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What is Immature Teratoma?

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Updated June 05, 2014

Immature Teratoma


Diagnosis and Prognosis
Immature teratomas grow tissues that resemble those found in an embryo and are the malignant cousins of the very common mature cystic teratomas or dermoid cysts. They may occur in combination with other germ cell tumors and are then called "mixed germ cell tumors." Pure immature teratoma is extremely rare and represents approximately 1% of all ovarian cancers, but within the germ cell tumor group, it is the second most common malignancy. In women under 20 years of age, these tumors represent 10% to 20% of all ovarian malignancies. Approximately half of all immature teratomas can occur even earlier, between the ages of 10 to 20 years. They rarely occur in postmenopausal women, though.

Patients with Stage Ia Grade 1 immature teratoma are usually treated with surgery alone, because the prognosis is excellent. When the grade advances to 2 or 3 or the stage goes beyond Ia, chemotherapy is usually recommended.

Grade is the single most important prognostic factor in early-stage disease. Even in the advanced stages, however, the grade is very important, assuming all of the visible cancer can be removed surgically. Across all stages, the five-year survival for grade 1 disease is approximately 82% and drops to approximately 30% when grade 3 disease is present. The five-year survival rate for stage 1 disease is 90% to 95%, while advanced stage survival drops to about 50% with Grade 1 to 2 cancer and to 25% or less when the tumors are found to be Grade 3.

Treatment
Treatment for immature teratoma includes both surgery and chemotherapy, in most cases. In reproductive-age women, who desire to retain fertility, removal of the involved ovary and surgical staging can be performed, leaving the uterus and the other ovary alone. This can be done, because the other ovary is rarely involved but staging is still required to make sure the cancer has not spread. When it spreads, it usually does so as with epithelial ovarian cancer, in and around the organs inside the peritoneal cavity. Less commonly, it may spread to the lymph nodes, and metastases to distant areas through the bloodstream, such as the lungs and liver.

Since this is a rare tumor, little research data is available compared to what we have for the much more common epithelial ovarian cancers. Those studies that have been completed, however, suggest that the best chemotherapy combinations are the BEP and VAC regimens. The specific drugs in these combinations are (BEP) bleomycin, etoposide, cisplatin; (VAC) vincristine, Adriamycin and cyclophosphamide. Much of the information about this disease comes from experience in male patients with testicular cancer; however, the Gynecologic Oncology Group (GOG) has published a few smaller multicenter trials. At this time, the BEP regimen is the recommended initial treatment in most cases, but the VAC regimen can also be used, especially when there is a recurrence.

Follow up after treatment is usually based on clinical exams and symptoms with expert use of CAT scans. What this means is that your doctor may order a scan if you have new symptoms or something is felt on examination. Routine scans are not recommended, and there are no reliable tumor markers.

Sources:

Retrospective analysis of 67 consecutive cases of pure ovarian immature teratoma. Li H, Hong W, Zhang R, Wu L, Liu L, Zhang W.Chin Med J(Engl). 2002 Oct;115(10):1496-500.

Adjuvant therapy of ovarian germ cell tumors with cisplatin, etoposide, and bleomycin: A trial of the Gynecologic Oncology Group. Williams S, Blessing JA, Liao SY, Ball H, Hanjani P. J Clin Oncol. 1994 Apr;12(4):701-6.

Bleomycin, etoposide, and cisplatin combination therapy of ovarian granulosa cell tumors and other stromal malignancies: A Gynecologic Oncology Group study. Homesley HD, Bundy BN, Hurteau JA, Roth LM.Gynecol Oncol. 1999 Feb;72(2):131-7.

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