Immature teratoma - Ovary -

This article will help you read and understand your pathology report for immature teratoma of the ovary.

by Emily Goebel MD FRCPC, reviewed on May 28, 2020

Quick facts:

• An immature teratoma is a type of ovarian cancer.
• Despite the name, immature teratomas are made up of both mature and immature types of tissue that are not normally found in the ovary, such as immature brain, skin, and intestinal type tissue.

The anatomy of the ovary

The ovaries are small, round, paired organs that are attached to the uterus by the fallopian tubes. The ovaries contain large cells called eggs. In adult women, these eggs are released from the ovary during ovulation. The eggs are a special type of cell called a germ cell. They are called germ cells because they have the potential to turn into any other type of cell in the body (the word germ comes from the Latin word for ‘seed’).

What is an immature teratoma?

An immature teratoma is a type of ovarian cancer. It develops from the germ cells in the ovary.

Because teratomas start from a type of cell that has the ability to turn into any other type of cell, teratomas may contain a variety of tissue types including skin, brain, intestine, and muscle. In fact, any type of tissue can be found in a teratoma.

Most immature teratomas contain a mixture of mature tissue that resembles adult tissue and immature tissue that is normally found in the developing human (embryo or fetus).

How do pathologists make this diagnosis?

The diagnosis can only be made after the tumour is removed and tissue is examined under a microscope by a pathologist. Although any type of immature tissue may be found in an immature teratoma, the pathologist must see immature brain tissue in order to make the diagnosis.

Your pathologist will examine the tumour closely to determine the amount of immature brain tissue present. This determines the histologic grade of the immature tumour.

Histologic grade

For immature teratomas, pathologists use the word grade to describe the amount of immature brain tissue found in the tumour. The grade can only be determined after the tumour has been examined under the microscope.

Pathologists divide immature teratomas into three grades as follows:

• Grade 1 – Only a small amount of immature brain tissue is found in a grade 1 tumour. Specifically, the immature brain tissue must occupy an area smaller than one low-power field of view when the tumour is examined under the microscope.
• Grade 2 – A moderate amount of immature brain tissue is found in a grade 2 tumour. The immature brain tissue occupies an area larger than one low-power field of view but no more than 3 low-power fields of view when examined under a microscope.
• Grade 3 – Large areas of immature brain tissue are found in a grade 3 tumour. The immature brain tissue occupies more than three low-power fields of view when the tumour is examined under the microscope.

Using the information above, immature teratomas are further divided in low and high grade. Grade 1 is called low grade. Grade 2 and 3 are called high grade because they are more likely to spread to other organs.

Tumour size

This is the size of the tumour measured in centimetres (cm). The tumour size is only measured after the entire tumour has been removed.

Ovarian surface involvement

Your pathologist will carefully examine the tissue under the microscope to see if there are any tumour cells on the surface of the ovary.

Tumour cells on the surface of the ovary increase the risk that the tumour will spread to other organs in the pelvis or abdomen. It is also used to determine the tumour stage (see Pathologic stage below).

Other organs or tissue involved

Small samples of tissue are commonly removed in a procedure called a biopsy to see if tumour cells have spread to the pelvis or abdomen. These biopsies which are often called omentum or peritoneum are sent for pathological examination along with the tumour.

Other organs (such as bladder, small intestine, or large intestine) are not typically removed and sent for pathological examination unless they are directly attached to the tumour. In these cases, your pathologist will examine each organ under the microscope to see if there are any tumour cells attached to those organs.

Tumour cells in other organs are used to determine the tumour stage (see Pathologic stage below).​

Lymph nodes

Lymph nodes are small immune organs located throughout the body. Tumour cells can travel from the tumour to a lymph node through lymphatic channels located in and around the tumour (see Lymphovascular invasion above). The movement of tumour cells from the tumour to a lymph node is called a metastasis.

Your pathologist will carefully examine all lymph nodes for tumour cells. Lymph nodes that contain tumour cells are often called positive while those that do not contain any tumour cells are called negative. Most reports include the total number of lymph nodes examined and the number, if any, that contain tumour cells.

If tumour cells are found in a lymph node, the size of the area involved by tumour will be measured and described in your report. ​

Tumour cells found in a lymph node is associated with a higher risk that the tumour cells will be found in other lymph nodes or in a distant organ such as the lungs. The size of the area with tumour cells in the lymph nodes are used to determine the nodal stage (see Pathologic stage below).

Pathologic stage

​The pathologic stage for immature teratoma is based on the TNM staging system, an internationally recognized system originally created by the American Joint Committee on Cancer.

This system uses information about the primary tumour (T), lymph nodes (N), and distant metastatic disease (M) to determine the complete pathologic stage (pTNM). Your pathologist will examine the tissue submitted and give each part a number. In general, a higher number means more advanced disease and worse prognosis.

Pathologic stage is not reported on a biopsy specimen. It is only reported when the entire tumour has been removed in an excision or resection specimen.

Tumour stage (pT)

• T0 – After careful examination of the tissue, no primary tumour is found. This can happen if you received treatment (for example chemotherapy) before surgery and the tumour shows complete response (see Treatment effect above).
• T1a – The tumour is found only in one ovary or fallopian tube.
• T1b – The tumour is found in both ovaries or fallopian tubes.
• T1c – The tumour is found in only one ovary or fallopian tube but the tumour capsule is broken OR cancer cells were found in fluid taken out of the abdomen or pelvis.
• T2a – The tumour extends to the uterus or tumour cells were found on the surface of the ovaries, fallopian tubes, or uterus (implants).
• T2b – The tumour extends to other parts of the pelvis or tumour cells were found on the surface of tissues in the pelvis (implants).
• T3 – Tumour cells are found outside of the pelvis in the tissues of the abdomen.​

Nodal stage (pN)

• NX – No lymph nodes were sent to pathology for examination.
• N0 – No tumour cells are found in any of the lymph nodes examined.
• N0(i+) -Only isolated tumour cells are found in a lymph node (the area with tumour cells is not greater than 0.2 millimetres in size).
• N1a – Tumour cells are found in a lymph node but the area with tumour cells is not greater than 10 millimetres.
• N1b – Tumour cells are found in a lymph node and the area with tumour cells is greater than 10 millimetres.

Metastatic stage (pM)

Immature teratoma is given a metastatic stage of 1 if there are tumour cells present at a distant site in the body (for example the liver or lungs). The metastatic stage can only be determined if tissue from a distant site is sent for pathological examination.