Most teratomas of the ovary are mature dermoid cysts. However, the presence of immature tissue in the teratoma may indicate malignant potential.
Parameters:
(1) presence and amount of immature tissue
(2) mitotic rate
The immature component may involve any cell type but most often consists of primitive neuroepithelium. If an immature teratoma is suspected it is very important to extensively sample the entire tumor since the distribution of immature areas may be limited. It is important to look for areas of yolk sac tumor or other indications of a mixed germ cell tumor.
Amount of Immature Tissue
Finding
Grade
none (all mature)
none
0
minor
none or slight
1
moderate
moderate
2
extensive, large
high
3
Some authors recommend compressing Grades 2 and 3 into a high grade class.
Grade
Followup
0
none
1
complete surgical excision and clinical followup
2 or 3
complete surgical excision if possible plus adjuvant chemotherapy plus clinical followup
I am not aware of any serum markers that can be used to monitor the patient for recurrence unless the tumor is a mixed germ cell tumor. Monitoring is usually based on periodic clinical examination and imaging studies.
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