This document discusses teratomas, which are embryonic tumors containing tissues from all three germ layers. It describes the different types of teratomas including mature cystic, immature, and monodermal. Mature cystic teratomas are most common and typically benign. Immature teratomas have a small risk of malignancy. Complications can include torsion, rupture, or malignant transformation. Diagnosis involves imaging and lab tests. Treatment is surgical excision with chemotherapy sometimes needed for immature types. Recurrence risks depend on maturity and completeness of resection.

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