Clinicopathological Characteristics of Mature Teratoma with Pregnancy

Introduction

Pregnancy is of great significance to patients and their families [1]. Pregnancy is associated with a lot of tumors, including benign and malignant tumors [2, 3, 4, 5, 6, 7]. Endometrial cancer, breast cancer, krukenberg tumor and other tumors are common [8, 9, 10]. During pregnancy, many tumors can occur, including teratoma and breast cancer [8, 11]. The treatment of abdominal and pelvic tumors during pregnancy is a problem that puzzles clinicians [4, 5, 11].

Teratoma is a common complication of pregnancy. Up to a quarter of ovarian masses originate from germ cells, and teratomas include mature and immature. The former is more common during pregnancy [11]. The clinical symptoms are not specific. The main manifestation is pelvic mass, and a quarter of patients are found by accident [11, 12]. But one tenth of patients will have acute abdominal pain due to tumor rupture, torsion or bleeding. The secondary development of malignancy is a rare but well-known phenomenon in patients with teratoma. Here, we observe the patients of mature teratoma with pregnancy in our hospital in order to improve our understanding of it.

Patients and Methods

759 cases mature teratoma was retrospectively analyzed from the first half of 2000 to the second half of 2013 in Anyang Tumor Hospital. The clinicopathological characteristics of mature teratoma with pregnancy were reviewed, which mainly included clinical symptoms, pregnancy, tumor markers, surgical methods and pathological features.

All tissues obtained by operation were fixed with 10% formalin and then embedded in paraffin. The tissues were cut into 5 mm slices, and serial 4 µm sections were stained with hematoxylin and eosin (HE). Tissues were then observed under different objective lenses. All pathological sections were confirmed by two senior doctors or above.

Results

Patient ages range from 25 to 42 with an average of 31.11. and the duration of pregnancy varies from 23 days to 141 days (Table 1). Except for four patients with nonspecific clinical symptoms, others were found unintentionally during pregnancy test. All patients were non-smokers and received accessory excision of affected side. Patients were followed- up for a minimum of 36 months and a maximum of 101 months (median follow-up 77.2 months).

Table 1: Clinical characteristics of 9 cases mature teratoma with pregnancy. P= Pregnancy; D= Delivery; A=Abortion; R=right; L=left Imaging examination showed that mixed mass of cyst and solid in affected ovary. The uterine body is enlarged, and the echo of uterine wall is homogeneous. The echo of gestational sac is visible in the uterine cavity; meanwhile the echo of embryo and the pulsation of primitive blood vessels can be detected in some cases. Only irregular thickening of endometrium was found in one patient after abortion, and no gestational sac was found.

On the general section, a cystic solid mass with hair and grease was seen. The affected adnexa with ectopic pregnancy were an irregular mass with incomplete capsule, and the ipsilateral ovary was surrounded by hematoma. Villi can be seen in the curettage of uterine cavity, and embryo can be seen in some cases.

The laboratory tumor index showed that CA125 increased in 4 cases (Table 2). Histologic sections of the specimen show that there are mature and differentiated multiple germ cells, and the most common are squamous epithelium, skin appendages, fat components, and so on massive clots were seen locally (Table 3). The sections of uterine cavity prolapse showed that the endometrium with high reaction change in secretory phase was accompanied with interstitial decidua change. Some villi and proliferative trophoblasts were consistent with pregnancy. Embryos are occasionally seen.

Discussion

We conducted this study to determine the association of mature teratoma and pregnancy and found that mature teratoma simultaneous with pregnancy was common. Mature teratoma has no effect on ovulation. Awareness is growing that neoplasm can be treated during pregnancy, but the effect of this change on maternal and neonatal outcomes is unknown.

Teratoma is a common tumor derived from germ cells. It is more common in women especially in ovaries. Teratoma outside gonads accounts for 2% -5% of adult germ cell tumors. It is most common in mediastinum and omentum [12, 13]. Teratoma can show different clinical symptoms, mainly in pelvic cavity and abdominal cavity, so timely and effective treatment is necessary [14, 15, 16, 17, 18].

In our study, 8 cases chose appendectomy combined with curettage abortion. The main reason for the operation is that the patient had no requirement for childbearing or had a history of incomplete, also few for the fear of affecting fetal growth and development. Occasional spontaneous abortion can be seen after surgery. Overall, surgical management of adnexal masses during pregnancy appears to have favorable outcomes for the mother and the fetus [19]. A research of 337 cases pregnancy with ovarian tumor in obstetrics department of Wuxi Maternal and Child Health Hospital showed that early detection of ovarian tumor is very important. Timely operation does not affect the outcome of pregnancy.

In conclusion, teratomas associated with pregnancy are mostly cystic mature teratomas, so tumor resection can be performed in the middle of pregnancy without any harmful to the fetus, especially for those who have fertility requirements.