Ovarian mature teratoma

Introduction to ovarian mature teratoma Ovarian mature teratoma is a part of the ovarian teratoma family, which originates from germ cells with pluripotent differentiation and contains ectoderm, mesoderm and endoderm structures. Ovarian teratoma was described by the author in the 17th century, which originated from the Greek teras. In 1843, Kohlrausch reported that the tumor contents contained sebum and hair. Later, different authors found that there were ganglion cells, brain tissue, smooth muscle, thyroid tissue, breast tissue, reproductive organs, teeth, joints, digestive tract tissues, and lungs. Remnants and other organ organizations. Ovarian mature teratoma can be divided into solid mature teratoma (mature solidteratoma) and cystic mature teratoma (maturecysticteratoma). The former is very rare, the surface of the tumor is smooth, the cut surface is solid, and there are honeycomb small capsules, and the three embryonic layers derived from the tumor are differentiated and mature. The latter is the most common benign tumor of the ovary, so it is also called benign cystic teratoma or dermoid cyst. basic knowledge The proportion of illness: 0.003% Susceptible people: women Mode of infection: non-infectious Complications: hemolytic anemia, splenomegaly

Ovarian mature teratoma etiology

First, the cause of the disease

Most mature teratomas show normal 46, XX karyotypes. In rare cases, the karyotype of teratomas can be trisomy or triploid.

Second, the pathogenesis

There are five possibilities for the mechanism of occurrence:

1, type I: the first meiosis failure of the egg cell or the fusion of the first polar body and the egg

which performed:

Both the tumor tissue and the host cell chromosome centromere markers are heterozygous.

Chromosome terminal isozyme sites: Depending on whether the centromere and end markers are interchanged and interchanged during meiosis.

2, type II: the second meiosis failure or the fusion of the second polar body and the egg

which performed:

The teratoma chromosome centromere markers are homozygous.

Chromosome end markers: interchangeable depending on meiosis.

3, type III: mature egg cell gene nuclear replication

Both centromere markers and chromosome ends are homozygous.

4, type IV: the first and second meiosis of primordial germ cells failed

There is no meiosis, and mitosis occurs.

Both the centromere and the terminal markers are consistent with the host and are heterozygous.

5, V type: caused by the fusion of two eggs

The teratoma chromosome centromere and terminal markers can be heterozygous or homozygous.

Ovarian mature teratoma prevention

Regular physical examination, early detection, early treatment, and good follow-up.

Ovarian mature teratoma complications Complications hemolytic anemia spleen

Reverse

Because tumors are often pedicled and dense, have a certain weight and the same tumor density is uneven, so it is easy to reverse, the cause is often pregnancy motility, bladder filling or emptying, cough, vomiting or accidental violence caused by sudden changes in abdominal pressure The incidence of torsion is 9% to 17%. After the torsion occurs, there are often typical symptoms such as acute abdominal pain, nausea and vomiting. The early tumor pedicle has tenderness. In the later stage, the whole tumor has tenderness. The symptoms and signs are not difficult to diagnose. When the 180° is reversed, the tumor can be oppressed. The veins can be reversed by 360° or 720°, causing the arterial blood supply to be interrupted, and the venous return blocked, leading to intracapsular hemorrhage. Stroke gangrene, if the delay is too long, can not retain the affected side of the ovary during surgery.

2. rupture

Teratoma rupture is rare, and only 4 of 647 patients in Peking Union Medical College Hospital have rupture. Data indicate that the incidence of tumor rupture during pregnancy is as high as 15.8%, but only 1.3% during pregnancy. Caused by trauma, torsion, infection or gangrene, sebaceous substance (including neutral fat, fatty acids, etc.), squamous cell debris, etc., can stimulate peritoneal thickening to form chronic granulomatosis or with scattered calcium salt In addition, there are cases of tumor-breaking hollow organs such as the bladder, intestines, etc., and frequent urination, dysuria, hematuria, and even discharge of sebum substances in the urine, hair, bone fragments, etc., or the anus discharges the above substances, so Get a diagnosis.

3. Infection

Caused by blood or lymphatic sources, may be caused by pelvic inflammatory disease, intestinal adhesions, postpartum and appendix abscess, or due to tumor puncture, torsion, rupture, etc., the pathogens of infection are mostly streptococcus, staphylococcus, Escherichia coli , Mycobacterium tuberculosis or aerogens.

4. Hemolytic anemia

Mature teratoma can be associated with the occurrence of hemolytic anemia, but it is very rare. Most of the patients have large spleen and positive Comb test. These patients have no effect on taking adrenal cortical hormone or splenectomy, or only have short-term effects, but have ovarian tumors. After that, it can be cured. The reason for this self-hemolytic anemia is as follows:

1 Hemolysis is caused by the action of antibodies stimulated by tumor antigens and red blood cells.

2 Because a substance produced by a tumor is coated on red blood cells, its antigenicity or resistance to hemolysis is changed.

5. Can be combined with other germ cell tumors.

Ovarian mature teratoma symptoms common symptoms abdominal distension abdominal pain urinary endometriosis abortion cyst

First, the age of good hair

It can occur at any age, and most of them occur in women of childbearing age around 30 years old.

Children and adolescents most often occur after the age of 5, and the cases are concentrated in the 6-11 age group. Teratomas often occur in the Shanwei area.

Second, the symptoms

Most of the tumors were unilateral, and the incidence rates on the left and right sides were similar and benign.

There are no complications such as torsion or infection, and there are often no special symptoms.

Large tumor volume causes abdominal distension, mild abdominal pain and compression symptoms.

Combined pregnancy: is the most common type of pregnancy with ovarian tumors.

Very few of the ovarian stroma of the tumor have luteinization changes, and there are many signs of hair.

Third, classification:

1, cystic

2, solid

3, single germ layer

Ovarian mature teratoma examination

1, general inspection

Mostly unilateral, the incidence of left and right sides is similar, but most are 5 ~ 15cm.

The mass is round, oval or lobulated, with a smooth surface and intact capsule.

The cut surface is mostly a large sac containing hair and sebum.

The inner wall of the capsule often shows solid nodules or solid nodules. The head nodules have hair and teeth on the surface, and bone, cartilage and adipose tissue can be seen on the cut surface.

2. Inspection under the microscope:

Often accompanied by foreign body giant cell response.

The outer wall of the capsule is interstitial to the ovary, and the inner wall is lined with skin, hair and skin attachments.

A variety of tissues of three germ layers are often seen in the head nodules.

3, ultrasound diagnosis

(1) Intracapsular dough sign:

Reflective strong light clusters in the capsule, mostly round, can be adhered to the inner wall. There is no echo behind the light group.

(2) Type capsule:

Mostly round or elliptical, the wall of the capsule is thicker, mostly single room, with dense and reflective light spots.

Sometimes a thin layer of liquid is visible on the inner wall.

(3) Intracapsular group sign:

A circular light cluster is visible in the capsule, and the upper part of the capsule has a strong echo of the crescent shape, and the rear side is attenuated with obvious sound and shadow.

(4) stratification of lipid in the capsule:

Upper lipids: strong reflection, dense spot echo.

Lower layer: clear liquid, or a small amount of light floating in the liquid.

Between the two layers: a layered plane of fat.

(5) Complex type:

The structure inside the capsule is complicated and may have two or more of the above types.

4, X-ray diagnosis

There are oily substances, teeth and bone fragments in the tumor: bone fragments and tooth shadows, and calcification of the capsule contents.

There are sebum substances and hair in the tumor: circular or oval shadows with reduced transparency or sharp outlines.

Precautions:

Laxatives or bowel washing should be performed before taking the film to avoid confusion with the gas in the intestinal fistula.

It should be differentiated from lesions with increased X-ray density in the pelvis.

5, other

Tumor marker examination, laparoscopy.

Diagnosis and differentiation of mature ovarian teratoma

diagnosis

Diagnosis of mature ovarian teratoma should be based on clinical manifestations, symptoms and laboratory tests.

Differential diagnosis

Ovarian immature teratoma should be differentiated from immature teratoma, ovarian monolayer-specific tumors such as ovarian goiter, ovarian carcinoid, and neuroectodermal tumors.

1. Immature teratoma

A good group of people: more common in young patients, the average age is 19-24 years old.

Symptoms: Asymptomatic, abdominal mass growth is fast, followed by abdominal distension and abdominal pain. Ascites is prone to occur.

2, ovarian carcinoid

A good group of people: postmenopausal women, often occur in the age of 60.

symptom:

There is a lump in the pelvic cavity.

Or carcinoid syndrome may occur: facial flushing, peripheral vascular dysfunction, diarrhea, abdominal pain, subcutaneous edema, right heart failure, bronchospasm, etc.

3, ovarian goiter

A good crowd: 30-50 years old.

symptom

Asymptomatic or only a bump in the abdomen.

When the mass is large, local compression occurs, and ascites and pleural effusion may occur.

There may be hyperthyroidism.

4. Identification of neuroectodermal tumors.

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