomas, while a majority of malignant teratomas are immature teratomas. The cause of formation of the tumor is unknown. Also, presently, the risk factors for the same are not well-established
• The signs and symptoms of Teratomas depend on the subtype and location of the tumor. Some tumors may grow to large sizes and cause obstructive signs and symptoms. Also, malignant tumors may metastasize to distant organs
• The treatment of Teratoma involves surgery in most cases. Immature Teratomas may be additionally treated using chemotherapy and/or radiation therapy
• In a majority of cases, the prognosis of mature Teratoma is excellent with early appropriate treatment. However, the prognosis of immature Teratoma depends upon various factors and can be only assessed on a case-by-case basis

Notes on germ cells:

• Germ cells are one of the two types of cells in the body. They form sex cells - the sperms and eggs, while the other type, the somatic cells, forms everything else (i.e., all other body organs and parts)
• Normal germ cells arise from pluripotent stem cells. Pluripotent stem cells can differentiate into, or become, any cell in the body. Thus, pluripotent stem cells may become either germ cells or somatic cells
• The process of pluripotent stem cells becoming other cell types is mediated by chemical signalling. Chemicals that act as signals include growth factors, nutrients, and hormones
• Stem cells that do not respond to normal signals may grow uncontrollably and cause tumors. This tumor-causing potential makes them “neoplastic”. Neoplastic cells that grow aggressively and spread to other areas are cancerous

Who gets Teratoma? (Age and Sex Distribution)

• Teratoma is mostly observed in young and old children and young adults. However, infants and older adults may also be affected
• In case the tumor is present at birth, then it is known as congenital Teratoma. But, when it is discovered in a developing fetus, it is called fetal Teratoma
• Both males and females are affected; mature Teratomas are generally observed in females, while immature Teratomas are more common in males
• No specific racial or ethnic group predilection is noted

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

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

The cause of development of Teratoma 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 Teratoma?

The signs and symptoms of Teratoma depend on the location (organ affected) and subtype of the tumor. It 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 tumor in the affected region; mature Teratomas are generally benign
• Immature Teratomas may be solid and locally invasive
• The tumors may range in size from a few cm to over 30 cm, depending on the location
• Teratoma can occur in many parts of the body - testis in men, ovary in women, in brain, mediastinum, retroperitoneum, and in the sacrococcygeal area
• Very uncommonly, it can occur in solid organs such as the heart and liver
• The most common type of fetal Teratoma is sacrococcygeal Teratoma (Teratoma of tailbone) and cervical Teratoma (Teratoma of neck)
• Trichoptysis: It is the most unusual and ‘specific’ sign of a teratoma, where the individual coughs-up hair or hair-like particles
• When metastasis is noted, it may result in weight loss, fatigue, and other systemic symptoms

How is Teratoma Diagnosed?

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

• Physical examination and complete medical history screening
• Assessment of the symptoms observed
• Imaging studies that may include a chest X-ray, MRI or CT scans (depending on the body part affected)
• Blood tests for various markers
• Prenatal diagnostic tests

Tissue biopsy from the affected region:

• A 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
• Sometimes, the pathologist may perform special studies, which may include immunohistochemical stains, molecular testing, flow cytometric analysis 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.

Based on a tissue biopsy, Teratomas may be classified according to Gonzalez-Crussi Teratoma grading system (based on the quantity of immature elements present in the tumor):

• Grade 0 - these are mature Teratomas that are benign
• Grade 1 - these are immature Teratomas that are probably benign
• Grade 2 - these are immature Teratomas that are possibly malignant
• Grade 3 - these are malignant Teratomas

What are the possible Complications of Teratoma?

The complications of Teratoma may depend on the size of the tumor and the region of the body affected. It also depends on the subtype of the tumor, whether benign or malignant, and may include the following:

• Some immature Teratomas are known to rupture and cause associated complications
• Metastasis of the 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
• Some mature Teratomas are known to transform to malignant Teratomas
• 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

How is Teratoma Treated?

The treatment of Teratoma may involve the following:

• Generally, the treatment of choice is complete surgical excision for all Teratomas (mature or immature)
• However, while it is usually possible to surgically remove a mature Teratoma, the complete removal of an immature teratoma may be challenging
• 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 Teratoma be Prevented?

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

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

• The prognosis of Teratoma depends upon whether it is a mature or immature type (also, whether the tumor is benign or malignant)
  • Many of the tumors are mature Teratomas that behave in a benign manner. With complete surgical removal of the tumor, the prognosis is typically excellent
  • Immature Teratomas 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

Additional and Relevant Useful Information for Teratoma:

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

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