Teratoma – ovary .

TERATOMA – OVARY

• Teratoma of ovary is germ cell tumor

• Teratoma  are categorized into 3 types

  • Benign cystic (Dermoid cysts)

  • Solid immature

  • Monodermal – Struma ovarii, Carcinoid

Mature Teratoma (Benign cystic teratoma) in Ovary – 

• It is a benign germ cell tumor of ovary

• Genetic analysis – 

  • karyotype of all the benign mature teratomas is 46 XX

  • Majority of teratomas arise from ovum after first meiotic division while minority arises before the first meiotic division

• MORPHOLOGY

  • GROSS

    • They are bilateral in 10 to 15% of cases

    • Mostly unilocular filled with cheesy sebaceous material and hiar follicles

    • Cut section shows thin wall lined by an opaque,wrinkled, gray white epidermis with protruding hair shafts

    • With in the wall areas of calcification, cartilagenous foci and tooth like structures can occur

    • Tooth if present is present on the protrusion called Rokitansky protuberance

  • MICROSCOPIC FEATURES

    • Cyst wall is lined by stratified squamous epithelium with underlying adnexal structures like hair follicles, sebaceous glands.

    • Tissue derived from all three germ layers endoderm, mesoderm and ectoderm are present

      • Ectodermal derivatives – skin and dermal appendages- Hair follicles, sebaceous glands

      • Endodermal derivatives– Respiratory & GIT epithelia

      • Mesodermal derivatives – Muscle, fat, cartilage

      • Glial elements are also seen

• Malignant transformation occurs in 1% of dermoids. Most common malignancy is Squamous cell carcinoma

Monodermal or specialized teratoma 

• These are specialized  and rare group of teratomas 

• They are unilateral (may have contralateral teratoma)

• Most common among them are

  • Struma ovarii – composed of mature thyroid tissue which may be functional

  • Carcinoid – which arises from intestinal tissue in intestine and may be functional .Large carcinoid (>7cms) can cause  sufficient amount of 5- hydroxytryptamine  to cause carcinoid syndrome

Immature teratoma

• These are rare malignant  tumors composed of immature or embryonal fetal tissue 

• Age – prepubertal and young women of age below 18years 

• Morphology 

  • Gross 

    • Solid tumors with smooth external surface

    • Cut scetion shows hair follicles, sebaceous material, cartilage or bone

  • Microscopy 

    • Varying amounts of immature neuroepithelium, cartilage, bone, muscle and other elements can be present

    • Grading of the tumor is done depending upon the proportion of immature neuroepithelium present in tumor

• Treatment and prognosis

  • These tumors grow rapidly

  • Low grade tumors in stage I have excellent prognosis

  • High grade tumors confined to ovary are treated by chemotherapy 

  • Recurrences can occur within 2 years

Reference

1. Lora Hedrick Ellenson, Edyta C pirog. The Female genital tract. In:Robbins and Cotran Pathologic basis of disease.2015. 9 edition. volume II.pg 991-1042