Teratomas are tumor-like entities that are relatively rare and still cause horror in many people today because of their strange appearance. Most of them are benign tumors.
What are teratomas?
Teratomas are congenital growths that contain one or more rudimentary tissue structure(s). They arise from the germ cells (stem cells) of the ovaries and testes and are usually localized there. However, they may also occur elsewhere (central nervous system, neck, coccyx, abdominal region, brain). Teratomas located in the testes are malignant, while those located in the ovaries are usually benign. Teratomas usually occur on one side only. They may arise from only one cotyledon (dermoid cysts) or from multiple cotyledons. Dermoid cysts contain only skin tissue, sebaceous and sweat glands, and hair follicles. If the tumors consist of the cells of several cotyledons, they still have teeth, muscle tissue and other structures. Such differentiated forms are also called mature teratomas. The immature ones, however (malignant teratomas), often contain only embryonic epithelial tissue. The majority of germ cell tumors arise from ectodermal and neuroectodermal tissue and develop skin, hair, sweat and sebaceous glands, and nerve tissue. Much less common are mesodermal forms involving bone, muscle, teeth, and entodermal teratomas. They are endowed with rudimentary thyroid, pancreatic and pituitary tissue. In very rare cases, the cysts even contain entire organs (hands, feet, eyes) or a structure resembling a malformed fetus (homunculus). Germ cell tumors are usually formed as cysts and have a cavity filled with yellow sebum or mucus. There are also solid teratomas. They are completely filled with tissue.
Causes
The cause of teratomas is probably that during the development of the embryo in the womb, embryonic stem cells become independent and settle elsewhere in the body. However, science assumes that carried-over germ cells can also become teratomas. This can happen, for example, during surgery or if the adult is injured: The tissue is accidentally pulled out with it and grows back in a different place, where it gradually expands. However, the term “twin tumor” by which the teratoma is sometimes named is misleading: a teratoma is not a vestigial twin formed in the body of its brother/sister, since it is made of embryonic stem cells and not gametes.
Symptoms, complaints, and signs
In most cases, symptoms do not appear and the teratoma is not discovered until adulthood. However, sometimes teratomas of considerable size are discovered in the bodies of infants. The type of symptoms depends on where the germ cell tumor is located and what size it has already developed. In the case of teratomas located in the abdomen, the affected person notices an increase in the circumference of the abdomen. If they are located further down, the lower abdomen bulges. There may be disturbances in urination and defecation. If the tumor presses on nerves or pushes organs aside due to its growing expansion, there is an increased feeling of pressure and pain. This may be the case, for example, due to a dermoid cyst. Malignant teratomas enlarge faster and even grow into neighboring organs. Then irregular menstrual cycles may also occur. Stalk twisting or capsule rupture cause extreme abdominal pain and can even be life-threatening if the contents of the tumor empty into the abdominal cavity, causing peritonitis. In rare cases, bleeding into the abdomen and detachment of the tumor may also occur. Teratomas located in the brain are associated with chronic headaches, dizziness, and symptoms typical of common brain tumors. If teratomas located in the ovary contain a high percentage of thyroid tissue, this can cause hyperthyroidism in the patient (struma ovarii). About one percent of germ cell tumors later become malignant.
Diagnosis and course of the disease
Teratomas of the abdomen are detected by palpation of the affected area. To be sure exactly what it is, an ultrasound and, if necessary, another X-ray examination are performed.If the teratoma contains calcareous substances such as teeth, the physician can already know at this stage of the examination which form of germ cell tumor is present. However, he only obtains complete certainty through a tissue biopsy, which is performed under local anesthesia. A tiny piece of tissue is removed from the affected area and examined histologically. Blood tests reveal a strong increase in the tumor markers bHCG, AFP and/or LDH. Most teratomas are not reliably diagnosed as such until they are already quite large and causing symptoms.
Complications
A teratoma can lead to a variety of symptoms. Above all, the exact position and size is very decisive for the complications and discomfort. Those affected primarily suffer from discomfort during bowel movements and urination. There may be a burning sensation or pain in general. Many sufferers experience psychological discomfort or depression. Women may also experience irregular menstrual periods due to the disease and thus mood swings. Sometimes abdominal pain occurs and the peritoneum itself can become inflamed. Furthermore, those affected by teratoma suffer from severe dizziness and a malfunction of the thyroid gland. This usually has a very negative effect on health and can possibly also reduce the patient’s life expectancy. In most cases, surgery is performed for a teratoma. The growth can be removed. Complications do not occur. However, some patients are dependent on chemotherapy, which can lead to side effects. After successful treatment, no further symptoms occur.
When should you see a doctor?
If swelling or general irregularities of body shape can be noticed in newborns and infants, the observations should be discussed with a doctor. In a teratoma, there are visual changes in the genital area. In males, swellings of the testicles appear, and in females, growths in the area of the ovaries. Therefore, if abnormalities are found in these body regions, consultation with a physician is necessary immediately. Since in most cases the first irregularities occur in adulthood, a doctor is needed as soon as the congenital disorder is noticed. Irregularities in toileting, abnormalities in urination or disturbances in bowel movements are signs of a health impairment. They should be investigated and treated. If young girls or women show disturbances of the menstrual cycle or unusually severe abdominal pain, a doctor is needed. If boys or men notice visual irregularities of their testicles, they should also see a doctor. Headaches, dizziness or unsteadiness of gait may also indicate a teratoma. If hoarseness, problems with swallowing or discomfort of the coccyx occur, a doctor should be consulted. Disturbances in concentration, loss of memory, and inconsistencies in coordination or general dysfunction should be examined by a physician as soon as possible.
Treatment and therapy
Treatment of teratoma depends on whether it is benign or malignant – which is determined by the tissue sample taken. If it is benign, it is sufficient if it is completely removed surgically. This is done by removing the ovary with the help of an abdominal endoscopy. In the case of a malignant teratoma, not only the tumor itself is removed, but also the affected neighboring tissue and the nearby lymph nodes. In men, the affected testis is removed. This is followed by cisplatin-based chemotherapeutic treatment. The prognosis is favorable in such cases. However, malignant teratomas occurring in some girls and young women usually respond negatively to chemotherapy or radiotherapy.
Prevention
Prevention is not possible because teratomas arise spontaneously.
Follow-up care
If the teratoma was removed surgically, it varies depending on the patient’s condition how long he or she must remain in the hospital afterwards. The extent of the germ cell tumor plays a crucial role. Other important factors include the position of the teratoma and the patient’s general health.If it is only a small teratoma, such as a dermoid in a woman’s ovary, outpatient removal is often sufficient so that the patient can then return home. In most cases, patients have to stay in the hospital for one to three days after the operation, which is usually performed as a laparoscopy. However, if a teratoma is present on a larger scale, this requires a more complex procedure such as an abdominal incision, which means that the duration of the hospital stay is longer. Thus, patients often stay in the hospital for up to a week. Babies or young children who have had a coccyx teratoma surgically removed also need to stay in the hospital for a few days, although the duration varies. In some cases, chemotherapy is given afterwards. Because a teratoma can recur despite successful treatment, which is usually the case after two to five years, regular follow-up care in the form of check-ups is recommended. These include a computed tomography or chest X-ray examination to detect any recurrence at an early stage and treat it accordingly.
Here’s what you can do yourself
Benign teratomas are removed surgically. After surgery, the usual measures apply. Recovery can be aided by providing adequate care and attention to the wound. If symptoms that indicate a recurrence occur again, the physician must be informed. Further treatment may be necessary. Teratoma patients should consult closely with their primary care physician, as a teratoma can cause hormonal complaints. Sweating and psychological complaints indicate an effect on hormonal balance and must be treated appropriately to avoid serious discomfort and complications. Exercise and the avoidance of stress also contribute to recovery. Especially after major operations, which are also a strain on the soul, a balance must be created. Those affected should also turn to a self-help group. Friends and acquaintances provide additional support in the event of cancer. In the case of malignant teratomas, the body is heavily burdened by chemotherapy and appropriate countermeasures are necessary. Sports and a diet plan are important components of the accompanying treatment. The doctor will consult other physicians for this purpose and urge the patient to strictly adhere to the measures.