Ovarian fetal fibroids

Many people may not have heard of ovarian fetal fibroids in their lives. This is a relatively common disease. It has a great impact after the onset of the disease. It is generally treated with the most common surgery. However, considering the particularity of this operation, we have no way to find a suitable treatment plan, so that the disease becomes worse in the end and even causes a burden on the body. We need to have relevant knowledge and correct understanding of the disease.

Teratomas can be found not only in the female ovaries, but also in the retroperitoneum, mediastinum, head and neck, sacrococcygeal region of the fetus, and male testicles. However, ovarian teratomas are more common.

The so-called teratoma is an embryo that grows "crooked". It usually originates in the early embryonic stage and exists before birth. The ovaries are a common site for teratoma in women, but it is usually discovered accidentally during physical examinations in adulthood.

Ultrasound examination can usually confirm the diagnosis of teratoma through unique sonographic features. Some patients can even see teeth in their lower abdomen during X-ray examination. Tissues developed from the three germ layers (ectoderm, mesoderm, and endoderm) can be seen inside the teratoma, most commonly skin, hair, oil, and cartilage, and occasionally thyroid and nerve tissue.

Ovarian teratomas are usually asymptomatic and vary in size, ranging from 3-5cm in size to over 20cm in size. The author has encountered ovarian teratomas with a diameter of up to 30cm, with the upper limit reaching below the xiphoid process and filling the entire pelvic and abdominal cavity. Since teratomas are mostly cystic and solid, and the solid components account for the majority, the center of gravity is unstable. Usually, a teratoma of 5-10 cm can twist with sudden changes in body position (a bit like a watermelon stem turning several times), causing acute abdominal pain. Ovarian teratoma may sometimes be accompanied by rare neurological diseases such as encephalitis symptoms. The neurological symptoms can be very severe and can only be relieved by removing the ovarian teratoma. We call it ovarian teratoma-associated encephalopathy.

Preoperative examinations may show elevated levels of tumor markers such as AFP and CA125 in some patients, but the positive rate and specificity are not high.

Usually, ovarian teratoma requires surgical treatment. Currently, laparoscopic surgery has become the mainstream surgical method. Laparoscopic surgery causes less bleeding, less trauma, faster recovery, less pain, and very small scars on the abdominal wall. It is especially suitable for young women who love beauty.

After a teratoma is discovered, elective surgery is usually required. For ovarian teratomas that are too small, such as those below 2-3 cm, there is no need to rush for surgery because they are too small to be explored, and follow-up examinations can be performed every 2-3 months. Teratomas that are larger than 3 cm should be operated on as soon as possible to avoid acute abdomen caused by torsion of the tumor and to avoid damage to too much normal ovarian tissue due to excessive tumor size. Some patients may ask whether they can get pregnant with a tumor and then have it treated during a cesarean section. It is not impossible to do so, but it is preferred to treat it before pregnancy to avoid accidents and difficulties in treatment during pregnancy due to torsion. A teratoma alone does not necessarily require a cesarean section.

Almost 95% of ovarian teratomas are mature, or benign, and only 5% are immature teratomas, or malignant, which are manifested by the appearance of fragile nerve-like tissue and head ganglia. Of course, the diagnosis mainly depends on postoperative pathological examination.

Regular follow-up is required after surgery. Some patients may also have recurrences on the same or opposite ovary. The author once encountered a patient who had three recurrences in just 3-4 years and underwent a total of four operations. After the recurrence, surgical treatment is still appropriate.