From the Guidelines
An immature teratoma is a rare, malignant type of germ cell tumor that contains incompletely differentiated tissues resembling those found in embryos or fetuses, and its treatment and prognosis depend on the tumor grade, stage, and completeness of surgical removal, as well as the patient's age and fertility status. According to the most recent and highest quality study 1, immature teratomas are classified based on the amount of immature tissue present, with grade 1 tumors showing rare foci of immature neuroepithelial tissue, grade 2 tumors showing similar elements occupying 1-3 low power fields, and grade 3 tumors exhibiting large amounts of immature neuroepithelial tissue occupying more than 3 low power fields. The diagnosis of immature teratoma is based on surgical removal and examination of the tumor tissue, and treatment typically involves surgical removal of the tumor followed by chemotherapy, especially for higher-grade tumors or those that have spread 1. The chemotherapy regimen often includes bleomycin, etoposide, and cisplatin (BEP), and prognosis depends on the tumor grade, stage, and completeness of surgical removal, with higher-grade tumors having a greater risk of recurrence 1. Regular follow-up with physical examinations, imaging studies, and tumor marker tests is essential after treatment to monitor for potential recurrence. In terms of treatment, patients with stage IA grade 1 immature teratoma do not require further adjuvant chemotherapy after adequate surgical staging 1, while those with higher-grade tumors or more advanced disease may require chemotherapy and/or more extensive surgery. Overall, the management of immature teratoma requires a multidisciplinary approach, taking into account the patient's age, fertility status, and overall health, as well as the tumor's grade, stage, and prognosis. Some key points to consider in the management of immature teratoma include:
- The importance of preserving fertility in young patients, whenever possible
- The need for careful surgical staging and examination of the tumor tissue to determine the grade and stage of the tumor
- The use of chemotherapy, particularly the BEP regimen, in the treatment of higher-grade tumors or those that have spread
- The importance of regular follow-up and monitoring for potential recurrence after treatment.
From the Research
Definition and Characteristics of Immature Teratoma
- Immature teratoma is a rare type of germ cell tumor that contains embryonic tissues and may be malignant 2.
- It usually occurs in young women and affects the ovaries, but can also occur in other locations such as the uterus 3.
- Teratomas can exhibit benign clinical behavior, but they can return as teratomas or with malignant components, and in a small subset of individuals, the prognosis may be deadly 2.
Diagnosis and Treatment
- Diagnosis of immature teratoma is typically made through histopathology results after surgery 2.
- Treatment options include fertility-sparing surgery, adjuvant chemotherapy, and surveillance 4, 5.
- The role of adjuvant chemotherapy in stage I disease remains controversial, with some studies suggesting that surveillance is an acceptable choice 4.
- Laparoscopic surgical staging is a potential alternative to laparotomy for surgical staging in malignant germ cell tumors, including immature teratoma 6.
Prognosis and Outcome
- Immature teratoma has a good prognosis, with an excellent overall survival rate and good fertility preservation 5.
- The 5-year disease-free survival was 87% and 90% in the surveillance and chemotherapy groups, respectively, in one study 4.
- Adjuvant chemotherapy may be reserved for relapses, and the potential benefit of chemotherapy should be discussed, especially for high-risk tumors 4.