Fertility sparing approach as the standard of care in young patients with immature teratomas

Abstract

Immature teratomas are quite rare tumors arising in young women. They are usually diagnosed in early stage and grade and have a good prognosis. In these young patients, fertility-sparing management is suggested as the standard of care. Bilateral immature teratoma is a rare condition with an incidence of 10%, with a five-year survival rate of 80%. The majority of patients received fertility-sparing treatment followed by adjuvant chemotherapy in 78%. Older age, advanced stage, and high grade are negative prognostic factors. The surgery-only, watch-and-wait approach was evaluated; however, after a median follow-up time of 42 months, 50% of patients experienced recurrence, but they were successfully salvaged with chemotherapy. In a retrospective study, 12 out of 27 patients tried to conceive, resulting in 10 pregnancies (8 after chemotherapy). We present a narrative review of the current literature regarding the essential multidisciplinary approach of such patients in order to achieve the best oncologic and fertility-sparing outcome.

Recurrent ovarian immature teratoma in a 12-year-old girl: Implications for management

“…From a surgical perspective, patients presenting with an ovarian mass undergo a pre-operative assessment with imaging (typically USS and MRI) and serum tumor marker estimation [19,20]. There has been a gradual move by pediatric surgeons to adopt fertility preserving approaches where possible [19][20][21], i.e. electing to perform an ovarian cystectomy rather than oophorectomy where pre-operative imaging and tumor markers suggest a likely non-malignant diagnosis.…”

“…For low-grade IT where oophorectomy is required, removing only the affected ovary and fallopian tube (and hence preserving the contralateral ovary, tube and uterus and thereby fertility), is sufficient and does not increase chances of recurrence [21,22]. The rationale for removing the tube with the affected ovary is that this reduces subsequent ectopic tubal pregnancy risk.…”

“…Given that IT generally presents in young women, maintenance of fertility where possible is important in this patient group. Fortunately, studies have shown that where fertilitysparing surgery is used, reproductive outcomes are favorable in that up to 80% of patients attempting to conceive become pregnant [21,[23][24][25].…”

Current management of gynecologic cancer in pregnancy

“…Of these, 33% are non-neoplastic (luteal cysts), 63% are benign (dermoid cyst 36%, serous cystadenoma 17%, mucinous cystadenoma 8%), 3% are malignant-low malignant potential and adenocarcinoma, and stromal or sex cord tumors comprise 1% ( 64 ). Germ cell tumors are more frequent in younger patients ( 65 ). However, the incidence of epithelial ovarian cancer is increasing as maternal age is also on the rise.…”

Immature Teratoma With Metastatic Gliosis

“…The grading system depends on the proportion of mature and immature neuroepithelial tissues, mitotic activity, and degree of differentiation. Per Iavazzo et al, grade 0 tumors contain solely mature tissue, whereas tumors of grades 1, 2, and 3 are mitotically active and possess limited, moderate, and large amounts of neuroepithelial tissue, respectively [2]. Following laparoscopic surgery, the pathological diagnosis of the excised tumor determines whether an ovarian tumor is mature or immature.…”