Teratoma

　　During the process of somatic and embryonic development, there are pluripotent cells with the potential for multipotent development. Under normal embryonic development, they develop and differentiate into mature cells of each germ layer. If, at different stages of the embryo, some pluripotent cells are separated or shed from the whole, causing mutations in cell genes and abnormal differentiation, embryonic abnormalities may occur. It is generally believed that such separation or shedding occurs in the early stage of the embryo, resulting in teratoma; while if it occurs in the late stage of the embryo, it forms abnormal differentiated tissues with three germ layers, namely the ectoderm, mesoderm, and endoderm, forming teratoma.

　　The pathological characteristics of teratoma are that the tumor tissue is composed of three germ layers: ectoderm, mesoderm, and endoderm. It often contains mature or immature tissues such as skin, teeth, bone, cartilage, nerve, muscle, fat, and epithelium. A few can also contain tissue components such as gastric mucosa, pancreas, liver, kidney, lung, thyroid, and thymus. Malignant teratoma often manifests as immature, indeterminate, and indistinguishable tissue. The malignancy of teratoma is often characterized by abnormal proliferation of neural or epithelial tissues, forming malignant teratoma.

　　Having a teratoma in women is like carrying a time bomb that can explode at any time. While ovarian mature teratomas are benign tumors, they can still develop complications such as torsion and infection, and a few cases have the potential for malignancy. Therefore, experts remind: Once a teratoma is diagnosed, it is necessary to strive for early surgical resection to avoid the malignancy of benign teratomas due to delayed surgery. What are the complications of ovarian teratomas? Experts introduce the following:

　　1. Torsion: Due to the tumor often having a pedicle and high density, with a certain weight and uneven density within the same tumor, it is prone to torsion. The trigger factors are often changes in abdominal pressure caused by factors such as pregnancy, intestinal peristalsis, bladder filling or emptying, coughing, vomiting, or unexpected violence, with a torsion incidence of 9% to 17%. After torsion occurs, typical symptoms such as acute abdominal pain, nausea, and vomiting often appear.

　　2. Rupture of teratomas is less common. Data shows that the incidence of tumor rupture during pregnancy is as high as 15.8%, while it is only 1.3% during non-pregnancy. The occurrence of rupture is often due to tumor trauma, torsion, infection, or gangrene. The extrusion of sebaceous substances (containing neutral fats, fatty acids, etc.) and squamous cell fragments can stimulate the thickening of the peritoneum, forming chronic granulomas or accompanied by scattered calcium deposits.

　　3. Infection: It is usually caused by blood or lymphatic sources and can be triggered by pelvic inflammation, intestinal adhesions, postpartum and appendiceal abscesses, or due to tumor puncture, torsion, and rupture. The causative bacteria are usually Streptococcus, Staphylococcus, Escherichia coli, tuberculosis bacteria, or gas-forming bacteria.

　　4. Hemolytic anemia: The occurrence of hemolytic anemia can be associated with mature teratomas, but it is very rare. Most patients have splenomegaly and a positive Comb test. Such patients have no effect from the administration of adrenal cortical hormones or splenectomy, or only have a temporary effect. However, after the removal of the ovarian tumor, they can be cured.

　　5. Can be associated with other germ cell tumors.

　　Teratomas, due to their varying locations, often have multiple complications and a significant trend towards malignancy, and therefore can present with various symptoms and manifestations in clinical practice:

　　①Asymptomatic mass: This is the most common symptom of teratomas, which are mostly circular, cystic, with clear boundaries, and uneven texture, and can even feel bony nodules. Externally growing tumors are commonly found in the midline areas such as the sacral tail, occiput, forehead, and nose. Sacral teratomas can often be divided into three clinical types according to their location: obvious, hidden, and mixed types. ②Symptoms of compression and obstruction of passages: Mediastinal teratomas can compress the respiratory tract, causing coughing, dyspnea, and jugular vein distension; retroperitoneal teratomas often cause abdominal pain and can lead to intestinal obstruction. Hidden teratomas in the pelvis and sacral tail region are often presented due to constipation, difficulty defecating, and urinary retention.

　　③Abnormal acute symptoms of tumors: Ovarian and testicular teratomas can undergo torsion and necrosis of the ovary or testis, presenting with severe pain and corresponding local symptoms; when secondary infection and intracystic hemorrhage occur in teratomas, they often rapidly increase in size, with marked local tenderness, and are accompanied by systemic symptoms such as fever, anemia, and shock; tumors in retroperitoneal, ovarian, pelvic, and sacral tail regions can also suddenly rupture, leading to massive hemorrhage, peritoneal effusion, and shock.

　　④ Symptoms of tumor malignancy: When malignant teratomas and benign teratomas undergo malignancy, they often show rapid growth, loss of original elasticity, and superficial venous engorgement, congestion, local skin infiltration, and an increase in skin temperature. They can metastasize through lymphatic and hematogenous routes, resulting in lymph node enlargement and symptoms of lung and bone metastasis. At the same time, systemic symptoms such as weight loss, anemia, and tumor fever may appear.

　　Ovarian teratoma is a common ovarian germ cell tumor. It is prevalent in women of childbearing age. It accounts for about 15% of the total number of primary ovarian tumors, of which 95%-98% are benign mature teratomas, and only 2%-5% are malignant teratomas. Mature cystic teratomas mostly occur in women around the age of 30. The clinical symptoms are non-specific, mainly manifested as pelvic masses, 25% of patients are found accidentally, and 10% of patients may have acute abdominal pain due to tumor rupture, torsion, or hemorrhage.

　　In general, the prevention of ovarian teratoma mainly includes the following aspects. Regular physical examinations should be conducted to achieve early detection and early treatment, and follow-up work should also be done after treatment. Generally, the prevention of mature ovarian teratoma is relatively good, with normal menstruation and normal fertility. If it is an immature ovarian teratoma, the prognosis is not very ideal, as there is a high probability of malignancy and the risk of recurrence. Women should regularly participate in gynecological examinations. Now, some units only organize married women to participate in gynecological examinations, but in fact, all women of childbearing age should participate in gynecological examinations, especially B-ultrasound examinations, to suppress the tumor at its infancy or early stage.

　　Mothers should often feel their children's abdomen, and adolescents, women, and middle-aged and elderly women should also often touch their abdomen to see if there are any lumps. After discovering a lump, regardless of its size or whether it is painful, it should be treated promptly. The better method of touching is: in the morning, after emptying the bladder, lying flat, slightly bending the legs, touching from one side of the lower abdomen to the other, if a hard foreign body is found, it can be suspected as a tumor.

　　The prognosis of teratoma is closely related to factors such as the age at initial diagnosis, tumor location, incidence of malignancy, and treatment outcomes. The younger the age at initial diagnosis, the lower the incidence of malignancy, with the latent teratoma having the highest malignancy rate of 71.4%; the mixed type is 46.7%, and the overt type is only 9.4%.

　　The common examinations for teratoma include:

　　1. Physical examination or gynecological examination with pelvic ultrasound. The best way to detect teratoma is through ultrasonic examination.

　　2. Acute abdominal pain may occur. Ovarian teratoma can lead to ovarian torsion and necrosis, manifested as severe pain and corresponding local symptoms; if the teratoma develops secondary infection and intracystic hemorrhage, it can often rapidly increase in size, with local significant tenderness, and is accompanied by symptoms such as fever, anemia, and shock.

　　3. Abnormal menstrual periods. Teratoma may cause abnormal menstrual periods, such as irregular cycles, excessive or insufficient amounts.

　　4. Found during cesarean section. Some overweight people or pregnant women may not find teratoma during ultrasound. Therefore, some women may find teratoma in the abdominal cavity during cesarean section, and the doctor will remove the teratoma at the same time.

　　5. Long-term infertility is found. Some women have been infertile for many years after marriage and only know it is a teratoma after going to the hospital for a check-up.

　　6. Finding a bulge by yourself. Some people's teratoma has grown very large, with a large belly, young women think they are 'accidentally pregnant', and older women think they have gained weight. Once they go to the hospital for a check-up, the disguised teratoma is exposed.

　　7. The X-ray manifestations of the spine have a wide range or obvious expansion of the vertebral canal, the pedicle of the lesion site is narrow, the distance between the pedicle roots is widened, the posterior margin of the vertebral body is concave, and in some cases, the manifestations of spinal bifida can be seen.

　　8. CT and magnetic resonance imaging have a significant advantage in the diagnosis of teratoma, both of which can better show the heterogeneity of the tumor. On magnetic resonance imaging, teratoma appears as mixed signal, often with a complete cyst wall, rich in fat signal, and may be accompanied by or without intratumoral enhancement nodules. Usually, in addition to finding the tumor, it is often accompanied by spinal bifida or vertebral malformation.

　　After the operation of ovarian teratoma, it is necessary to pay close attention to diet. The diet of patients with ovarian teratoma should be light and nutritious, with more lean meat, chicken, eggs, quail eggs, crucian carp, turtle, white fish, cabbage, asparagus, celery, spinach, cucumber, winter melon, mushrooms, tofu, kelp, seaweed, vegetables, fruits, and so on. Pay attention to eat less raw, cold, and hard food to avoid stimulating the intestines and causing indigestion. Under the guidance of a doctor, you can take some soup and medicinal diet according to your taste. It is not advisable to eat cold, cold, and spicy and stimulating foods. Do not eat mutton, shrimp, crab, eel, salted fish, black fish, and other stimulating foods. Avoid or eat less high-dose lactose and excessive animal fat. Do not have a one-sided diet and eat more foods rich in fiber, trace elements, and fiber, such as mushrooms, soybeans, fresh vegetables, winter mushrooms, and turtle, kelp, seaweed, oysters, and so on. Avoid eating chili, Sichuan peppercorns, green onions, garlic, white wine, and other刺激性 foods and drinks. It should be noted that dragon eyes, jujube, glue, royal jelly, and other hot, hemostatic, and hormone-containing foods should be avoided. The main treatment method for the operation is local, with strong limitations. After the operation for ovarian teratoma, it is still necessary to take natural anti-cancer active ingredients ginsenoside Rh2 (Houttuynia cordata) to enhance immunity and resistance, accelerate wound healing, anti-inflammatory analgesia, prevent infection, inhibit the growth and proliferation of cancer cells, reduce the side effects of treatment, and prevent complications. The patient can start with a small amount of liquid food, such as thin rice porridge, noodle soup, etc., 6 hours after the operation. Do not give the patient sweet milk, milk powder, and other sugary drinks to prevent bloating. Due to the stimulation of the intestinal tract and the anesthetic effect during the operation, the gastrointestinal function may be a bit disordered. Generally, it is forbidden to eat before the exhaust is released. After exhaust, you can eat semi-liquid food such as congee, noodles, rice porridge, and millet porridge. Return to normal diet after one week.

　　Once a teratoma is diagnosed, it is necessary to strive for early surgical resection to avoid the benign teratoma from becoming malignant due to delayed surgery, and at the same time, it can prevent the occurrence of tumor infection, rupture, hemorrhage, and complications. The surgical points of teratoma are to completely resect the tumor, and unilateral oophorectomy or orchiectomy is performed for ovarian and testicular tumors. For sacral teratomas, it is emphasized that the coccyx must be resected together to avoid residual pluripotent cells leading to tumor recurrence.

　　The treatment principle for malignant teratoma is combined adjuvant therapy. Conventional chemotherapy for 1.5 to 2 years is performed after surgical resection, commonly using cisplatin, vinblastine or vincristine, and bleomycin. In recent years, it is recommended to apply combined chemotherapy with chemotherapy drugs such as cisplatin, doxorubicin, and ifosfamide. Radiotherapy is only used for cases of malignant teratoma with definite microscopic or gross residual, with a radiotherapy dose of 25 Gy for microscopic residual, and up to 35 Gy for gross residual. For those with complete resection, it is advocated in recent years to focus on chemotherapy and use radiotherapy cautiously to avoid delayed damage to reproductive organs and skeletal development during radiotherapy.

　　For malignant teratoma that is large or extensively infiltrative and cannot be removed by clinical judgment, preoperative chemotherapy or radiotherapy can be applied to reduce the tumor size before delayed radical surgery, which is of positive significance for improving the resection rate of surgery and preserving important organs. For advanced cases, preoperative chemotherapy or radiotherapy can also achieve the therapeutic purpose of relieving tumor compression, controlling metastatic foci, and gaining a second surgical opportunity.