Cystic Teratoma Clinical Presentation

Updated: Nov 22, 2019
  • Author: Chad A Hamilton, MD; Chief Editor: Yukio Sonoda, MD  more...
  • Print

History and Physical Examination

Sacrococcygeal teratoma 

Sacrococcygeal teratomas may be diagnosed antenatally during routine ultrasounds, fetal anomaly scans, or when the mother presents with clinical symptoms such as size greater than dates or polyhydramnios. [2]  Those not diagnosed antenatally present in 2 patterns. The most common pattern is in neonates, who present with a large, predominantly benign tumor protruding from the sacral area that is noted prenatally or at the time of delivery. Less commonly, the newborn may exhibit only asymmetry of the buttocks or present at 1 month to 4 years of age with a presacral tumor that may extend into the pelvis. Symptoms of bladder or bowel dysfunction may be present. The latter group is at a significantly higher risk for malignancy. [18]

Ovarian teratoma

Mature cystic teratomas of the ovary are often discovered as incidental findings on physical examination, during radiographic studies, or during abdominal surgery performed for other indications. Asymptomatic mature cystic teratomas of the ovaries have been reported at rates of 6-65% in various series. When symptoms are present, they may include abdominal pain, mass or swelling, and abnormal uterine bleeding. Bladder symptoms, gastrointestinal disturbances, and back pain are less frequent. When abdominal pain is present, it usually is constant and ranges from slight to moderate in intensity. Torsion and acute rupture commonly are associated with severe pain. Hormonal production is thought to account for cases of abnormal uterine bleeding, but histologic examination has not provided evidence to support this theory. [19, 4, 3, 36]  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.

Testicular teratomas

Testicular teratomas most often present as a painless scrotal mass, except in the case of torsion. In most cases, the masses are firm or hard, nontender, and do not transilluminate. Testicular pain and scrotal swelling are occasionally reported with teratomas, but this is nonspecific and simply indicates torsion until proven otherwise. Hydrocele is frequently associated with teratoma in childhood. On examination, the testis is diffusely enlarged, rather than nodular, although a discreet nodule in the upper or lower pole sometimes can be appreciated. [37, 38]

Mediastinal teratomas

Mediastinal teratomas are often asymptomatic. When symptoms are present, they relate to mechanical effects and include chest pain, cough, dyspnea, or symptoms related to recurrent pneumonitis. Many patients present with respiratory findings, and the pathognomonic finding of trichoptysis (cough productive of hair or sebaceous material) may result if a communication develops between the mass and the tracheobronchial tree. Other serious presentations are superior vena cava syndrome or lipoid pneumonia. Mediastinal teratomas are occasionally discovered incidentally on chest radiographsa. [39, 6, 16, 21]