Cystic Teratoma Treatment & Management

  • Author: Chad A Hamilton, MD; Chief Editor: Jules E Harris, MD   more...
 
Updated: Jun 5, 2014
 

Surgical Care

The treatment of mature teratomas is largely surgical.

  • Sacrococcygeal teratomas diagnosed prenatally should be monitored closely.
    • In high-risk (large, solid, vascular) sacrococcygeal teratoma, in utero surgery may be an option in carefully selected cases. In the presence of developing hydrops, other minimally invasive antenatal procedures such as fetoscopic laser ablation, radiofrequency ablation, interstitial laser ablation, or vascular coiling may be options to interrupt the vascular flow to the tumor. In selected high-risk fetuses, early delivery and ex utero surgery may be an option.[48, 49]
    • In fetuses with larger tumors, cesarean delivery should be considered to prevent dystocia or tumor rupture. Because of the poor prognosis associated with development of hydrops prior to 30 weeks' gestation, these fetuses may benefit from in utero surgery. In most cases, sacrococcygeal teratomas should be resected electively in the first week of life, since long delays may be associated with a higher rate of malignancy.[50]
    • Complete excision should be done through a chevron-shaped buttock incision, with careful attention to the preservation of the muscles of the rectal sphincter. The coccyx always should be resected with the tumor, as failure to do so results in a 35-40% recurrence rate. Hemorrhage from the middle sacral vessels and hypogastric arteries is the most common complication.[4]
  • Mature cystic teratomas of the ovaries may be removed by simple cystectomy rather than salpingo-oophorectomy. See the image below. A 12-cm mature cystic teratoma of the ovary prior A 12-cm mature cystic teratoma of the ovary prior to excision.
    • Although malignant degeneration is quite rare, the cyst should be removed in its entirety, and if immature elements are found, the patient should undergo a standard staging procedure.
    • The patient should be counseled appropriately about the risks and benefits of laparoscopy and laparotomy. Ample literature supports laparoscopy as an acceptable alternative approach in resection. Benefits include reductions in postoperative pain, blood loss, hospital stay, and total cost. Risks include prolonged operative time, increased operating room costs, and potential need for a prompt second staging procedure if an unexpected malignancy is revealed. Some studies have found an increased intraoperative spillage rate with laparoscopy, while others have not. Spillage is associated with increased risk of chemical peritonitis (estimated incidence of 0.2%) and increased risk of adhesion formation. The risks of recurrence (4%), as well as malignant degeneration (0.2-2%), should be discussed.[51, 52, 53, 54, 55]
  • Testicular teratomas traditionally have been treated by simple or radical orchiectomy. More recently, conservative excision by enucleation also has been recommended for prepubertal teratomas of the testis.[26, 56]
    • Several studies have failed to demonstrate negative sequelae for prepubertal testicular teratomas and testis-sparing procedures are appropriate.[57, 58] Patients should be counseled regarding the risks of inadequate sampling, incorrect diagnosis by frozen section, tumor spillage and seeding, and unidentified microinvasive disease.[33, 27]
    • The risk of malignancy increases with maturation of the testes, and this is a significant concern in children at or near puberty. In this group, areas of normal surrounding testicular tissue should be excised and sent for frozen section. If frozen section reveals areas of maturity, proceeding to orchiectomy is recommended. Enucleation or partial orchiectomy for teratoma in pubertal or adult males is not recommended.[27]
  • Mature teratomas of the mediastinum should be completely surgically resected. The tumor may be adherent to surrounding structures, necessitating resection of the pericardium, pleura, or lung. When complete resection is achieved, it results in excellent long-term cure rates with little chance of recurrence. When complete resection is impossible, partial resection often leads to symptom relief, frequently without relapse.[44, 38]
Proceed to Follow-up
 
 
Contributor Information and Disclosures
Author

Chad A Hamilton, MD  Chief, Gynecologic Oncology Service, Walter Reed National Military Medical Center; Program Director, NCC Fellowship in Gynecologic Oncology

Chad A Hamilton, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Obstetricians and Gynecologists, and Society of Gynecologist Oncologists

Disclosure: Nothing to disclose.

Coauthor(s)

Margarett C Ellison, MD  Consulting Staff, Kaiser Permanente, Los Angeles Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Lodovico Balducci, MD  Professor of Oncology and Medicine, University of South Florida College of Medicine; Division Chief, Senior Adult Oncology Program, H Lee Moffitt Cancer Center and Research Institute

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Benjamin Movsas, MD  Vice-Chairman, Department of Radiation Oncology, Fox Chase Cancer Center

Benjamin Movsas, MD is a member of the following medical societies: American College of Radiology, American Radium Society, and American Society for Therapeutic Radiology and Oncology

Disclosure: Nothing to disclose.

Rajalaxmi McKenna, MD, FACP  Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems

Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis

Disclosure: Nothing to disclose.

Chief Editor

Jules E Harris, MD  Clinical Professor of Medicine, Section of Hematology/Oncology, University of Arizona College of Medicine, Arizona Cancer Center

Jules E Harris, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Association of Immunologists, American Society of Hematology, and Central Society for Clinical Research

Disclosure: Nothing to disclose.

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Mature cystic teratoma of the ovary exhibiting multiple tissue types.
Mature cystic teratoma of the ovary with hair, sebaceous material, and thyroid tissue.
Large teratomatous epignathus diagnosed by prenatal ultrasound.
A 12-cm mature cystic teratoma of the ovary prior to excision.
 
 
 
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