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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Other diseases from the group Diseases of the genitourinary system:
| "Acute abdomen" in gynecology |
| Algodismenorrhea (dysmenorrhea) |
| Algodismenorrhea secondary |
| Amenorrhea |
| Amenorrhea of pituitary origin |
| Kidney amyloidosis |
| Ovarian apoplexy |
| Bacterial vaginosis |
| Infertility |
| Vaginal candidiasis |
| Ectopic pregnancy |
| Intrauterine septum |
| Intrauterine synechiae (fusions) |
| Inflammatory diseases of the genital organs in women |
| Secondary renal amyloidosis |
| Secondary acute pyelonephritis |
| Genital fistulas |
| Genital herpes |
| Genital tuberculosis |
| Hepatorenal syndrome |
| Germ cell tumors |
| Hyperplastic processes of the endometrium |
| Gonorrhea |
| Diabetic glomerulosclerosis |
| Dysfunctional uterine bleeding |
| Dysfunctional uterine bleeding of the perimenopausal period |
| Cervical diseases |
| Delayed puberty in girls |
| Foreign bodies in the uterus |
| Interstitial nephritis |
| Vaginal candidiasis |
| Corpus luteum cyst |
| Intestinal-genital fistulas of inflammatory origin |
| Colpitis |
| Myeloma nephropathy |
| Uterine fibroids |
| Genitourinary fistulas |
| Disorders of sexual development in girls |
| Hereditary nephropathies |
| Urinary incontinence in women |
| Necrosis of myomatous node |
| Incorrect positions of the genitals |
| Nephrocalcinosis |
| Nephropathy in pregnancy |
| Nephrotic syndrome |
| Nephrotic syndrome primary and secondary |
| Acute urological diseases |
| Oliguria and anuria |
| Tumor-like formations of the uterine appendages |
| Tumors and tumor-like formations of the ovaries |
| Sex cord stromal tumors (hormonally active) |
| Prolapse and prolapse of the uterus and vagina |
| Acute renal failure |
| Acute glomerulonephritis |
| Acute glomerulonephritis (AGN) |
| Acute diffuse glomerulonephritis |
| Acute nephritic syndrome |
| Acute pyelonephritis |
| Acute pyelonephritis |
| Lack of sexual development in girls |
| Focal nephritis |
| Paraovarian cysts |
| Torsion of the pedicle of adnexal tumors |
| Testicular torsion |
| Pyelonephritis |
| Pyelonephritis |
| subacute glomerulonephritis |
| Subacute diffuse glomerulocephritis |
| Submucosal (submucosal) uterine fibroids |
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 their appearance is also possible 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 say 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 industrial hazards contribute to this process.
The tumor can be quite large both by the time the child is born and 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, we need to remember the development of the human embryo, which is studied in biology classes 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 cell movements are 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:
- Immature – malignant, teratoblastoma.
- Mature – benign, can be solid or cystic.
Immature teratoma (teratoblastoma a) consists of poorly differentiated embryonic tissues, papillary growths from trophoblast elements, which were subsequently supposed to become part of the placenta. The combination of rudiments is very diverse. Teratoblastomas tend to metastasize, grow rapidly, and have a poor prognosis.
Mature teratoma constitute 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,
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.
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.
Neck teratoma
Fetal neck teratoma is very rare and most cases are benign, but involvement of blood vessels, nervous tissue, and respiratory organs in the pathological process makes it deadly in 80-100% 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 airway, 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 formation 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. Cysticteratoma, 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, it comes to the rescue ultrasonography, 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 It 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 study 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 found widespread use in 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, therefore, 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.
Video: ovarian teratoma in the program “Live Healthy!”
The author selectively answers adequate questions from readers within his competence and only within the OnkoLib.ru resource. Face-to-face consultations and assistance in organizing treatment are not provided at this time.
One type of tumor that can affect the female reproductive system is immature ovarian teratoma. The disease has other names: tridermoma, embryoma. It has not yet been thoroughly studied. Even the exact reasons for its appearance are unknown.
Laparoscopy has the following advantages:
- the patient does not experience pain after the intervention, so she will not have to take painkillers;
- severe blood loss is excluded;
- minimal trauma to soft tissues and muscles;
- absence of cosmetic defect;
- it is possible to conduct additional diagnostics even during surgery;
- the risk of occurrence is reduced as there is minimal contact with the intestines;
- The recovery period lasts only a few days, after which the patient quickly returns to work.
If immature ovarian teratoma can be treated, the prognosis is favorable in most cases. However, early diagnosis and qualified actions of specialists are important here. After the operation, the woman is prescribed radiation or.
The patient is prescribed at least 6 courses of treatment with platinum-based antitumor drugs: Platinol, Cisplatin. If radiation therapy is used, it is prescribed at stages 2-3 of the development of a malignant tumor.
Features of neoplasms during pregnancy
For example, a large tumor can interfere with the natural process of labor. Naturally, it is better to eliminate the teratoma before pregnancy occurs, because the next surgical intervention can only be permitted after the 16th week. But during this time the tumor can reach large sizes.
If this fails, then the woman will have to follow all the doctors’ instructions. Self-treatment, which can only complicate the problem, is strictly prohibited. Immature teratoma must be disposed of by coordinating each step with a specialist.
19.02.2017
In the article we will consider what a teratoma is, what are the reasons for its development and what symptoms it is characterized by. We will also learn how to recognize and get rid of the disease in time.
Externally, this pathology looks terrible, its internal content is atypical. Teratoma develops before birth, but symptoms appear at any age. Sacrococcygeal teratoma and mediastinal teratoma are common.
Teratoma - what is it?
In essence, this is a tumor formation containing tissues that are atypical for a given location. Inside the teratoma you can find different types of tissue (nervous, muscle, connective), hair, teeth, eyes, and sometimes individual organs that are more complex in structure. Therefore, it is not for nothing that its name translated from Greek sounds like “ugly tumor.”
A teratoma develops from embryonic cells, which can transform into other tissues of the body. Teratomas with the most complex structure occur when the embryo just begins to form. The formation of a tumor as the tissue or organ is formed leads to its homogeneity in composition.
The manifestation of pathology in childhood and adolescence is typical, but its development also occurs in other age groups. With high teratogenicity, newborns also fall into this group. In children, teratoma occurs in the coccyx area, and less often in other organs.
In adulthood, teratoma affects the reproductive system - in women it occurs in the ovaries, and in men in the testicles. Depending on the degree of development and course, teratomas can be benign or malignant.
Causes of teratoma
The causes of teratoma can only be judged hypothetically, since no doctor can tell you the exact reasons. A rather peculiar theory, which has practical confirmation, is called “embryo in the embryo.” During surgery, parts of the body are found in the tumor, indicating that during a multiple pregnancy, one of the fetuses, genetically stronger, absorbed another, weaker one.
Less dubious is the theory that teratoma occurs due to abnormal embryogenesis. That is why the tumor is most often located in the testicles and ovaries. Examination using a microscope allows us to detect the formation of embryonic layers - the primary gonads of the embryo from which they are formed.
This is the outer layer (ectoderm), below it is the middle layer (mesoderm) and the inner layer (endoderm) completes the structure. The theory points to the germinal nature of teratoma. And the fact that a tumor can develop into benign and malignant under the influence of various somatic and genetic factors does not prevent its formation in other parts of the body.
Symptoms of teratoma and how does it manifest?
The symptoms of the tumor depend on where the teratoma is located and at what stage of embryo formation it arose. For a long period of time, the pathology does not make itself felt, being in standby mode, and manifests itself mainly in adolescence, or when a person has already grown up.
It can be detected even at the birth of a child. Teratoma tumor is a pathology of tissues and skeleton. The natural process of physical development is disrupted, since the tumor is present in the body from the beginning of its formation.
This pathology is characterized by various manifestations. Clearly expressed symptoms of teratoma are visible when the tumor develops into a malignant course. The most obvious signs are:
- Irregular heartbeat.
- Squeezing.
- Swelling.
- Temperature increase.
If the tumor is located in the chest or lungs, characteristic symptoms will be shortness of breath, compression in the chest area, and arrhythmia occurs.
Teratoma in the male gonads is manifested by an increase in the size of the scrotum, and the pain present in this case indicates the malignant nature of the development of the tumor disease.
The favorable period for its removal is within two months of birth, since a teratoma can be identified at birth, and if this is not done, then after hormonal changes the outcome is fraught with malignancy, which increases the risk of degeneration into a malignant tumor from a benign one. Unfortunately, most testicular teratoma occurs between the ages of 18 and 20 years.
The development of teratoma in children in the sacral area near the coccyx is accompanied by dysfunction of the genitourinary system and the process of defecation. Pathology in this area can be detected at birth, or even in utero with ultrasound examination. More often the tumor formation is large and round. Located behind the fetal sacrum. Obstetricians in such a situation recommend a caesarean section.
In addition, teratoma of the neck, pharynx or mouth can be detected in the prenatal period, but they are less common and also require surgical intervention during childbirth due to possible asphyxia.
If a teratoma is found at the base of the skull, the tumor affects the brain. Symptoms are manifested by endocrine disorders and damage to brain structures.
With the development of teratoma in the retroperitoneal space, the manifestations are in the nature of diseases of the gastrointestinal tract. In this case, the patient experiences nausea and vomiting.
The tumor develops more often during the period when the body undergoes a restructuring of hormonal levels. Twisting of the cyst stalk makes itself felt by acute pain, as a result of which the patient faces peritonitis if medical assistance is not provided in time.
Types of teratoma in humans
Abnormalities at the chromosomal level form a tumor, and the maturity and immaturity of the teratoma can be judged from the type of abnormality present in the patient.
Immature teratoma is characterized by the presence of tissue within the tumor that is difficult to identify. The majority of tumors of this form are malignant.
In terms of composition, teratomas can be dense, which contain only tissue, and cystic, which in addition to tissue also contain liquid.
Mature teratoma– dermoid contains tissue, the elements of which are clearly defined: adipose tissue, muscle, nervous or connective. Externally, mature teratomas differ from immature ones. Their growth characteristics are also different. They can be divided into two large groups: solid and cystic.
Solid– dense in composition, can have different sizes, with a smooth or bumpy surface according to the sensations upon palpation. The structure of the tumor formation is heterogeneous, and the content is unclear, since there are tissues inside that are difficult to determine. In addition, the tumor may contain small cysts containing fluid or mucus. The course is mostly benign.
Cystic– tumor-like formations are large in size and smooth in tactile sensation. Inside they contain several cavities, the contents of which are cloudy. In addition to this, it is in such tumors that teeth, cartilage, hair and other fragments are found. The prognosis for tumor treatment is favorable, but there is a risk of twisting or rupture of the tumor stalk. The danger is size, and therefore cutting occurs in any case, regardless of the patient’s age.
Diagnosis of teratoma
In order to timely detect teratoma in the fetus even during intrauterine development, it is necessary to conduct a high-quality examination and accurate diagnosis, which plays a major role in the process.
It begins with identifying the patient’s complaints, and examination and research are carried out using laboratory and instrumental methods.
The list consists of methods:
- Examination with gynecological speculum.
- Bimanual examination of the vagina.
- Ultrasonography.
- X-ray.
- Angiography.
- CT scan.
- Abdominal puncture.
- Biopsy.
- Histology.
- Blood test for tumor markers.
- Chromocystoscopy.
More often, the diagnosis is determined using obstetric ultrasound data. In this case, the examination is carried out not only of the tumor formation itself, but also of the organs around it, and during pregnancy, this method allows you to determine the pathology at an early stage. This method provides information about the location and volume of the tumor, which allows us to judge its development. Ultrasound is common, which indicates that the method is used in every case of detection of teratoma.
Fluoroscopy is also used for organs in which metastases are possible. And if necessary, the doctor prescribes x-ray contrast studies to clarify the situation. Using an X-ray machine, a two-projection examination of the patient is performed.
A clarifying method after ultrasound and x-rays is computed tomography of the affected area, in which the pathology can be assessed visually. This method contains more information. The data obtained shows the size of the tumor, its structure and shape. At the same time, its connection with the rest of the structural elements of the body and the spread of metastases are clearly visible.
The presence of teratoma can be definitively confirmed using a puncture biopsy. The results obtained from the study of the obtained material form the diagnosis completely. The stage of teratoma and its course are determined.
According to the doctor's indications, a blood test can be performed, which is carried out if a teratoma is suspected. The level of chronic ganadotropin and alpha-fetoprotein and some other indicators are determined.
For women, if a teratoma is suspected in the ovaries, palpation is performed through the vagina. The tumor will be located in the front and feel dense, and touching it will cause pain. In size it does not exceed 15 centimeters.
Two more methods used for clarification are color Doppler mapping and echography. CDC indicates that there is no blood flow in the tumor, and echography indicates an acoustic shadow that arises due to the structure and sound conductivity properties of the tumor.
Treatment of ovarian teratoma
If a teratoma is determined based on the diagnostic results, then treatment will only be surgical, and it is better to remove it immediately after detection. The timing of the operation and its complexity depend on the age of the patient, the extent of the pathology, and the stage of the tumor process. In case of twisting of the leg and hemorrhage into the peritoneum, the operation is carried out immediately and does not allow for delay.
In girls and women with teratoma in the groin area, ovarian resection is performed, and during the postmenopausal period, the uterus is probably removed. If a testicular teratoma is noticed in time, it can be successfully treated, but with an immature tumor with metastases, the prognosis will not be favorable, so surgery with chemotherapy is necessary.
Pilonidal teratoma in children is removed along with the coccyx. If the tissues are damaged deeper, a complex operation is performed on them. Sometimes it is necessary to influence the gluteal region. Externally, this is then corrected, but further examination of the child is necessary. The prognosis after surgery is favorable.
If the teratoma is determined to be mature, then the surgical intervention is performed laparoscopically, which leaves the possibility of a future birth of a child.
More often, the prognosis will be favorable, but if a relapse occurs, radical treatment measures, including chemotherapy, are necessary. It consists of six or more courses, which mainly use the drugs platinum, platinol and cisplatin. If the tumor is sensitive to hormonal drugs, then they are also prescribed for treatment.
– an embryonic cell tumor developing from the layers of endo-exo- and mesoderm. Can be benign or malignant. Located in the testicles, ovaries, or extragonadally. Small benign tumors are asymptomatic. Large teratomas cause compression of nearby organs with the appearance of corresponding symptoms. Malignant neoplasms can metastasize. The diagnosis is made on the basis of complaints, examination, radiography, ultrasound, CT, MRI, biopsy and other studies. Treatment – surgery, radiotherapy, chemotherapy.
General information
Teratoma is a germ cell tumor containing areas of tissue or organs that are atypical for the location of the tumor. May include hair, bone, muscle, cartilage, adipose, glandular and nervous tissue, and less commonly, parts of the human body (limb, torso, eye). Usually diagnosed in childhood and adolescence. Sometimes detected in utero. Large teratomas that arise in the prenatal period can impede the development of the fetus and complicate the course of labor.
Teratomas make up 24-36% of the total number of tumors in children and 2.7-7% in adults. Gradually increase in size as the body grows. Often manifests during periods of hormonal changes. In most cases, teratomas are considered a prognostically favorable disease. Treatment is carried out by specialists in the field of oncology, gynecology, urology, andrology, neurology, otolaryngology, pulmonology and other specialties (depending on the location of the tumor).
Causes
The etiological factors for the development of teratoma have not been precisely established. It is assumed that the tumor arises as a result of embryogenesis disorders. Teratomas originate from primary germ cells, which during development must transform into eggs or sperm. Sometimes this process is disrupted; undifferentiated gonocytes remain in the body, which, under the influence of certain factors, begin to transform and give rise to various tissues of the human body.
Teratomas are often detected in the tissues of the testicles or ovaries, but they can also occur extragonadally. The reason for the atypical localization of teratomas is the delay in the advancement of the embryonic epithelium to the sites of gonad formation. 25-30% of tumors are located in the ovarian area, 25-30% in the sacrum and coccyx area, 10-15% in the retroperitoneal space, 5-7% in the testicles, 5-7% in the presacral area, 5% in the mediastinal zone. In addition, teratomas can be localized in the brain (usually in the ventricles of the brain or in the area of the pineal gland), jaws, nasal cavity or lungs.
Classification
Taking into account the characteristics of the histological structure, they distinguish:
- Mature teratomas are neoplasms, the study of which reveals several differentiated tissues that are derivatives of one or more germ layers.
- Immature teratomas are tumors, the study of which reveals tissues of an embryonic structure that are derivatives of the three germ layers.
- Malignant teratomas are immature or (less commonly) mature teratomas, combined with chorionic carcinoma, seminoma or embryonal cancer.
There are mature teratomas of cystic and solid structure. A solid tumor is a dense, smooth or lumpy nodule. The tissue of the node on the section is heterogeneous, light gray, with small cysts and dense inclusions (foci of bone and cartilage tissue). A mature cystic teratoma looks like a large smooth nodule. The section reveals large cysts containing mucus, cloudy liquid or a pasty mass. Bone and cartilage inclusions, teeth or hair may be found in the cavities.
Microscopic examination of mature solid and cystic teratomas reveals a similar picture. The basis of the neoplasms is represented by fibrous tissue, in which random inclusions of other tissues are visible: stratified squamous epithelium, epithelium of the mucous membranes, bone, cartilage, adipose and smooth muscle tissue, tissue of peripheral nerves and the brain. Sometimes fragments of lung and kidney tissue are found in a teratoma, as well as areas of glandular structure resembling tissue of the mammary gland, pancreas and salivary glands. Cystic mature teratomas are dermoid cysts, the walls of which are covered with epithelium containing hair follicles, sebaceous and sweat glands.
Immature teratomas are light gray in section, with small cysts, and contain inclusions of immature integumentary epithelium, neurogenic epithelium, striated muscles and cartilaginous tissue. Mature teratomas are considered benign tumors, while immature ones are considered potentially malignant. Malignancy is rare. When malignant, neoplasms give lymphogenous and hematogenous metastases. In their structure, metastatic tumors resemble an immature teratoma or one of its components.
Certain types of teratomas
Testicular teratomas constitute approximately 40% of the total number of germ cell tumors in men. Small tumors can be asymptomatic; large nodes are easily detected because they cause external deformation of the testicle. They usually begin to grow during puberty. They are extremely rare in adult men. They can be mature, immature and malignant. Of particular danger are rare immature malignized teratomas in the area of the undescended testicle - such neoplasms are asymptomatic for a long time, are not detected during a routine examination and are diagnosed in late stages.
Ovarian teratomas are diagnosed more often than testicular tumors. They make up 20% of the total number of ovarian tumors. In most cases, they are mature nodes of a cystic structure. Sometimes immature teratomas occur. They are often asymptomatic and become an incidental finding during research due to suspicion of other diseases. They can become more active during periods of hormonal changes (in adolescence, during gestation, and less often during menopause).
Sacrococcygeal teratoma– the most common congenital tumor. Sacrococcygeal teratoma is a round tumor-like formation with a diameter of 1-2 to 30 cm. Girls are affected more often than boys. Large teratomas provoke displacement of internal organs and can cause fetal development disorders. Possible developmental abnormalities of the pelvis, rectal displacement, urethral atresia or hydronephrosis. Large tumors with an intensive blood supply can provoke the development of heart failure. Taking into account the location features, 4 types of teratomas are distinguished: mainly external, external-internal, internal and presacral. Large teratomas can complicate labor. Neoplasms are removed surgically in the first six months of the child’s life.
Neck teratoma- a rare neoplasm. Usually diagnosed immediately after birth. Small tumors sometimes remain unrecognized and are detected after growth has begun. The size of a teratoma can range from 3 to 10-15 cm. Depending on the condition of nearby anatomical formations (presence or absence of compression), they are asymptomatic or manifested by difficulty breathing, cyanosis of the skin, suffocation and difficulty eating.
Mediastinal teratomas usually located in the anterior mediastinum, next to large vessels and the pericardium. They don't show up for a long time. They usually begin to grow during adolescence or gestation. They can increase up to 20-25 cm. They compress the lungs, heart, pleura and blood vessels. Compression of internal organs is accompanied by increased heart rate, heart pain, shortness of breath and cough. When a mediastinal teratoma breaks through into the bronchus or pleural cavity, cyanosis of the skin, suffocation, increased body temperature, asymmetry of the chest, hiccups, and radiating pain in the shoulder girdle on the affected side occur. Possible pulmonary hemorrhage and the development of aspiration pneumonia.
Teratoma of the brain rarely detected. Usually diagnosed in boys 10-12 years old. Prone to malignancy, malignant degeneration is observed in more than half of the cases. It remains asymptomatic for a long time. When increased, it causes headaches, nausea and dizziness.
Diagnostics
To identify sacrococcygeal teratomas, the leading role is played by adequate examination of the fetus during intrauterine development. The diagnosis is usually made by the results of an obstetric ultrasound. In other cases, diagnosis is carried out on the basis of complaints, objective examination data, laboratory and instrumental studies. For mediastinal teratomas and sacrococcygeal neoplasms, plain radiography is prescribed, and, if necessary, X-ray contrast studies and angiography are performed.
A highly informative way to diagnose teratomas is CT of the affected area. The technique allows you to determine the shape, size and structure of the tumor, as well as assess its relationship with other anatomical structures. If the presence of metastases is suspected, CT, MRI, chest x-ray, scintigraphy and other studies are prescribed. As a clarifying method, a blood test for human chorionic gonadotropin and alpha-fetoprotein is used. The final diagnosis is made taking into account the results of a puncture biopsy and subsequent microscopic examination of the material.
Treatment of teratoma
Treatment is surgical. Benign tumors are usually excised within healthy tissue. An exception is ovarian teratomas. Girls and women of reproductive age with this disease undergo partial resection of the ovaries; in the premenopausal and menopausal periods, adnexectomy and supravaginal amputation of the uterus and appendages are performed. The scope of surgical intervention for malignant teratomas is determined by the location and extent of the tumor. In the postoperative period, radiotherapy and chemotherapy are prescribed.
Forecast
The prognosis depends on the location and characteristics of the histological structure of the teratoma. For mature and immature benign tumors, the outcome is usually favorable with the exception of large sacrococcygeal teratomas. The survival rate for neoplasms of this localization is about 50%. The cause of death is developmental defects, compression of internal organs or rupture of a teratoma during childbirth. For malignant tumors, the prognosis is determined by the extent of the process. Teratomas with seminoma have a more favorable course compared to teratomas in combination with chorionepithelioma or embryonal cancer.