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Teratome des Ovars

Klinisch-pathologische Unterschiede zwischen unreifen und reifen Teratomen

Teratoma of the ovary

Clinical and pathological differences between mature and immature teratomas

  • Schwerpunkt: Ovarialtumoren
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Zusammenfassung

Teratome sind die häufigsten Keimzelltumoren des Ovars. Zwei große Gruppen lassen sich dabei unterscheiden: reife und unreife Teratome. Reife Teratome sind benigne Tumoren, die meist aus Derivaten von 2 oder 3 Keimblättern bestehen. Nur in Einzelfällen zeigen sie eine maligne Transformation (meist Plattenepithelkarzinom). Unreife Teratome sind dagegen maligne Ovarialtumoren. Sie enthalten zusätzlich zur reifen Komponente unreife Gewebselemente, zumeist in Form unreifen neuralen Gewebes, histologisch erkennbar als Neurotubuli und/oder Rosetten. Der Anteil der unreifen Komponenten am Gesamttumorgewebe definiert den Grad der Unreife. Er wird nach der derzeit gültigen WHO-Klassifikation in 4 Graden ausgedrückt, wobei der Grad 0 einem reifen Teratom entspricht. Mit Ausnahme der kindlichen Teratome werden die unreifen Teratome vom Grad 2 und 3 mit einer Chemotherapie behandelt. Bei den kindlichen unreifen Teratomen muss nach einer Dottersacktumorkomponente gefahndet werden, da diese die Prognose bestimmt. Ist eine solche nachweisbar, wird der Tumor ebenfalls mit einer Chemotherapie behandelt. Sowohl beim reifen als auch beim unreifen Teratom können peritoneale Implantate (Gliomatosis peritonei) auftreten, die ebenfalls gradiert werden. Sind sie unreif, werden die Patientinnen ebenfalls mit einer Chemotherapie behandelt. Diese Implantate entstehen mit hoher Wahrscheinlichkeit aus einer Metaplasie der subperitonealen Zellen und stellen keine Metastasen des ovariellen Teratoms dar.

Abstract

Teratomas are the most frequent germ cell tumors of the ovary. Two main groups can be distinguished: mature and immature teratomas. Mature teratomas are benign tumors, which are most often composed of derivatives of two or three germ cell layers. Only in rare cases is the transition into a malignant tumor observed (most often squamous cell carcinoma). In contrast, immature teratomas are malignant ovarian tumors. They contain immature tissue elements in addition to the mature components, most often consisting of immature neural tissue. Histologically, this tumor component can be identified as neurotubules or rosettes. The proportion of immature tissue elements defines the grade of immaturity. Four grades have been defined in to the WHO classification. Grade 0 represents a mature teratoma. With the exception of childhood cases, grade 2 and 3 immature teratomas are treated with chemotherapy. In childhood cases, foci of yolk sac tumor (YST) must be looked for, since this determines the prognosis. If a focus of YST is present, the patient is treated with chemotherapy. Both in cases of mature and immature teratoma, peritoneal implants can be found (gliomatosis peritonei), which are also graded. In cases of immature peritoneal implants, patients are also treated with chemotherapy. Gliomatosis peritonei is most likely derived from metaplasia of subperitoneal stem cells; it does not represent a metastatic disease of the ovarian teratoma.

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Schmidt, D., Kommoss, F. Teratome des Ovars. Pathologe 28, 203–208 (2007). https://doi.org/10.1007/s00292-007-0909-7

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  • DOI: https://doi.org/10.1007/s00292-007-0909-7

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