How Are Ovarian Teratomas Treated? 3 Types, Mature Cystic Teratomas & Symptoms

Mature teratomas vary greatly in appearance and may be further classified as follows as cystic, solid, and mixed.

Ovarian teratomas are a rare type of tumor in the ovaries that are made up of developed tissues and organs such as the hair, teeth, muscle, and bone. When viewed under a microscope, ovarian teratomas look like three layers of a developing embryo.

Teratomas can occur in newborns, children, and adults and are most common in women in their 20s. They are usually benign, although some may be cancerous and require surgical removal and/or chemotherapy:

• Surgery: Laparoscopic surgical removal is usually the first treatment option:
  • A small incision is made in the abdomen, and a laparoscope with a small cutting tool is inserted through the incision to remove the teratoma.
  • If the ovarian teratoma is large, a surgeon may remove a part or all of the ovary. The remaining ovary will continue processes of ovulation and hormone secretion will continue from the remaining ovary. 
  • Complications can occur if the teratoma ruptures during removal and leaks out a waxy material, which may result in an inflammatory response known as chemical peritonitis.
  • Even after surgical removal, teratomas may grow back.
• Chemotherapy: Malignant teratomas are treated with a combination of surgery and chemotherapy, with chemotherapy following surgical removal.

What causes ovarian teratomas?

Ovarian teratomas develop in germ cells, which are produced during the early stages of fetus development and are capable of differentiating into cells specialized for different functions.  

Ovarian teratomas result from complications in the cell differentiation and specialization processes.

Types of ovarian teratomas

There are three types of ovarian teratomas:

1. Mature teratomas
2. Immature teratomas
3. Monodermal teratomas

Mature teratomas

Mature teratomas are generally benign, with only about 1%-3% being cancerous. They are usually found in women in their reproductive years.

Mature teratomas vary greatly in appearance, and maybe further classified as follows:

• Cystic: Self-enclosed in a fluid-containing sac
• Solid: Made up of tissues but not self-enclosed
• Mixed: Contains solid and cystic parts

Mature cystic teratomas, also known as dermoid cysts, contain structures characteristic of normal skin, complete with other tissues like hair follicles, hair (sometimes abundant clumps of long hair), sweat glands with pockets of sebum, blood, fat (93%), bone, nails, teeth, eyes, cartilage, and thyroid tissue. Diameter is typically less than 10 centimeters and rarely more than 15 centimeters.

Immature teratomas

Immature teratomas are more likely to develop into malignant cancer and are made up of tissues derived from the three germ layers. They are rare and generally found in girls and women under the age of 20.

Monodermal teratomas

Monodermal teratomas are predominantly made up of only one type of tissue. The three main subtypes are:

• Struma ovarii
• Carcinoid tumors
• Neural tumors

Where does ovarian cancer occur?
See Answer

What are signs and symptoms of ovarian teratoma?

Ovarian teratomas usually don’t present symptoms at first. As the teratomas develop, symptoms may include:

• Abdominal swelling
• Distended veins over the skin
• Intense pain in the pelvis or abdomen caused by ovarian torsion (twisting of the ovary) because of the growing mass

Sometimes ovarian teratomas may be accompanied by N-methyl-D-aspartate receptor (NMDA) encephalitis, which is a rare condition that can cause intense headaches and psychiatric symptoms such as confusion, violent behavior, and psychosis.

How are ovarian teratomas diagnosed?

Ovarian teratomas are often diagnosed during routine gynecologic examinations.

• Mature teratomas can be diagnosed by an ultrasound, a computed tomography scan (CT scan), and a magnetic resonance imaging (MRI) scan.
• Immature and monodermal teratomas can be diagnosed by a combination of clinical features and imaging scans.