Definition

Ovarian teratoma, also known as ovarian dermoid cyst, is a tumor that grows on the ovary and is generally benign. However, ovarian teratomas can also be malignant. The longer a teratoma remains in the body, the greater the likelihood of it becoming malignant.

Teratomas are commonly found in the ovaries, testes, or spinal cord, but they can occur in any part of the body. Teratomas can consist of various types of tissues, such as bone, teeth, muscle, and hair.

Teratoma is a type of germ cell tumor, originating from cells that reproduce. Ovarian teratoma is one of the most common germ cell tumors occurring in women under the age of 45. However, teratomas can occur at any age.

There are several types of teratomas, including

• Solid - compose of tissue but not enclosed in a sac
• Cystic - contained within a sac
• Mixed - exhibit characteristics of both solid and cystic teratomas

Causes

The exact cause of ovarian teratoma is still unknown. Teratomas occur due to complications during the process of cell differentiation. Specifically, these cells develop within growing cells and fail to differentiate, thus potentially transforming into various types of cells (ranging from egg and sperm cells to hair cells).

During fetal development, germ cells move to various locations in the body to differentiate into cells such as eggs in the ovaries and sperm in the testes. It may explain why teratomas are often found in the ovaries or testes and may contain elements such as hair, teeth, wax, oil, and skin.

Risk Factor

The exact risk factors and causes of ovarian teratoma are not well understood, but some experts have identified potential risk factors that may lead to ovarian teratoma. These include:

• Alcohol abuse
• Irregular menstrual cycles and delayed menstruation
• Previous occurrence of ovarian teratoma
• Infertility
• Rare pregnancies

Symptoms

The primary symptom of ovarian teratoma is intense abdominal pain and pelvic pain. It occurs because the growth of the lump exceeds its space and presses against the uterus. About 6–65% of ovarian teratoma cases are asymptomatic. Possible symptoms include:

• Pain (occurring in about 44-47% of cases)
• Tumor growth in the abdomen
• Digestive disorders
• Urinary issues such as increased frequency of urination

In some rare cases, ovarian teratomas can cause symptoms such as:

• Fever
• Fatigue and weakness
• Intense abdominal pain

Diagnosis

You may not be aware of having an ovarian teratoma until it is detected by a doctor during an examination, revealing a lump on the ovary. In other cases, teratomas are discovered during acute symptoms of torsion. Once detected, the doctor will recommend tests to determine the size and location of the teratoma.

Ovarian teratoma can be diagnosed through physical examination, supportive tests such as blood tests to check hormone levels and tumor markers, radiological examinations, and histopathological analysis. The doctor will also inquire about symptoms. Recommended tests include transvaginal ultrasonography (USG), which uses sound waves to provide images of the teratoma's shape and size.

Management

Benign Ovarian Teratoma

In most cases of benign ovarian teratoma, the doctor can treat it while preserving the uterus. Treatment for teratoma has a high likelihood of success with early diagnosis and proper treatment. However, despite successful treatment, ovarian teratomas can recur within 2–10 years.

Some treatment options for benign ovarian teratoma include:

• Observation. It is suitable for pregnant patients or those planning to conceive and have small cysts with slow growth.
• Surgery. The doctor may recommend laparoscopic surgery for younger patients with small cysts. For postmenopausal patients with multiple cysts, the doctor may recommend an oophorectomy, which involves removing the entire ovary.

Malignant Ovarian Teratoma

If an ovarian teratoma becomes malignant, the doctor will recommend additional treatment methods such as:

• Hysterectomy
• Chemotherapy
• Total removal of the ovary

In cases where the teratoma is not fully developed, the doctor will provide cancer treatment based on the cancer's stage.

Complications

Complications arising from ovarian teratoma include:

• Ovarian torsion. A complication of ovarian teratoma that can cause bleeding.
• Uterine wall erosion. Though rare, this risk occurs in about 1-4% of all ovarian teratoma cases.
• Infection. The risk of infection from ovarian teratoma occurs in about 1-4%. Infections can originate from blood, lymph nodes, or directly from organ structures such as the digestive tract. Infection can also result from bleeding due to uterine wall erosion.
• Malignant transformation. It is reported to occur in 1-3% of all ovarian teratoma cases, especially between ages 30 and 70, with a higher likelihood in patients aged 40 to 60. Patients with tumors larger than 10 mm have a higher risk of malignant transformation.

Prevention

Ovarian teratomas cannot be prevented except through lifestyle choices to reduce the risk of uterine prolapse, such as:

• Regular pelvic exams and Pap smears for sexually active women aged 18-65
• Drinking plenty of water and eating high-fiber foods like fruits, vegetables, seeds, and nuts to maintain a healthy weight and lifestyle
• Regular exercise to maintain a healthy weight
• Avoiding stress
• Avoiding excessive alcohol consumption

When to See a Doctor?

You may not realize you have an ovarian teratoma due to a lack of symptoms. Ovarian teratomas are often discovered during routine examinations (such as during pregnancy). Therefore, it is recommended that sexually active women aged 18-65 undergo regular pelvic exams and Pap smears at least once a year to increase the chances of detecting a teratoma during the examination. Immediately contact a doctor if you experience sudden abdominal pain, nausea, vomiting, and other digestive problems.

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