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class="mw-body-content"><div class="mw-content-ltr mw-parser-output" lang="en" dir="ltr"><div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Medical condition</div><style data-mw-deduplicate="TemplateStyles:r1257001546">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox ib-medical-condition"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Immature teratoma</th></tr><tr style="background-color: #f8f9fa;"><td colspan="2" class="infobox-full-data"><span class="mw-default-size" typeof="mw:File/Frameless"><a href="/wiki/File:Immature_teratoma_high_mag.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/2/23/Immature_teratoma_high_mag.jpg/220px-Immature_teratoma_high_mag.jpg" decoding="async" width="220" height="147" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/2/23/Immature_teratoma_high_mag.jpg/330px-Immature_teratoma_high_mag.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/2/23/Immature_teratoma_high_mag.jpg/440px-Immature_teratoma_high_mag.jpg 2x" data-file-width="4272" data-file-height="2848" /></a></span></td></tr><tr><td colspan="2" class="infobox-full-data"><a href="/wiki/Micrograph" title="Micrograph">Micrograph</a> of the primitive neuroepithelium of an immature teratoma. <a href="/wiki/H%26E_stain" title="H&E stain">H&E stain</a>.</td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data"><a href="/wiki/Oncology" title="Oncology">Oncology</a></td></tr></tbody></table> <p>An <b>immature teratoma</b> is a <a href="/wiki/Teratoma" title="Teratoma">teratoma</a> that contains <a href="/wiki/Anaplastic" class="mw-redirect" title="Anaplastic">anaplastic</a> immature elements, and is often synonymous with <b>malignant teratoma</b>.<sup id="cite_ref-SunDing2019_1-0" class="reference"><a href="#cite_note-SunDing2019-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> A teratoma is a tumor of germ cell origin, containing tissues from more than one germ cell line,<sup id="cite_ref-2" class="reference"><a href="#cite_note-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-3" class="reference"><a href="#cite_note-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:13_4-0" class="reference"><a href="#cite_note-:13-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> It can be ovarian or testicular in its origin.<sup id="cite_ref-:13_4-1" class="reference"><a href="#cite_note-:13-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> and are almost always benign.<sup id="cite_ref-:2_5-0" class="reference"><a href="#cite_note-:2-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> An immature teratoma is thus a very rare tumor, representing 1% of all <a href="/wiki/Teratoma" title="Teratoma">teratomas</a>, 1% of all <a href="/wiki/Ovarian_cancer" title="Ovarian cancer">ovarian cancers</a>, and 35.6% of malignant ovarian <a href="/wiki/Germ_cell_tumor" title="Germ cell tumor">germ cell tumors</a>.<sup id="cite_ref-6" class="reference"><a href="#cite_note-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> It displays a specific age of incidence, occurring most frequently in the first two decades of life and almost never after <a href="/wiki/Menopause" title="Menopause">menopause</a>.<sup id="cite_ref-:13_4-2" class="reference"><a href="#cite_note-:13-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> Unlike a mature cystic teratoma, an immature teratoma contains immature or embryonic structures. It can coexist with mature cystic teratomas and can constitute of a combination of both adult and embryonic tissue.<sup id="cite_ref-:0_7-0" class="reference"><a href="#cite_note-:0-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:1_8-0" class="reference"><a href="#cite_note-:1-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> The most common symptoms noted are <a href="/wiki/Abdominal_distension" title="Abdominal distension">abdominal distension</a> and masses.<sup id="cite_ref-9" class="reference"><a href="#cite_note-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Prognosis" title="Prognosis">Prognosis</a> and treatment options vary and largely depend on <a href="/wiki/Grading_(tumors)" title="Grading (tumors)">grade</a>, <a href="/wiki/Cancer_staging" title="Cancer staging">stage</a> and <a href="/wiki/Karyotype" title="Karyotype">karyotype</a> of the tumor itself. </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Diagnosis">Diagnosis</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Immature_teratoma&action=edit&section=1" title="Edit section: Diagnosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>At <a href="/wiki/CT_scan" title="CT scan">CT</a> and <a href="/wiki/Magnetic_resonance_imaging" title="Magnetic resonance imaging">MRI</a>, an immature teratoma possesses characteristic appearance. It is typically large (12–25 cm) and has prominent solid components with cystic elements.<sup id="cite_ref-:3_10-0" class="reference"><a href="#cite_note-:3-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> It is usually filled with lipid constituents and therefore demonstrates fat density at <a href="/wiki/CT_scan" title="CT scan">CT</a> and <a href="/wiki/Magnetic_resonance_imaging" title="Magnetic resonance imaging">MRI</a>.<sup id="cite_ref-:3_10-1" class="reference"><a href="#cite_note-:3-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> Ultrasound appearance of an immature teratoma is nonspecific. It is highly heterogeneous with partially solid lesions and scattered <a href="/wiki/Calcification" title="Calcification">calcifications.</a><sup id="cite_ref-11" class="reference"><a href="#cite_note-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-12" class="reference"><a href="#cite_note-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Stage">Stage</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Immature_teratoma&action=edit&section=2" title="Edit section: Stage"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Traditionally, comprehensive surgical staging is performed via exploratory <a href="/wiki/Laparotomy" title="Laparotomy">laparotomy</a> with cytologic washings, <a href="/wiki/Peritoneum" title="Peritoneum">peritoneal</a> biopsies, an <a href="/wiki/Greater_omentum" title="Greater omentum">omental</a> assessment (either biopsy or rarely a full <a href="/wiki/Greater_omentum" title="Greater omentum">omentectomy</a>), and both pelvic and aortic <a href="/wiki/Lymph_node" title="Lymph node">lymph node</a> dissection. <a href="/wiki/Laparoscopy" title="Laparoscopy">Laproscopy</a> is often suggested as an alternative to surgically stage patients with immature teratoma.<sup id="cite_ref-13" class="reference"><a href="#cite_note-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-14" class="reference"><a href="#cite_note-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> </p><p><a href="/wiki/Ovarian_cancer" title="Ovarian cancer">Ovarian cancer</a> is staged using the FIGO staging system and uses information obtained after surgery, which can include a total abdominal <a href="/wiki/Hysterectomy" title="Hysterectomy">hysterectomy</a> via midline <a href="/wiki/Laparotomy" title="Laparotomy">laparotomy</a>, unilateral (or bilateral) salpingo-oophorectomy, pelvic (peritoneal) washings, assessment of <a href="/wiki/Retroperitoneal_space" title="Retroperitoneal space">retroperitoneal</a> lymph nodes and/or <a href="/wiki/Appendectomy" title="Appendectomy">appendectomy</a>.<sup id="cite_ref-15" class="reference"><a href="#cite_note-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:4_16-0" class="reference"><a href="#cite_note-:4-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> The <a href="/wiki/American_Joint_Committee_on_Cancer" title="American Joint Committee on Cancer">AJCC</a> staging system, identical to the FIGO staging system, describes the extent of tumor (T), the presence of absences of metastases to lymph nodes (N), the presence or absence of distant metastases (M).<sup id="cite_ref-17" class="reference"><a href="#cite_note-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> </p> <table class="wikitable"> <caption>Table 1: FIGO Staging System for Ovarian Cancers<sup id="cite_ref-:4_16-1" class="reference"><a href="#cite_note-:4-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> </caption> <tbody><tr> <th>Stage </th> <th> </th> <th> </th> <th> </th> <th>Description </th></tr> <tr> <td>I </td> <td> </td> <td> </td> <td> </td> <td>Cancer is completely limited to the ovary </td></tr> <tr> <td> </td> <td>IA </td> <td> </td> <td> </td> <td>involves one ovary, capsule intact, no tumor on ovarian surface, negative washings </td></tr> <tr> <td> </td> <td>IB </td> <td> </td> <td> </td> <td>involves both ovaries; capsule intact; no tumor on ovarian surface; negative washings </td></tr> <tr> <td> </td> <td>IC </td> <td> </td> <td> </td> <td>tumor involves one or both ovaries </td></tr> <tr> <td> </td> <td>IC1 </td> <td> </td> <td> </td> <td>surgical spill </td></tr> <tr> <td> </td> <td>IC2 </td> <td> </td> <td> </td> <td>capsule has ruptured or tumor on ovarian surface </td></tr> <tr> <td> </td> <td>IC3 </td> <td> </td> <td> </td> <td>positive ascites or washings </td></tr> <tr> <td>II </td> <td> </td> <td> </td> <td> </td> <td>pelvic extension of the tumor (must be confined to the pelvis) or primary peritoneal tumor, involves one or both ovaries </td></tr> <tr> <td> </td> <td>IIA </td> <td> </td> <td> </td> <td>tumor found on uterus or fallopian tubes </td></tr> <tr> <td> </td> <td>IIB </td> <td> </td> <td> </td> <td>tumor elsewhere in the pelvis </td></tr> <tr> <td>III </td> <td> </td> <td> </td> <td> </td> <td>cancer found outside the pelvis or in the retroperitoneal lymph nodes, involves one or both ovaries </td></tr> <tr> <td> </td> <td>IIIA </td> <td> </td> <td> </td> <td>metastasis in retroperitoneal lymph nodes or microscopic extrapelvic metastasis </td></tr> <tr> <td> </td> <td> </td> <td>IIIA1 </td> <td> </td> <td>metastasis in retroperitoneal lymph nodes </td></tr> <tr> <td> </td> <td> </td> <td> </td> <td>IIIA1(i) </td> <td>the metastasis is less than 10 mm in diameter </td></tr> <tr> <td> </td> <td> </td> <td> </td> <td>IIIA1(ii) </td> <td>the metastasis is greater than 10 mm in diameter </td></tr> <tr> <td> </td> <td> </td> <td>IIIA2 </td> <td> </td> <td>microscopic metastasis in the peritoneum, regardless of retroperitoneal lymph node status </td></tr> <tr> <td> </td> <td>IIIB </td> <td> </td> <td> </td> <td>metastasis in the peritoneum less than or equal to 2 cm in diameter, regardless of retroperitoneal lymph node status; or metastasis to liver or spleen capsule </td></tr> <tr> <td> </td> <td>IIIC </td> <td> </td> <td> </td> <td>metastasis in the peritoneum greater than 2 cm in diameter, regardless of retroperitoneal lymph node status; or metastasis to liver or spleen capsule </td></tr> <tr> <td>IV </td> <td> </td> <td> </td> <td> </td> <td>distant metastasis (i.e. outside of the peritoneum) </td></tr> <tr> <td> </td> <td>IVA </td> <td> </td> <td> </td> <td>pleural effusion containing cancer cells </td></tr> <tr> <td> </td> <td>IVB </td> <td> </td> <td> </td> <td>metastasis to distant organs (including the parenchyma of the spleen or liver), or metastasis to the inguinal and extra-abdominal lymph nodes </td></tr></tbody></table> <div class="mw-heading mw-heading3"><h3 id="Pathology">Pathology</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Immature_teratoma&action=edit&section=3" title="Edit section: Pathology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure typeof="mw:File/Thumb"><a href="/wiki/File:Ovarian_tumors_by_incidence_and_cancer_risk.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/9/9a/Ovarian_tumors_by_incidence_and_cancer_risk.png/320px-Ovarian_tumors_by_incidence_and_cancer_risk.png" decoding="async" width="320" height="162" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/9/9a/Ovarian_tumors_by_incidence_and_cancer_risk.png/480px-Ovarian_tumors_by_incidence_and_cancer_risk.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/9/9a/Ovarian_tumors_by_incidence_and_cancer_risk.png/640px-Ovarian_tumors_by_incidence_and_cancer_risk.png 2x" data-file-width="2153" data-file-height="1093" /></a><figcaption><a href="/wiki/Ovarian_tumor" title="Ovarian tumor">Ovarian tumors</a> by <a href="/wiki/Incidence_(epidemiology)" title="Incidence (epidemiology)">incidence</a> and risk of <a href="/wiki/Ovarian_cancer" title="Ovarian cancer">ovarian cancer</a>, with immature teratoma at right.<sup id="cite_ref-18" class="reference"><a href="#cite_note-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup></figcaption></figure> <p>An immature teratoma contains varying compositions of adult and embryonic tissue. The most common embryonic component identified in immature teratomas is the <a href="/wiki/Neuroectoderm" title="Neuroectoderm">neuroectoderm</a>.<sup id="cite_ref-:5_19-0" class="reference"><a href="#cite_note-:5-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> Occasionally, tumors may present <a href="/wiki/Neuroepithelial_cell" title="Neuroepithelial cell">neuroepithelium</a> that resemble <a href="/wiki/Neuroblast" title="Neuroblast">neuroblasts</a>.<sup id="cite_ref-:5_19-1" class="reference"><a href="#cite_note-:5-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> Tumors may also present embryonic components such as immature <a href="/wiki/Cartilage" title="Cartilage">cartilage</a> and <a href="/wiki/Skeletal_muscle" title="Skeletal muscle">skeletal muscle</a> of <a href="/wiki/Mesoderm" title="Mesoderm">mesodermal</a> origin.<sup id="cite_ref-:5_19-2" class="reference"><a href="#cite_note-:5-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> Immature teratomas composed of embryonic <a href="/wiki/Endoderm" title="Endoderm">endodermal</a> derivatives are rare.<sup id="cite_ref-:5_19-3" class="reference"><a href="#cite_note-:5-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> </p><p>Often a mature cystic teratoma is misdiagnosed as its immature counterpart due to the misinterpretation of mature neural tissue as immature.<sup id="cite_ref-:6_20-0" class="reference"><a href="#cite_note-:6-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> While mature neural cells have <a href="/wiki/Cell_nucleus" title="Cell nucleus">nuclei</a> with uniformly dense <a href="/wiki/Chromatin" title="Chromatin">chromatin</a> and neither exhibit <a href="/wiki/Apoptosis" title="Apoptosis">apoptotic</a> or <a href="/wiki/Mitosis" title="Mitosis">mitotic</a> activity, immature neural cells have <a href="/wiki/Cell_nucleus" title="Cell nucleus">nuclei</a> with vesicular <a href="/wiki/Chromatin" title="Chromatin">chromatin</a> and exhibit both <a href="/wiki/Apoptosis" title="Apoptosis">apoptotic</a> and <a href="/wiki/Mitosis" title="Mitosis">mitotic</a> activity.<sup id="cite_ref-:6_20-1" class="reference"><a href="#cite_note-:6-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> A recent study has identified the use of <a href="/wiki/Oct-4" title="Oct-4">Oct-4</a> as a reliable <a href="/wiki/Biomarker" title="Biomarker">biomarker</a> for the diagnosis of highly malignant cases of immature teratomas.<sup id="cite_ref-21" class="reference"><a href="#cite_note-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Grade">Grade</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Immature_teratoma&action=edit&section=4" title="Edit section: Grade"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Thurlbeck and Scully devised a grading system for “pure” immature teratomas on the basis of differentiation of the cellular elements of the tumor.<sup id="cite_ref-:7_22-0" class="reference"><a href="#cite_note-:7-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> The proportion of immature tissue elements defines the grade of immaturity.<sup id="cite_ref-:7_22-1" class="reference"><a href="#cite_note-:7-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> This was later modified by Norris <i>et al</i>. (1976), who added a quantitative aspect to the degree of immaturity.<sup id="cite_ref-:8_23-0" class="reference"><a href="#cite_note-:8-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> </p> <table class="wikitable"> <caption>Table 2: Identifying Tumor Grade in Immature Teratomas<sup id="cite_ref-:7_22-2" class="reference"><a href="#cite_note-:7-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:8_23-1" class="reference"><a href="#cite_note-:8-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> </caption> <tbody><tr> <th>Grade </th> <th>Thurlbeck and Scully (1960) </th> <th>Norris <i>et al</i>. (1976) </th></tr> <tr> <td>0 </td> <td>All cells are well differentiated </td> <td>All cells are mature; mitotic activity is rare or absent. </td></tr> <tr> <td>1 </td> <td>Cells are well differentiated except in rare small foci of embryonic tissue; neuroepithelium is absent or rare </td> <td>Neuroepithelium absent or limited to fewer than one low-magnification field (x40) per slide </td></tr> <tr> <td>2 </td> <td>Moderate quantities of embryonic tissue present; cells show atypicality and mitotic activity </td> <td>Neuroepithelium does not exceed more than three low-magnification fields (x40) per slide </td></tr> <tr> <td>3 </td> <td>Large quantities of embryonic tissue present; cells show atypicality and mitotic activity </td> <td>Neuroepithelium exceeds more than three low-magnification fields (x40) per slide </td></tr></tbody></table> <div class="mw-heading mw-heading3"><h3 id="Karyotype">Karyotype</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Immature_teratoma&action=edit&section=5" title="Edit section: Karyotype"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>An ovarian immature teratoma is <a href="/wiki/Karyotype" title="Karyotype">karyotypically</a> normal 46,XX or near-normal. Grade 1 or 2 tumors exhibit 46,XX normal karyotype, whereas grade 3 tumors show a variety of abnormal <a href="/wiki/Karyotype" title="Karyotype">karyotypes</a>.<sup id="cite_ref-:9_24-0" class="reference"><a href="#cite_note-:9-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> Though immature teratoma cells show a normal <a href="/wiki/Karyotype" title="Karyotype">karyotype</a>, there may still be detectable alterations in the gene level and that these aberrations may influence the stability of <a href="/wiki/Chromosome" title="Chromosome">chromosome</a> status.<sup id="cite_ref-:9_24-1" class="reference"><a href="#cite_note-:9-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Genetics">Genetics</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Immature_teratoma&action=edit&section=6" title="Edit section: Genetics"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Ovarian immature teratomas have been classified as among the least mutated of all solid cancers.<sup id="cite_ref-:14_25-0" class="reference"><a href="#cite_note-:14-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup> Immature teratomas originate from germ cells that undergo one of several meiotic failures, leading to a tumor genome with high levels of copy neutral loss of heterozygosity.<sup id="cite_ref-:14_25-1" class="reference"><a href="#cite_note-:14-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Prognosis">Prognosis</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Immature_teratoma&action=edit&section=7" title="Edit section: Prognosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Though several studies have shown that size and stage of the primary tumor are related to survival, the grade of the tumor is the best determinant of prognosis prior to <a href="/wiki/Peritoneum" title="Peritoneum">peritoneal</a> spread.<sup id="cite_ref-:8_23-2" class="reference"><a href="#cite_note-:8-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:9_24-2" class="reference"><a href="#cite_note-:9-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> Once <a href="/wiki/Peritoneum" title="Peritoneum">peritoneal</a> spread has occurred, the grade of metastatic lesions or implants is the best determinant of <a href="/wiki/Prognosis" title="Prognosis">prognosis</a>.<sup id="cite_ref-:8_23-3" class="reference"><a href="#cite_note-:8-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:9_24-3" class="reference"><a href="#cite_note-:9-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> Multiple sections of the primary tumor and wide sampling of the implants are necessary to properly grade the tumor. In most cases, the implants are better differentiated than the primary tumors.<sup id="cite_ref-:1_8-1" class="reference"><a href="#cite_note-:1-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> Gliomatosis peritonei, a rare condition often associated with immature ovarian teratoma, is characterized by the presence of mature <a href="/wiki/Neuroglia" class="mw-redirect" title="Neuroglia">glial</a> implants in the <a href="/wiki/Peritoneum" title="Peritoneum">peritoneum</a>.<sup id="cite_ref-26" class="reference"><a href="#cite_note-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> Yoon <i>et al.</i> (2012)<i>,</i> reported that immature ovarian teratoma patients with Gliomatosis peritonei have larger tumors, more frequent recurrence and higher <a href="/wiki/CA-125" class="mw-redirect" title="CA-125">CA-125</a> levels than immature ovarian teratoma patients without gliomatosis peritonei.<sup id="cite_ref-27" class="reference"><a href="#cite_note-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> </p><p>A high degree of immaturity in the primary tumor, one that corresponds with a grade 3 diagnosis is a sign of poor prognosis.<sup id="cite_ref-:8_23-4" class="reference"><a href="#cite_note-:8-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:1_8-2" class="reference"><a href="#cite_note-:1-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:10_28-0" class="reference"><a href="#cite_note-:10-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-29" class="reference"><a href="#cite_note-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup> Grade 3 tumors often display <a href="/wiki/Chromosome_abnormality" title="Chromosome abnormality">chromosomal abnormalities</a>, also an indication of poor prognosis.<sup id="cite_ref-:9_24-4" class="reference"><a href="#cite_note-:9-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> Tumor grade is the most important factor for <a href="/wiki/Relapse" title="Relapse">relapse</a> in immature teratomas.<sup id="cite_ref-:10_28-1" class="reference"><a href="#cite_note-:10-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> Vicus <i>et al.</i> (2011)<i>,</i> reported that grade 2 or 3 tumors are associated with a greater chance of <a href="/wiki/Relapse" title="Relapse">relapse</a> that can be fatal, predominantly within 2 years of diagnosis.<sup id="cite_ref-:11_30-0" class="reference"><a href="#cite_note-:11-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> Among grade 3 patients, the stage was significantly associated with <a href="/wiki/Relapse" title="Relapse">relapse</a>.<sup id="cite_ref-:11_30-1" class="reference"><a href="#cite_note-:11-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> </p><p>In the past, survival rates were low for high-grade immature teratomas. Norris <i>et al.</i> (1976)<i>,</i> reported a survival rate of 82% for patients with grade 1 tumors, 62% for grade 2 and 30% for grade 3 tumors.<sup id="cite_ref-:8_23-5" class="reference"><a href="#cite_note-:8-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> However, these results antedate the use of multi-agent <a href="/wiki/Chemotherapy" title="Chemotherapy">chemotherapy</a>.<sup id="cite_ref-:1_8-3" class="reference"><a href="#cite_note-:1-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> With the advent of multiagent <a href="/wiki/Chemotherapy" title="Chemotherapy">chemotherapy</a> after surgical resection, long-term remission and increased survival rates have been achieved. Pashankar <i>et al.</i> (2016)<i>,</i> reported that the estimated 5-year overall survival rate for grade 3 Stage I and II disease was 91% compared with 88% for grade 3, Stage III and IV disease.<sup id="cite_ref-:10_28-2" class="reference"><a href="#cite_note-:10-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Treatment">Treatment</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Immature_teratoma&action=edit&section=8" title="Edit section: Treatment"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Histologic grade and fertility desires of the patient are key considerations in determining treatment options. In adult women postoperative adjuvant chemotherapy is standard except for stage I /grade 1 disease. In pediatric patients, surgery alone is standard.<sup id="cite_ref-:10_28-3" class="reference"><a href="#cite_note-:10-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Surgery">Surgery</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Immature_teratoma&action=edit&section=9" title="Edit section: Surgery"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Since the occurrence of immature teratoma is very rarely bilateral, current standard of care of <a href="/wiki/Oophorectomy" title="Oophorectomy">unilateral salpingo-oophorectomy</a> with wide sampling of peritoneal implants.<sup id="cite_ref-:1_8-4" class="reference"><a href="#cite_note-:1-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> Total abdominal <a href="/wiki/Hysterectomy" title="Hysterectomy">hysterectomy</a> with <a href="/wiki/Oophorectomy" title="Oophorectomy">bilateral salpingo-oophorectomy</a> are not indicated as they do not influence outcomes.<sup id="cite_ref-:1_8-5" class="reference"><a href="#cite_note-:1-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> Fertility-sparing surgery in the form of <a href="/wiki/Oophorectomy" title="Oophorectomy">unilateral salpingo-oophorectomy</a> is the primary treatment modality in young patients.<sup id="cite_ref-31" class="reference"><a href="#cite_note-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-32" class="reference"><a href="#cite_note-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-33" class="reference"><a href="#cite_note-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup> Some physicians recommend <a href="/wiki/Cystectomy" title="Cystectomy">ovarian cystectomy</a> alone, rather than a <a href="/wiki/Oophorectomy" title="Oophorectomy">unilateral salpingo-oophorectomy</a> for patients with an early stage low grade disease. Zhao <i>et al. (2017)</i>, reported no significant differences in survival rates or post-operative fertility outcomes between the two treatment options.<sup id="cite_ref-34" class="reference"><a href="#cite_note-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> However, others caution against such an approach.<sup id="cite_ref-:1_8-6" class="reference"><a href="#cite_note-:1-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Chemotherapy">Chemotherapy</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Immature_teratoma&action=edit&section=10" title="Edit section: Chemotherapy"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Norris <i>et al.</i> (1976) observed an 18% recurrence rate in grade 2 tumors and 70% recurrence in grade 3 tumors.<sup id="cite_ref-:8_23-6" class="reference"><a href="#cite_note-:8-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> Gershenson <i>et al.</i> (1986), reported outcomes of 41 patients with Stage I-IV disease and observed recurrences in 94% of patients treated with surgery alone compared with 14% in patients treated with surgery and chemotherapy.<sup id="cite_ref-35" class="reference"><a href="#cite_note-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup> Studies like these resulted in the recommendation to use <a href="/wiki/Chemotherapy" title="Chemotherapy">chemotherapy</a> for grade 2 and 3 tumors. Currently, the use of multi agent chemotherapy for adult patients with ovarian immature teratoma is standard of care except for grade 1, stage I tumors.<sup id="cite_ref-:10_28-4" class="reference"><a href="#cite_note-:10-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> There is considerable experience with a combination of <a href="/wiki/Vincristine" title="Vincristine">vincristine</a>, <a href="/wiki/Dactinomycin" title="Dactinomycin">dactinomycin</a>, and <a href="/wiki/Cyclophosphamide" title="Cyclophosphamide">cyclophosphamide</a> (VAC) given in an adjuvant setting; however, combinations containing <a href="/wiki/Cisplatin" title="Cisplatin">cisplatin</a>, <a href="/wiki/Etoposide" title="Etoposide">etoposide</a>, and <a href="/wiki/Bleomycin" title="Bleomycin">bleomycin</a> (BEP) are now preferred because of a lower <a href="/wiki/Relapse" title="Relapse">relapse</a> rate and shorter treatment time.<sup id="cite_ref-:12_36-0" class="reference"><a href="#cite_note-:12-36"><span class="cite-bracket">[</span>36<span class="cite-bracket">]</span></a></sup> While a prospective comparison of VAC versus BEP has not been performed, in well-staged patients with completely resected tumors, relapse is essentially unheard of following <a href="/wiki/Platinum-based_antineoplastic" title="Platinum-based antineoplastic">platinum-based chemotherapy</a>.<sup id="cite_ref-:12_36-1" class="reference"><a href="#cite_note-:12-36"><span class="cite-bracket">[</span>36<span class="cite-bracket">]</span></a></sup> However, the disease will recur in about 25% of well-staged patients treated with 6 months of VAC.<sup id="cite_ref-37" class="reference"><a href="#cite_note-37"><span class="cite-bracket">[</span>37<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Immature_teratoma&action=edit&section=11" title="Edit section: See also"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a href="/wiki/Teratoma" title="Teratoma">Teratoma</a></li> <li><a href="/wiki/Ovarian_cancer" title="Ovarian cancer">Ovarian Cancer</a></li> <li><a href="/wiki/Germ_cell_tumor" title="Germ cell tumor">Germ Cell Tumor</a></li></ul> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Immature_teratoma&action=edit&section=12" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist 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no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output 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class="mw-cite-backlink"><b><a href="#cite_ref-17">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://www.cancer.org/cancer/ovarian-cancer/detection-diagnosis-staging/staging.html">"How is Ovarian Cancer Staged?"</a>. <i>American Cancer Society</i>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=American+Cancer+Society&rft.atitle=How+is+Ovarian+Cancer+Staged%3F&rft_id=https%3A%2F%2Fwww.cancer.org%2Fcancer%2Fovarian-cancer%2Fdetection-diagnosis-staging%2Fstaging.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImmature+teratoma" class="Z3988"></span></span> </li> <li id="cite_note-18"><span class="mw-cite-backlink"><b><a href="#cite_ref-18">^</a></b></span> <span class="reference-text">- <link rel="mw-deduplicated-inline-style" 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"Adjuvant therapy of ovarian germ cell tumors with cisplatin, etoposide, and bleomycin: a trial of the Gynecologic Oncology Group". <i>Journal of Clinical Oncology</i>. <b>12</b> (4): 701–6. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1200%2FJCO.1994.12.4.701">10.1200/JCO.1994.12.4.701</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/7512129">7512129</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Clinical+Oncology&rft.atitle=Adjuvant+therapy+of+ovarian+germ+cell+tumors+with+cisplatin%2C+etoposide%2C+and+bleomycin%3A+a+trial+of+the+Gynecologic+Oncology+Group&rft.volume=12&rft.issue=4&rft.pages=701-6&rft.date=1994-04&rft_id=info%3Adoi%2F10.1200%2FJCO.1994.12.4.701&rft_id=info%3Apmid%2F7512129&rft.aulast=Williams&rft.aufirst=S&rft.au=Blessing%2C+JA&rft.au=Liao%2C+SY&rft.au=Ball%2C+H&rft.au=Hanjani%2C+P&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImmature+teratoma" class="Z3988"></span></span> </li> <li id="cite_note-37"><span class="mw-cite-backlink"><b><a href="#cite_ref-37">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFSlaytonParkSilverbergShingleton1985" class="citation journal cs1">Slayton RE, Park RC, Silverberg SG, Shingleton H, Creasman WT, Blessing JA (July 1985). <a rel="nofollow" class="external text" href="https://doi.org/10.1002%2F1097-0142%2819850715%2956%3A2%3C243%3A%3AAID-CNCR2820560206%3E3.0.CO%3B2-T">"Vincristine, dactinomycin, and cyclophosphamide in the treatment of malignant germ cell tumors of the ovary. 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