ASO Author Reflections: Ovarian Cystectomy for Apparent Early-Stage Pure Immature Ovarian Teratomas

Abstract

Immature teratomas (IMTs) are a specific subgroup of malignant ovarian germ cell tumors (MOGCTs) involving tissues derived from the ectoderm, mesoderm, and endoderm. IMTs present a distinct biological behavior, and patients may relapse with IMT or develop mature elements. Most IMTs occur in young patients wishing to retain their fertility, and are diagnosed at an early stage with an excellent prognosis. Current management for earlystage IMTs, except stage IA grade 1 IMT, is unilateral salpingo-oophorectomy (USO) with complete staging surgery (CSS), followed by platinum-based chemotherapy; however, the necessity and extent of CSS remains controversial. Chemotherapy is less effective in IMTs compared with other histological subtypes of MOGCTs. Many young patients with IMTs present with acute abdominal pain (tumor torsion, tumor rupture) requiring emergency surgery, and some patients might thus undergo ovarian cystectomy with incomplete staging due to a lack of frozen sections and/or a non-gynecologic oncologist surgeon. Management of these patients poses a clinical dilemma if a postoperative diagnosis of IMT is made; however, information on this topic is lacking because of the rarity of IMTs. PRESENT