Teratomas are the most common ovarian germ cell tumor and have a distinct appearance on imaging. Current practice frequently uses minimally invasive surgery (MIS) for management of suspected mature teratomas. This study aims to describe the clinical management, outcomes and pathologic features of over 1,000 teratomas at a single institution.
A retrospective chart review was performed on all patients with a pathologic diagnosis of a teratoma over an 11-year period at a single academic hospital.
1,055 patients were included in the study. Mean age at time of surgery was 38 (range 14-82). 72% of cysts were removed via MIS, and 63.8% via cystectomy. Spillage of cyst contents occurred in 37.2% of cases and was associated with MIS and cystectomy but not cyst size. There was 1 case of chemical peritonitis (0.09%) in a patient with spontaneous cyst rupture prior to surgery. There were 3 cases of immature teratoma (0.3%) and 12 cases of malignant transformation of dermoid (1.1%). 100 teratomas were associated with pregnancy with a rate of torsion of 9% compared to 5.2% in non-pregnant patients (p-value 0.16). Cysts larger than 5cm were more likely to undergo torsion compared to cysts < 5cm (83.1% vs 16.9%, p-value < 0.0001).
Minimally invasive surgery and cystectomy are safe management strategies for suspected mature teratomas, and cysts larger than 5cm should be removed due to the increased risk of torsion.