Gada, Abdullah Nasiru
(2015)
A review of ovarian teratoma in Hospital Universiti Sains Malaysia ten years experience : 2003 to 2012.
Masters thesis, Universiti Sains Malaysia.
Abstract
Introduction
Ovarian cancer is the fourth most common cancer among women in United Kingdom
(UK) and in Malaysia. It constituted 6.5% of total female cancer with age standardized
incidence rate (ASR) of 8.6 per 100,000, and is a major source of morbidity and
mortality among women coming only after cancers of lungs, breast and colon in
Malaysia. Mature ovarian teratoma is commonly benign; however it is associated with
malignant transformation in up to 15% and no reliable preoperative diagnostic
procedures to detect this transformation. Immature teratoma represents 3% of total
ovarian teratoma but constitutes 20% of germ cell malignancies, it occurs commonly
among women below 20 years old and has tendency of recurrence. Fertility preservation
approach of management is highly crucial but in advance stage may be difficult and
occasionally the fatal complication associated with chemotherapy is a concern.
Objective
We aim to review the clinico-pathological pattern and outcome of management of
ovarian teratoma patients in Hospital Universiti Malaysia (HUSM).
Methodology
A total of 160 women diagnosed with ovarian teratoma and managed in HUSM from
2003 to 2012 were reviewed retrospectively. List of patients with confirmed histological
diagnosis was obtained from pathology department record and their folders were traced,
data collected and analyzed using SPSS 21 software (Inc., Chicago, USA).
Results
Ovarian teratoma is seen from 4 years to 75 years old women and commonest among
21-40 years age group (59.4%). Majority were married (74.4%) and most of them never
use oral contraceptive pills (OCP), 64% have 1- 4 children and breast fed for at least one
year and 53(33.1%) were pregnant during diagnosis. Abdominal mass or distension and
abdominal pain were the commonest presenting symptoms in 32 in cases, 45 cases were
incidental diagnosis while 18 presented with acute abdomen. 43.1% of the cases were
obese. Mature cystic teratoma is the commonest histological type (91.9%), monodermal
3.1%, immature 2.5% while, malignant transformation and mixed germ teratoma have
1.25% each. Ultrasound features were unilateral 108 (67.5%), bilateral 14 (8.8%). There
were mixed solid cystic tumors in majority of cases 89(55.6%), 29(18.1%) were pure
cystic while 4(2.5%) were pure solid tumors. Only in 38(31.1%) cases had discrete
echogenic mass reported. Laparotomy was the commonest surgical approach 114 cases
(71.3%), removal of tumor in the same setting during lower segment Caesarean section
(LSCS) were 34 cases (21.3%) and laparoscopic approach was 12 cases (7.5%). The rate
of spillage was found to be 21.1%, 20.6% and 58.3% for laparotomy, LSCS and
laparoscopic approach respectively. Two cases had adjuvant chemotherapy with
Bleomycine, Etoposide and Platinum regimen (BEP) involving one case of immature
teratoma and the other of mature teratoma with malignant transformation. Follow up
period was 3 -60 months and two cases of recurrent mature ovarian teratoma occurred
but no chemical peritonitis reported.
Conclusion
Teratoma is the commonest ovarian tumor in the reproductive age women, however, we
found no significant association with factors such as marital status, parity, breast
feeding, use of combine oral contraceptive and body mass index despite the presence ofthese factors in majority of our cases, this might be as a result of low power of the study
to detect such an association.
Fertility conservation is a great concern; ultrasonography is a reliable means for
diagnosing and careful selection of patients for expectant management or surgical
intervention. This study reveals that majority (122/160) of ovarian teratoma cases had
ultrasound done pre operatively and diagnosis of teratoma was suspected or made but
only one out of many presumed pathognomic features of teratoma was reported in
38/112 cases. As such there is need to improve in sonographic reporting of suspected
cases of ovarian teratoma. Twelve cases of ovarian teratoma had laparoscopic removal
of the tumor with 58.3% spillage rate, however none of the cases had a recurrence or
chemical peritonitis therefore laparoscopic approach can be consider as an alternative to
traditional laparotomy approach.
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