Characteristics, treatment and outcomes of women with immature ovarian teratoma, 1998–2012

Abstract

Objective To explore the presentation, management and outcomes of adult women diagnosed with immature ovarian teratoma. Methods The National Cancer Database (NCDB) was used to identify women ≥18 years of age diagnosed with an immature teratoma from 1998–2012. We analyzed demographic, clinical and tumor characteristics, and treatment trends. Multivariable models were employed to examine predictors of adjuvant chemotherapy use and survival. Results We identified a total of 1045 adult women with immature teratoma. The median age of diagnosis was 27 years and most were diagnosed between ages 18 and 39 (88.9%). The majority presented with early-stage (I/II) disease (76.0%), underwent unilateral salpingo-oophorectomy (52.5%) and received adjuvant chemotherapy (56.8%). The probability of receiving chemotherapy increased with stage, grade, and treatment at academic compared to community based centers (P<0.05.). Older age, advanced stage, and grade III histology were associated with worse survival (P<0.05). Five-year survival rates were: 98.3% (95% CI 96.8–99.1), 93.2% (95% CI 82.8–97.4), 82.7% (95% CI 74.3–88.5), and 72.0% (95% CI,50.1–85.5) for stages I, II, III, and IV disease, respectively. Conclusions The incidence of immature teratoma is highest in young adults aged 18 to 39. Most patients present with early-stage disease, are managed with fertility sparing surgery and chemotherapy and have an excellent prognosis. Later age at diagnosis, advanced stage, and high-grade histology confer a worse prognosis.

Multiregion exome sequencing of ovarian immature teratomas reveals 2N near-diploid genomes, paucity of somatic mutations, and extensive allelic imbalances shared across mature, immature, and disseminated components

“…Ovarian teratomas contain tissue elements from at least 2 of the 3 germ cell layers and frequently display a disorganized mixture of mature tissues including skin and hair (ectoderm), neural tissue (ectoderm), fat (mesoderm), muscle (mesoderm), cartilage (mesoderm), bone (mesoderm), respiratory epithelium (endoderm), and gastrointestinal epithelium (endoderm). Teratomas can occur in the mature form, composed exclusively of mature tissues, or the immature form, which contains variable amounts of immature elements (usually primitive neuroectodermal tissue consisting of primitive neural tubules) in a background of mature teratoma [5]. Not infrequently, malignant GCTs of the ovary contain a mixture of different histologic subtypes (e.g.…”

Fertility sparing approach as the standard of care in young patients with immature teratomas

“…The majority of the patients received fertility-sparing treatment followed by adjuvant chemotherapy in 78% ( 13 ). Jorge et al ( 14 ), in a recent multivariate analysis, showed that 90% of patients with immature teratoma were aged 18 to 39 years, three quarters of whom were early staged and could be treated conservatively combining fertility-sparing surgery and chemotherapy. Older age, advanced stage, and high grade are negative prognostic factors ( 14 ).…”

Ultrasound features of immature ovarian teratomas: Case series and review of literature

“…2,6,7 IOTs are graded 1-3 depending 1 on the amount of atypia of the immature tissue. 2,8 There is a paucity of literature to date regarding the ultrasound features of immature ovarian teratomas, so the aim of this study was to characterise IOTs using grey-scale and Doppler ultrasonography and review the literature to help to refine the diagnosis and increase awareness of these tumours.…”