Ovarian teratoma

　　1,Etiology

　　The majority of mature teratomas present with a normal 46,XX karyotype, while in a very few cases, the karyotype of the teratoma may be trisomy or triploid.

　　Monoploid generation theory

　　The monoploid generation caused by stimulated atypical division of primordial germ cells is the most common etiological theory for immature teratomas.

　　Pluripotent cell theory

　　Early studies believed that teratomas originated from primitive abnormal tissues in the early stages of embryogenesis, possessing the instinct for self-differentiation. These residual 'pluripotent cells' undergo dysregulated growth and abnormal embryonic development, thereby detaching from the whole and undergoing disordered differentiation, hyperplasia, and ultimately forming a teratoma.

　　Secondly,Pathogenesis

　　The mechanisms involved may include the following five possibilities:

　　1, Type I: Failure of the first meiotic division of the oocyte or fusion of the first polar body with the ovum

　　Manifestation:

　　The centromere markers of the tumor tissue and host cell chromosomes are all heterozygous.

　　Isocitrate dehydrogenase (IDH) sites at the chromosome ends: depending on whether the centromere and terminal markers of the chromosome undergo exchange during meiosis and the frequency of such exchanges.

　　2, Type II: Failure of the second meiotic division or fusion of the second polar body with the ovum

　　Manifestation:

　　The centromere markers of the teratoma chromosomes are all homozygous.

　　Chromosome terminal markers: depending on whether there is crossing over during meiosis

　　3, Type III: the gene nucleus of the mature oocyte is self-replicated internally

　　The centromere and terminal markers of the chromosomes are all expressed as homozygous.

　　4, Type IV: the first and second meiotic divisions of the primordial germ cells both fail

　　No meiosis occurs, but mitosis occurs

　　The centromere and terminal markers of the chromosomes are consistent with the host, showing heterozygosity.

　　5, Type V: caused by the fusion of two eggs

　　The centromere and terminal markers of the teratoma chromosomes can be heterozygous or homozygous.

1、Tumor rupture: About 3% of ovarian tumors may rupture, with ovarian tumor pedicle torsion, rupture can be traumatic or spontaneous. Traumatic rupture often occurs due to abdominal blows, delivery, sexual intercourse, gynecological examination, and puncture, while spontaneous rupture often occurs due to rapid growth of the tumor, mostly due to invasive growth of the tumor piercing the capsule wall. The severity of symptoms depends on the size of the rupture, the nature and quantity of the fluid in the abdominal cavity, and the quality of the cyst. In cases of small cysts or simple serous cystadenoma rupture, the patient may only feel mild abdominal pain, while in cases of large cysts or mature teratoma rupture, it often causes severe abdominal pain, nausea and vomiting, and sometimes leads to internal bleeding, peritonitis, and shock.
2、Infection: Less common, often caused by tumor torsion or rupture, or can come from nearby organ infection foci such as appendiceal abscess spread. Clinical manifestations include fever, abdominal pain, mass, abdominal tenderness, muscle tension, and increased white blood cells. Treatment should first use antibiotics, followed by surgical removal of the tumor. If infection cannot be controlled within a short period of time, immediate surgery should be performed.
3、Pedicle torsion: Common, one of the gynecological acute abdomen. About 10% of ovarian tumors have complications such as torsion of the pedicle. It is more common in large, medium-sized, highly mobile, and unbalanced central mass cystic tumors, often occurring during sudden changes in posture, early pregnancy, or postpartum. The pedicle of the ovarian tumor is composed of the infundibulopelvic ligament, the ovarian proper ligament, and the fallopian tube. After acute torsion, venous return is obstructed, leading to severe congestion within the tumor or vascular rupture, causing the tumor to急剧增大, internal bleeding, and finally, arterial blood flow is obstructed, resulting in tumor necrosis and turning purple-black, making it prone to rupture and secondary infection.
4、Malignant transformation: Malignant transformation of ovarian benign tumors often occurs in older individuals, especially postmenopausal women, with rapid growth of the tumor in a short period of time, the patient feeling abdominal distension, loss of appetite, and significant increase in tumor volume on examination, with ascites. In cases suspected of malignant transformation, timely treatment should be sought.

　　Ovarian teratoma, due to its varying locations, often has various complications and a significant trend of malignant transformation, so there can be various symptoms and manifestations in clinical practice:

　　Symptoms of tumor malignant transformation

　　Malignant teratoma and benign teratoma with malignant transformation often show rapid growth of the tumor, loss of original elasticity, superficial varicose veins visible on the exophytic tumor, congestion, local skin infiltration, and increased skin temperature. Lymphatic and hematogenous metastasis can occur with lymph node enlargement and symptoms of lung and bone metastasis, accompanied by systemic symptoms such as weight loss, anemia, and tumor fever every day.

　　Acute symptoms

　　Ovarian and testicular teratomas can cause torsion, necrosis of the ovary or testis, and manifest as severe pain and corresponding local symptoms.

　　Ovarian teratoma that has been surgically removed; when teratoma develops secondary infection and intracystic hemorrhage, it often causes the mass to rapidly increase, with local marked tenderness, and is accompanied by systemic infection or hemorrhagic symptoms such as fever, anemia, and shock; tumors in retroperitoneal, ovarian, pelvic, and sacral tail regions can also suddenly rupture, causing massive hemorrhage, peritoneal hemorrhage, and shock.

　　Symptoms of compression and cavity obstruction

　　Mediastinal teratoma can often compress the respiratory tract, causing coughing, difficulty breathing, and jugular vein distension; retroperitoneal teratoma often causes abdominal pain and can lead to intestinal obstruction. Hidden teratomas in the pelvic and sacral tail regions often lead to medical consultation due to constipation, difficulty defecating, and urinary retention.

　　Painless mass

　　This is the most common symptom of teratoma, mostly round cystic, with clear boundaries, uneven texture, and even palpable bony nodules. Externally growing tumors are common in the midline areas such as the sacral tail, occiput, forehead, and nose. Sacral teratoma can often be divided into three medical clinical types according to its location: apparent, hidden, and mixed types.

　　The whole process of ovarian maintenance is roughly as follows:

　　Firstly, deep cleaning, moisturizing the abdominal skin, laying the foundation for nutrient absorption.

　　Secondly, apply rose essential oil to the abdomen and perform local massage to accelerate local blood circulation and stimulate ovarian function.

　　Again, wrap with plastic film to help tighten the skin and make the essential oil components more easily absorbed.

　　Finally, wipe clean, apply firming and elastic essential oil and massage to promote local blood circulation.

　　Ovarian maintenance care is once a week, with a course of 10 to 12 times. Almost all beauty salons claim that by using the above method, essential oils can penetrate into the ovaries, helping to treat gynecological diseases such as menstrual irregularity, dysmenorrhea, and delaying early ovarian failure.

　　The reason is that 'ovarian maintenance' involves placing medicine on the abdomen and gently massaging it, allowing the medicine to渗透 into the ovaries through the subcutaneous capillaries. By using this method to maintain the ovaries, it can delay the early aging of ovarian function, adjust the menstrual cycle, enhance 'sex interest', improve sleep quality, and also remove female facial freckles and acne, making the skin delicate and looking younger.

　　The common examinations are mainly MR, CT, or imaging ultrasound.

　　MR manifestation

　　(1) The signal intensity of the liquid fat part within the tumor shows short T1 and long T2 signals, which is the main basis for diagnosing teratoma.

　　(2) The internal structure of the tumor mainly includes debris and wall protuberances, with the composition of wall protuberances being lipid tissue, hair, teeth, and bones. Debris is often located in the lower layer of the cystic part, while liquid fat is located in the upper layer, producing stratified signals. The signal intensity of debris and wall protuberances is generally moderate. Lipids show very high signal intensity on T2-weighted imaging, hair has lower signal intensity than muscle tissue, and bones and teeth have no signal.

　　(3) Due to the chemical shift artifact caused by fat, it can appear both within the tumor and around the tumor, which can be distinguished from hemorrhagic lesions.

　　CT manifestation

　　(1) The typical CT sign is a cystic mass with inhomogeneous density, unilateral or bilateral.

　　(2) The thickness of the cyst wall is uneven, and the edge is smooth.

　　(3) It contains fat density shadow and underdeveloped bones and teeth, and may also show solid nodular shadows protruding from the cyst wall. If fat and liquid are present in the cyst at the same time, a liquid-fat interface can be seen, which can change position with body position.

　　(4) If it is a dermoid cyst, CT only shows a cystic space occupying lesion containing liquid, but the cyst wall may have eggshell-like calcification.

　　(5) Malignant teratoma invades adjacent tissues, showing the disappearance of the fat layer between the tumor and surrounding organs; if the tumor invades the bladder, pelvic muscles, or intestinal tract, the boundary between them is unclear.

　　Ultrasound manifestation

　　(1) Mature teratoma has clear boundaries, complete and smooth capsule and contour.

　　(2) The oily substance in the tumor presents as homogeneous, dense, fine light spots, partially or completely filling the cavity.

　　(3) When oil and粘, pulp are in the same cavity, a level of echo enhancement can be seen, called the liquid-oil interface.

　　(4) When hair is present, spherical or hemispherical light spots can be seen with shadowing or attenuation. The floating movement of the hair light spots in the liquid.

　　(5) Bone, teeth, and cartilage present as strip-like strong echoes with shadowing or attenuation.

　　(6) The solid part presents an inhomogeneous solid mass with diffuse distribution of moderate or strong echo. Plain film manifestation: Often found with specific ossification and calcification, or teeth. Shell-like calcification may appear on the tumor wall. Low-density translucent shadows may appear in the tumor interior.

　　Most cases of teratoma are caused by various types of external genital atrophy, external genital heat, chronic irritation and itching, certain nutritional deficiencies, allergic reactions, metabolic disorders, and nervous and mental factors, which may be the cause of the disease. Therefore, this disease is also known as leukoplakia of the vulva and vulvar atrophy.

　　Food to eatIt is recommended to eat more foods that have the effect of anti-external genital tumor and leukoplakia, such as sesame, almonds, wheat, barley, loofah, black-bone chicken, cuttlefish, blacksnake, pork pancreas, chrysanthemum, black plum, peach, lychee, horse-tail weed, chicken blood, eel, abalone, crab, sea cucumber, sardine, clam, and tortoise shell. For pain, eat cuttlefish, red, lobster, clam, sea cucumber, tiger fish, beetroot, mung bean, radish, and chicken blood. For itching, eat amaranth, cabbage, mustard, taro, kelp, nori, chicken blood, snake meat, and pangolin. To enhance physical fitness and prevent metastasis, eat silver ear, black fungus, mushrooms, monkey head fungus, gizzard, sea cucumber, Job's tears, walnut, crab, lizard, needlefish, etc.

　　TaboosAvoid smoking, alcohol, and spicy刺激性食物. Avoid greasy, fried, moldy, and preserved foods. Avoid chicken, geese, and other 'arousing' foods. Avoid seafood and刺激性, allergenic foods when itching is severe. Avoid warm foods such as lamb, chives, ginger, pepper, cassia, etc. when there are ulcers or bleeding.

　　Once an ovarian teratoma is diagnosed, it is necessary to strive for early detection and surgical resection to avoid the malignant transformation of benign teratoma due to delay in scientific research and surgery, and at the same time, it can prevent the occurrence of tumor infection, rupture, hemorrhage, and complications. The key points of the surgery for teratoma are to completely resect the tumor, to perform unilateral oophorectomy or orchiectomy for ovarian or testicular tumors, and to emphasize that the coccyx must be resected together with the sacral teratoma to avoid residual pluripotent cells leading to tumor recurrence.

      The treatment principle for malignant ovarian teratoma is combined adjuvant therapy. After surgical resection, conventional chemotherapy for 1.5 to 2 years is commonly used, including cisplatin, vinblastine or vinorelbine, and bleomycin. Since 2006, it has been recommended to use a combination of chemotherapy drugs such as cisplatin, doxorubicin, and ifosfamide for combined chemotherapy. Radiotherapy is only used for cases with microscopic or macroscopic residual malignant teratoma. The dose of radiotherapy for microscopic residual is recommended to be 25 Gy, and for macroscopic residual, it can be up to 35 Gy. For those who have been completely resected by surgery, 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 giant or extensively infiltrative malignant teratoma that cannot be resected clinically, preoperative chemotherapy or radiotherapy can be used to shrink the tumor before performing a delayed radical surgery, which is of positive significance for improving the resection rate and preserving important organs.

      For advanced cases, preoperative chemotherapy or radiotherapy can also achieve the therapeutic goal of alleviating tumor compression, controlling metastatic foci, and trying to perform surgery again. Ovarian teratoma is generally asymptomatic in clinical practice. When it grows larger, it can cause abdominal distension, mild abdominal pain, and compression symptoms. The contents of the teratoma are composed of various mature tissues from 2 to 3 germ layers, and the vast majority are ectodermal tissue.

      Therefore, the cyst can be seen to contain squamous epithelium, sebaceous glands, sweat glands, hair, and mature nerve tissue, as well as mesenchymal fatty cartilage and bone tissue. About half of the ovarian dermoid cysts contain teeth. Generally speaking, the prognosis of immature teratoma is poor, and surgery cannot guarantee a complete and clean elimination of it, with a risk of recurrence. On the other hand, the prognosis of benign teratoma is good, the possibility of benign teratoma becoming malignant is only 2% - 3%, it does not affect the ovarian function, menstrual periods are normal after surgery, the fertility rate is normal, and there is no problem of recurrence.