Teratoma: Types, Symptoms, Causes, Diagnosis And Treatment

Teratoma is a very rare type of tumour which is made up of three different germ cell layers (an embryonic cell); endoderm, mesoderm and ectoderm. In simple terms, it is a mixed tumour made up of different types of tissues like teeth, hair, bone and muscle. As the tumour is made up of germ or embryonic cell, it occurs basically in reproductive organs like ovaries and testicles. However, the tumour can occur in other body parts like tailbone, mediastinum, neck, tongue, skull and nose ^[1] .

Teratoma is common in newborns (neonatal teratomas) ^[2] and females. If it occurs in a newborn, it is usually benign (harmless) and can be removed surgically. According to a news published inSeptember 2019, in Greater Noida, a baby boy was born with a teratoma on his coccyx (tailbone) that looked similar to a one and half inch tail. Another news from Patna (Bihar) suggests that a 17-year old girl was diagnosed with a big tumour mass in her stomach which was later discovered to be a teratoma filled with bones, hair, teeth, cartilage and fat.

Types Of Teratomas

There are two types of teratomas - mature cystic teratomas and immature cystic teratomas.

Mature cystic teratomas (MCT): They are also known as 'dermoid cysts' and made up of at least two out of three germ cell layers. MCT mainly affects children and people of younger age group and grow slowly. They are benign and filled with material which is liquid at body temperature but semisolid at normal room temperature ^[3] .

Immature cystic teratomas (ICT): They are made up of all three types of germ layers and typically larger. Such type of teratomas are often solid and filled with mucinous fluid and fatty sebaceous material. They are often malignant or cancerous ^[4] .

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Symptoms Of Teratomas

In the initial stage, teratomas do not give any symptoms. Later, they start showing symptoms based on the location. The symptoms of teratomas according to their location are as follows:

1. Brain and spinal cord teratomas: They mainly develop in the lumbar and dorsal spine of the spinal cord and are mature cysts in several cases. The symptoms are as follows ^[5] :

• Tingling
• Sharp pain
• Numbness
• Vomiting
• Headache
• Weakness
• Seizures

2. Ovarian teratomas: They mainly develop in the ovaries (especially right ovary) and can be mature or immature. The symptoms are as follows ^[6] :

• Intense pain in the stomach
• Ovarian torsion
• Abnormal uterine bleeding
• Headache
• Psychosis

3. Mediastinal teratomas: They develop in the area between both the lungs and are basically mature cysts. The symptoms are as follows ^[7] :

• Persistent cough
• Pain while deep breathing
• Chest pain
• Pulmonary infection
• Shortness of breathe

4. Sacrococcygeal teratomas: They mainly develop in the tailbone or coccyx of a newborn and are both mature and immature ^[8] . The symptoms are as follows:

• Numbness in the legs
• Tingling of the legs
• Partial paralysis of the legs
• Constipation ^[9]
• Increased urinary tract infection
• Increased frequency of stools

5. Testicular teratomas: They mainly develop in the testicles and are common in the age group of 20-30 years. They can be both mature and immature ^[10] . The symptoms are as follows:

• Swelling in the testicles
• Pain in the testicles
• Lump in the testicles

Causes Of Teratomas

The main cause of teratoma is still unknown. However, it is basically caused due to some complications in the way cells divide during the body's growth. As aforementioned, teratomas arise mainly in the germ cells, the cells which are responsible for creating reproductive cells or any type of specialized cell in the body. These cells are developed very early in the foetus. Therefore, a large number of teratomas are detected during the pregnancy as during that time, the germ cells of the foetal develop and divide very fast ^[11] .

Diagnosis Of Teratomas

• Prenatal Magnetic Resonance Imaging (PMRI): To find abnormalities in the foetus's body, brain and spinal cord ^[12] .
• Maternal Serum Alpha-Fetoprotein Screening: To screen for any problem during the foetus development like spina bifida, down syndrome and gastroschisis ^[13] .
• Ultrasound: To find out the progress of teratoma. Large sacrococcygeal teratomas are often detected in the process.
• Gynecologic examinations: The test is done especially to find out the twisting of the ovary due to ovarian teratoma ^[14] .
• Blood tests: To detect elevated levels of hormones like AFP and BhCG as tumour markers.

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Treatment Of Teratomas

Teratomas are tumours which mainly develop during the development of a foetus. When a teratoma is detected during the foetal stage, the delivery of the baby is properly examined. If the teratoma is small, the doctor may suggest for normal deliver. In case of a large tumour, a Caesarean delivery is considered.

• Surgery: The foremost treatment of malignant teratoma is surgery. When teratoma of the tailbone, ovaries and testicles become very large, complex and protruded, they are often removed through surgery ^[15] . Also, when the teratoma is benign, it is surgically removed to avoid chances of them becoming cancerous.
• Chemotherapy: When the tumour is malignant, surgery along with chemotherapy is performed. However, when the tumour is complex and located at surgically inaccessible places, the foremost step is chemotherapy ^[16] .