Introduction
Immature teratoma is the only neoplasm-containing germ cell that is histologically graded, and it is the second most common malignant germinal tumor after dysgerminoma. With a good survival rate and strong fertility preservation, it has a positive prognosis, even though opinions on therapeutic care are divided. Adjuvant chemotherapy is necessary in pediatric oncology, although further research is required. The main treatment is fertility-sparing surgery. However, monitoring or targeted treatment is favored due to chemotherapy's long-term side effects. Given its importance in prognosis and future treatment, particular attention should be paid to the genetic mapping of the histological components for patient risk classification.
What Is the Age Group of Women With Immature Teratoma?
These tumors account for 10–20 percent of all ovarian cancers in women under the age of 20. The recommended course of treatment for juvenile individuals with immature teratomas is a fertility-sparing strategy. Ten to twenty years of age is even earlier, and about half of all juvenile teratomas can occur in this age range. They do not often happen to postmenopausal women.
What Are the Causative Factors for Immature Teratoma?
The most typical location for the formation of an immature teratoma is the ovary. Although they typically arise alone, occasionally they are a component of mixed germ cell tumors, which are most commonly associated with yolk sac tumors. All things considered, the second most typical kind of ovarian malignant germ cell tumor is immature teratoma.Following its initial meiotic division, an unfertilized ovum, or egg, gives rise to them on their own. So as to create four gametes, the parent cell in this type of division cuts its chromosome count in half.
They develop as a result of an anomaly that occurs early in the development of a fertilized egg.
What Are the Symptoms of Immature Teratoma?
Pain, which affects 44-47 percent of instances; obvious growth or tumor in the abdomen; gastrointestinal symptoms; and urine symptoms, like an elevated need to urinate. Immature teratomas can, in extreme situations, result in:
- Fever exhaustion or debility.
- Severe discomfort in the abdomen.
- Acute symptoms that could include rapid start: could occur if the mature teratoma produces an ovarian torsion.
- Stomach aches, nausea, and vomiting.
What Are the Diagnostic Tests for Immature Teratoma?
It is possible that a person will not be aware they have an immature cystic teratoma until a doctor finds the lump during a regular examination. Due to ovarian torsion, which produces abrupt, severe symptoms, others might learn about it.
If a physician finds it, they will probably request imaging tests. Transvaginal ultrasound is the recommended test. The appearance of the teratoma on an ultrasound usually allows for its identification.
What Is the Treatment of Immature Teratoma?
Chemotherapy and surgery are both used in the treatment of immature teratomas. Patients with stage Ia grade 1 immature teratomas typically just require surgery due to their excellent prognosis. Chemotherapy is typically advised when the tumor progresses to a grade of two or three, or when the stage rises above Ia.
The fraction of tissue that has immature neural elements which resemble embryonic organs is referred to as the grade of an immature teratoma. For example, a grade 1 immature teratoma, as described by the American Cancer Society, is primarily composed of noncancerous tissue with a little amount of visible cancerous cells. An immature teratoma's stage indicates how far it has spread; a stage I tumor indicates that its growth is limited to ovaries.
Surgical Intervention:
- Reproductive-age women who wish to maintain their fertility may opt for surgical staging and ovarectomy, leaving the uterus and other ovary unaltered. Because the other ovary is rarely affected, this can be done; however, staging is still necessary to ensure that the cancer has not spread.
- Similar to epithelial ovarian cancer, it typically progresses to the organs inside the peritoneal cavity. Less frequently, it can go to the lymph nodes and then use the bloodstream to metastasis to far-off organs including the liver and lungs.
Chemotherapy:
- In comparison to the abundance of research data on the far more prevalent epithelial ovarian malignancies, this tumor is rare.
- The particular medications in these combos, which collectively are referred to as BEP, include: Bleomycin,Cisplatin,Etoposide.
VAC, a second-line treatment, consists of the following:
- Vincristine, Cyclophosphamide, Adriamycin.
However the majority of the knowledge on this disease is derived from experience with male patients who have testicular cancer. Currently, the VAC regimen can also be employed, particularly in cases where there has been a recurrence, although the BEP regimen is the recommended initial treatment in the majority of patients.
Follow-up After Immature Teratoma Treatment:
After treatment for an immature teratoma, clinical examinations, patient symptoms, and imaging tests such as CAT scans are typically used to guide follow-up. This implies that if one experience new symptoms or the doctor feels something during an examination, they might prescribe a scan for them. As of right present, there are no trustworthy tumor indicators, and routine scans are not advised.
What Is the Prognosis of Immature Teratoma?
The single most significant prognostic marker in early-stage disease is the tumor's grade; prognosis is a person's likelihood of making a full recovery. To put it another way, the grade is crucial even if an immature teratoma is in an advanced stage (assuming all visible malignancy can be removed surgically).
The five-year survival rate for grade 1 disease is over 82 percent throughout all stages, and it falls to about 30 percent in cases of grade 3 disease. Ninety to ninety-five percent of patients survive beyond the first five years of diagnosis; this percentage falls to fifty percent in cases of Grade 1 to 2 cancer and to twenty-five percent or less in cases of Grade 3 malignancies.
Conclusion
If a physician finds it, they will probably request imaging tests. Transvaginal ultrasound is the recommended test. The appearance of the teratoma on an ultrasound usually allows for its identification. A rare germinal malignant tumor, an immature teratoma is the only one for which there is a tumor grading system among germ cell tumors. Despite disagreements over pathology management, there is a good therapeutic outcome, good survival rates, and a high degree of fertility preservation for immature teratomas. To fully understand the necessity of chemotherapy, particularly in pediatric oncology, more research is required. Given the side effects of chemotherapy, surveillance is recommended. The future also includes potential targeted alternative treatments. The age at which these malignant tumors manifest themselves and the possibility of curing the illness make these efforts essential. Given the significance in prognosis and future treatment, particular attention should be paid to the genetic mapping of the histological components for patient risk classification.
