Teratoma pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Gertrude Djouka, M.D.[2]


The histopathology of teratoma depends on the histological subtype.Teratoma is a germ cell tumor due to abnormal development of pluripotent cells and renmant of primitive node.


Germ cell
Malignant transformation
Mature teratoma
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Tumors with primitive embryonic ectoderm, mesoderm, and/or endoderm differentiation{{{ }}}
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Immature teratoma


  • Mature teratoma arises from a pathological transformation of primordial germ cell during the develompment.[1][2]
  • Mature teratoma comes from a single germ cell tumor after first phase of meiosis and failure of meiosis type II.[3][4][5]
  • Mature teratoma contains a well differentiated tumor with all three germ layers (ectoderm, mesoderm and endoderm).[2]
  • Mature teratoma may be located in the embryonic fusion midline or paraxial, mediastinum, ovary, retroperitoneum, and sacrococcygeal.[6]
  • Immature teratoma may be due to the malignant tranformation of primitive germ cell layers and renmant of primive node.[7][8]


Genes involved in the pathogenesis of teratoma include:[9]

  • Gain of part or all chromosomes
    • 1p
    • 16p
    • 19
    • 22q


  • Neuronal element found in mature or immature teratoma are positive for:[10][11]
  • Carcinoid tumor found in the monodermal teratoma may be positive for:[12]
    • Serotonin and peptides hormones.

Associated conditions

Conditions associated with teratoma include:

Gross and microscopy pathology

The gross and microscopy features of teratoma are described below:[16][12][17][7][18][19][20][21][22][23][24]

Types Gross pathology Microscopic pathology Images
Mature teratoma
  • Unilateral cystic mass in most cases, rarely solid
  • Predominantly cystic with hair tufts, teeth, and cartilaginous material
  • Unilocular in most cases
  • Capsular compoment is well defined
  • Soft, tan, measured about 3 to 21 cm in diameter
  • Contains three embryonic layers (misoderm, endoderm, and ectoderm)
  • Keratinized squamous cells epithelium
  • Adnexal structures (sebaceous glands, hair follicles)
  • Adipose tissues
  • Lobules of mature cartilage
  • Glands lined by the respiratry mucosa and digestive mucosa
  • Skeletal muscles
  • No cytology atypia
Immature teratoma
  • Solid mass with necrotic and hemorrhagic areas
  • Cystic cavities may be filled with serous or mucinous fluid
  • Capsular is not well defined
  • Tends to be larger than mature cystic teratoma
  • Neural tissues with neuroepithelial rosettes
  • Choroid plexus
  • Immature mesenchymal
  • Presence of primtive elements
  • Cytology atypia
Monodermal teratoma
  • Unilateral mass
  • Well differentiated neoplasm


  1. Vural, F.; Vural, B.; Paksoy, N. (2015). "Vaginal teratoma: A case report and review of the literature". Journal of Obstetrics and Gynaecology. 35 (7): 757–758. doi:10.3109/01443615.2015.1004525. ISSN 0144-3615.
  2. 2.0 2.1 El-Maarri, Osman; Rijlaarsdam, Martin A.; Tax, David M. J.; Gillis, Ad J. M.; Dorssers, Lambert C. J.; Koestler, Devin C.; de Ridder, Jeroen; Looijenga, Leendert H. J. (2015). "Genome Wide DNA Methylation Profiles Provide Clues to the Origin and Pathogenesis of Germ Cell Tumors". PLOS ONE. 10 (4): e0122146. doi:10.1371/journal.pone.0122146. ISSN 1932-6203.
  3. Linder, David; McCaw, Barbara Kaiser; Hecht, Frederick (1975). "Parthenogenic Origin of Benign Ovarian Teratomas". New England Journal of Medicine. 292 (2): 63–66. doi:10.1056/NEJM197501092920202. ISSN 0028-4793.
  4. Surti U, Hoffner L, Chakravarti A, Ferrell RE (1990). "Genetics and biology of human ovarian teratomas. I. Cytogenetic analysis and mechanism of origin". Am J Hum Genet. 47 (4): 635–43. PMC 1683780. PMID 2220805.
  5. Caspi B, Lerner-Geva L, Dahan M, Chetrit A, Modan B, Hagay Z; et al. (2003). "A possible genetic factor in the pathogenesis of ovarian dermoid cysts". Gynecol Obstet Invest. 56 (4): 203–6. doi:10.1159/000074755. PMID 14614249.
  6. Comerci JT, Licciardi F, Bergh PA, Gregori C, Breen JL (1994). "Mature cystic teratoma: a clinicopathologic evaluation of 517 cases and review of the literature". Obstet Gynecol. 84 (1): 22–8. PMID 8008317.
  7. 7.0 7.1 Varma AV, Malpani G, Agrawal P, Malukani K, Dosi S (2017). "Clinicopathological spectrum of teratomas: An 8-year retrospective study from a tertiary care institute". Indian J Cancer. 54 (3): 576–579. doi:10.4103/ijc.IJC_294_17. PMID 29798962.
  8. Keene DJ, Craigie RJ, Shabani A, Batra G, Hennayake S (2011). "Bipartite anterior extraperitoneal teratoma: evidence for the embryological origins of teratomas?". Case Rep Med. 2011: 208940. doi:10.1155/2011/208940. PMC 3163403. PMID 21949666.
  9. Kraggerud SM, Szymanska J, Abeler VM, Kaern J, Eknaes M, Heim S et al. (2000) DNA copy number changes in malignant ovarian germ cell tumors. Cancer Res 60 (11):3025-30. PMID: 10850452
  10. Yoshikata R, Yamamoto T, Kobayashi M, Ota H (2006). "Immunohistochemical characteristics of mature ovarian cystic teratomas in patients with postoperative recurrence". Int J Gynecol Pathol. 25 (1): 95–100. doi:10.1097/01.pgp.0000172082.17805.6c. PMID 16306792.
  11. Takayama, Yoshiyasu; Matsumura, Nozomi; Nobusawa, Sumihito; Ikota, Hayato; Minegishi, Takashi; Yokoo, Hideaki (2015). "Immunophenotypic features of immaturity of neural elements in ovarian teratoma". Virchows Archiv. 468 (3): 337–343. doi:10.1007/s00428-015-1891-8. ISSN 0945-6317.
  12. 12.0 12.1 Outwater, Eric K.; Siegelman, Evan S.; Hunt, Jennifer L. (2001). "Ovarian Teratomas: Tumor Types and Imaging Characteristics". RadioGraphics. 21 (2): 475–490. doi:10.1148/radiographics.21.2.g01mr09475. ISSN 0271-5333.
  13. Liang Z, Yang S, Sun X, Li B, Li W, Liu Z et al. (2017) Teratoma-associated anti-NMDAR encephalitis: Two cases report and literature review. Medicine (Baltimore) 96 (49):e9177. DOI:10.1097/MD.0000000000009177 PMID: 29245365
  14. Dalmau, Josep; Gleichman, Amy J; Hughes, Ethan G; Rossi, Jeffrey E; Peng, Xiaoyu; Lai, Meizan; Dessain, Scott K; Rosenfeld, Myrna R; Balice-Gordon, Rita; Lynch, David R (2008). "Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies". The Lancet Neurology. 7 (12): 1091–1098. doi:10.1016/S1474-4422(08)70224-2. ISSN 1474-4422.
  15. Malayev, Yuliya; Alberts, Jared; Verardi, Mary Ann; Mattison, Anissa R.; Imlay, Sherwin (2015). "Immature Teratoma Associated With Anti–N-Methyl-D-Aspartate Receptor Encephalitis". The Journal of the American Osteopathic Association. 115 (9): 573. doi:10.7556/jaoa.2015.116. ISSN 0098-6151.
  16. Yayla Abide, Çiğdem; Bostancı Ergen, Evrim (2018). "Retrospective analysis of mature cystic teratomas in a single center and review of the literature". Journal of Turkish Society of Obstetric and Gynecology. 15 (2): 95–98. doi:10.4274/tjod.86244. ISSN 1307-699X.
  17. Ulbright, Thomas M (2005). "Germ cell tumors of the gonads: a selective review emphasizing problems in differential diagnosis, newly appreciated, and controversial issues". Modern Pathology. 18 (S2): S61–S79. doi:10.1038/modpathol.3800310. ISSN 0893-3952.
  18. Jung SE, Lee JM, Rha SE, Byun JY, Jung JI, Hahn ST (2002). "CT and MR imaging of ovarian tumors with emphasis on differential diagnosis". Radiographics. 22 (6): 1305–25. doi:10.1148/rg.226025033. PMID 12432104.
  19. da Silva TK, Ribeiro GJ, Scortegagna FA, Zanetti G, Marchiori E (2015). "Teratoma: a set of teeth in the pelvis". Radiol Bras. 48 (4): 263–4. doi:10.1590/0100-3984.2015.0034. PMC 4567366. PMID 26379326.
  20. Rathore R, Sharma S, Agarwal S (2018). "Malignant transformation in mature cystic teratoma of the ovary: a retrospective study of eight cases and review of literature". Prz Menopauzalny. 17 (2): 63–68. doi:10.5114/pm.2018.77304. PMC 6107092. PMID 30150913.
  21. Caruso PA, Marsh MR, Minkowitz S, Karten G (1971). "An intense clinicopathologic study of 305 teratomas of the ovary". Cancer. 27 (2): 343–8. doi:10.1002/1097-0142(197102)27:2<343::aid-cncr2820270215>3.0.co;2-b. PMID 5100397.
  22. Wisniewski M, Deppisch LM (1973). "Solid teratomas of the ovary". Cancer. 32 (2): 440–6. doi:10.1002/1097-0142(197308)32:2<440::aid-cncr2820320222>3.0.co;2-8. PMID 4722922.
  23. Moran CA, Suster S (1997). "Primary germ cell tumors of the mediastinum: I. Analysis of 322 cases with special emphasis on teratomatous lesions and a proposal for histopathologic classification and clinical staging". Cancer. 80 (4): 681–90. PMID 9264351.
  24. Kao CS, Bangs CD, Aldrete G, Cherry AM, Ulbright TM (2018). "A Clinicopathologic and Molecular Analysis of 34 Mediastinal Germ Cell Tumors Suggesting Different Modes of Teratoma Development". Am J Surg Pathol. 42 (12): 1662–1673. doi:10.1097/PAS.0000000000001164. PMID 30256256.

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