What are the potential complications of ovarian teratoma?

Updated: Nov 22, 2019
  • Author: Chad A Hamilton, MD; Chief Editor: Yukio Sonoda, MD  more...
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Complications of ovarian teratomas include the following:

Torsion is by far the most significant cause of morbidity, occurring in –3-11% of cases. Several series have demonstrated that increasing tumor size correlates with increased risk of torsion. [4, 29]

Rupture of a cystic teratoma is rare and may be spontaneous or associated with torsion. Most series report a rate of less than 1%, [4, 3]  though Ahan et al reported a rate of 2.5% in their report of 501 patients. [19]  Rupture may occur suddenly, leading to shock or hemorrhage with acute chemical peritonitis. Chronic leakage also may occur, with resultant granulomatous peritonitis. Prognosis after rupture is usually favorable, but the rupture often results in formation of dense adhesions.

Infection is uncommon and occurs in less than 1-2% of cases. Coliform bacteria are the organisms most commonly implicated. [19, 29]

Encephalitis associated with antibodies against the N-methyl D-aspartate receptor (NMDAR) has been linked to tumors, especially ovarian mature teratomas. In a series of 400 cases, 335 of them in women, 165  patients (49%) had tumors and all but six were ovarian teratomas. The syndrome is characterized by a viral-like prodrome followed by a multistage progression of symptoms that includes psychosis, memory deficits, seizures, language disintegration, decreased consciousness, dyskinesias, and autonomic instability. Substantial recovery is usually seen with tumor resection and immunotherapy. [30]

Autoimmune hemolytic anemia has been associated with mature cystic teratomas in rare cases. In these reports, removal of the tumor resulted in complete resolution of symptoms. Theories behind the pathogenetic mechanism include (1) tumor substances that are antigenically different from the host and produce an antibody response within the host that cross reacts with native red blood cells, (2) antibody production by the tumor directed against host red blood cells, and (3) coating of the red blood cells by tumor substance that changes red blood cell antigenicity. In this context, radiologic imaging of the pelvis may be indicated in cases of refractory hemolytic anemia. [31, 32]

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