Ovarian teratoma is a type of germ cell tumour

1. Uma Chidiebere John

2. Introduction
Types
Manifestations
Cause
Diagnosis
Retroconversion
Complications
Treatment

3. Terato - Greek : monster, oma : swelling)
Teratomas - embryonic neoplasm from
totipotent stem cells.
Component derived from all 3 germ layers.
Tissues foreign to the location found.

6. Mature,
1. cystic
2. solid
malignant transformation in < 2%
Immature
Monodermal, highly specialized

7. Most common germ cell neoplasm
Well-differentiated derivations from at least two of
the three germ cell layers
Younger age group (mean patient age, 30 years)
Asymptomatic
Grow slowly
Bilateral in about 10% of cases

8. Unilocular in 88% of cases
Filled with sebaceous material,
Squamous epithelium lines the wall of the cyst,
Hyalinized ovarian stroma covers the external
surface
Hair follicles, skin glands, muscle, and other
tissues lie within the wall.

9. Gross appearance of a mature dermoid cyst

10. Mesodermal tissue (fat, bone, cartilage, muscle) –
90%
Endodermal tissue (gastrointestinal and bronchial
epithelium, thyroid tissue) – 80%
Adipose tissue 67-75%
Teeth – 31%

11. Rokitansky nodule
Echogenic area usually demonstrating sound
attenuation owing to sebaceous material and hair
within the cyst cavity
Multiple thin, echogenic bands caused by hair in
the cyst cavity

12. A raised protuberance projecting into the cyst cavity.
Most of the hair typically arises from this protuberance.
When bone or teeth are present, they tend to be located within
this nodule

14. Has no identifiable immature components
Are benign, corresponding to grade 0 immature
teratomas.
Radiologically indistinguishable from immature
teratomas and occur in a similar age group (20 years).
 Fat may be visible at MR imaging or CT

15. Mature solid teratoma

16. Demonstrate clinically malignant behavior
Much less common (1% of ovarian teratomas)
Affect a younger age group (mean patient age, 20
years)
Histologically distinguished by the presence of
immature or embryonic tissues
Usually perforated

17. Photograph of an immature teratoma

18. At initial manifestation, immature teratomas
are typically larger (14–25 cm) than mature
cystic teratomas (average, 7 cm)
May be solid or have a prominent solid
component with cystic elements.
Usually filled with serous or mucinous fluid or
may be filled with fatty sebaceous material.

19. Ipsilateral typical mature cystic teratomas
are present in 26% of cases of immature
teratoma, and an immature teratoma will be
seen in the contralateral ovary in 10%

20. Tumors are heterogeneous, partially solid lesions
Scattered calcifications
Small foci of fat
At CT and MR imaging, irregular solid component
containing coarse calcifications and small foci of fat
is seen.
Hemorrhage is often present.

21. Gross appearance of immature teratoma

22. This is a situation where immature teratomas
undergo tissue maturation and take on an
appearance more typical of mature cystic
teratomas.
CT features of maturation include
i. increased density of mass lesions,
ii. the onset of internal calcification, with fatty areas
and cystic change.

23. Composed predominantly or solely of one
tissue type.
There are three main types of ovarian
monodermal tumors:
i. struma ovarii,
ii. ovarian carcinoid tumors, and
iii. tumors with neural differentiation.

24. Composed predominantly or solely of mature
thyroid tissue
Such thyroid tissue can occur as a minor
component of mature cystic teratomas.
Accounts for approximately 3% of all mature
teratomas.
In rare cases, thyrotoxicosis has been seen as a
complication of struma ovarii

25. Consists of amber-colored thyroid tissue, hemorrhage,
necrosis, and fibrosis.
Malignancy is uncommon
The US features:
a heterogeneous, predominantly solid mass
with multiple cystic and solid areas
MR imaging findings:
The cystic spaces demonstrate both high and low signal
intensity on T1- and T2-weighted images
No fat is evident in these lesions.

26. Uncommon.
May be insular (islet tumors), trabecular, or
mucinous.
Frequently associated with a mature cystic
teratoma or mucinous tumor
At gross pathologic examination, ovarian carcinoid
tumors are solid

27. Usually occur in postmenopausal women.
Most of these tumors have a relatively benign
clinical course, with metastases being uncommon.
Secretory granules are seen within the tumor cells,
Immunocytochemical analysis demonstrates
serotonin and hormonal peptides.
Carcinoid syndrome is uncommon.

28. Monodermal teratomas with neuroectodermal
differentiation can form benign, or primitive
neuroectodermal tumors
May be associated with glia formation.

29. Abdominal pain; depending on the size
Dyspareunia
Compression

30. Serum alpha-fetoprotein (AFP)
Beta-human chorionic gonadotropin (HCG)
Cancer antigen 125 (CA125),
CA19-9, and
Carcinoembryonic antigen (CEA)

31. US
Rokitansky nodule
Echogenic area
CT
Fat attenuation, with/without calcification in the
wall
MRI
Sebaceous component has a very high signal for T1
Fat attenuation, T2

32. Ultrasound image of a mature dermoid cyst

33. Axial unenhanced CT scan shows intratumoral fat
(small arrows) and calcifications (large arrow)

34. Ovarian torsion: ~3-16% of ovarian teratomas,
Rupture: ~1-4%; peritonitis
Malignant transformation: ~1-2%, usually
into squamous cell carcinoma (adults) or rarely
into endodermal sinus tumors (pediatrics)
Superimposed infection: 1%

35. Axial contrast-enhanced CT scans show several free-
floating areas of fat attenuation from a perforated
dermoid cyst

36. Photograph of squamous cell carcinoma malignant
transformation within a mature cystic teratoma

37. Stage 1 - means the cancer is only in the ovary (or both
ovaries)
Stage 2 - means the cancer has spread into the fallopian
tube, womb, or elsewhere in the area circled by your hip
bones (your pelvis)
Stage 3 - means the cancer has spread to the lymph nodes
or to the tissues lining the abdomen (called the
peritoneum)
Stage 4 - means the cancer has spread to another body
organ some distance away, for example the lungs

38. 3D-reconstructed CT showing a calcification

39. Blood clot
Hemorrhagic cyst
Echogenic bowel
Perforated appendix with appendicolith
Pedunculated lipoleiomyoma of the uterus
Ovarian serous or mucinous
cystadenoma/cystadenocarcinoma

40. Goals
Removal, where possible
Relief of symptoms
Depends on diagnosis
Surgical excision.
Chemotherapy
Follow-up

41. Risk of recurrence related to degree of maturity.
<10% in completely resected mature Teratoma.
33% immature Teratoma.
Completeness of resection.

42.  Williams GYNECOLOGY
 Radiographics (RSNA)
 Medscape
 Cancer Research UK
 Patient Info
 University of Ottawa
 Radiopaedia