Removing a teratoma without removing the ovary

Everywhere they tell you that if you get a teratoma you have to remove the entire ovary… But #KnowledgeIsSuccess and although they look very ugly, they are benign, it is never urgent to operate on them and the cyst can be removed without having to remove the entire ovary, This way you preserve your fertility and hormonal balance.

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What are teratomas or dermoid cysts?

What’s up good morning! Remember, you have been asking us a lot about teratomas, which are ovarian cysts, the vast majority of them are benign, so remember our motto: power, documenting, asking what type of cyst it could be, between teratoma, endometriotic cyst or simple cyst, which are the three most frequent that we had talked about and we would like to show an example right now because just yesterday we operated on two patients, one who has a giant fibroid with a teratoma on the right side and another patient with a giant fibroid.

So, it is very important to know, teratomas mainly have an embryonic germinal origin, that is, they have tissue that comes from the ecto, endo and mesoderm, that is, in these tumors, fatty tissue, hair, bone, teeth, even some balloons can be found. ocular, then sometimes they tend to be very unpleasant but they are generally benign tumors called benign or simple teratoma. So, this patient came because she had a large fibroid, however, she was already pregnant 5 years ago and in addition, a teratoma was found in the MRI. Why do I say as a finding? She came with me to a consultation, I did a vaginal ultrasound, we saw the fibroid tumor but since it was very large it did not allow us to access the ovaries either vaginally or abdominally and then we took the tomography and you will be able to see it in the video We are going to show you what the well-defined cystic image looks like clearly.

The most important thing is the teratoma, although it is a tumor that seems to be very unpleasant to look at, it is benign in the vast majority of cases, in almost all proportions it comes from the unilateral right side, that is, only from one side. In this specific case of this little patient who had the teratoma on the right side and the tumor, which you will see was a little big, I always like to start with the simplest or most accessible. Because? Because it will take up less of our time because it will stress us out much less and in the end, now we will have to concentrate on the difficult stage which would be the fibroid in this case.

Teratoma and uterine fibroid surgery

So, in this case I started with the little cyst, you’ll see, it was a fairly large cyst of 8-10 cm. in length, in diameter and I started to remove it, I started to dry it out, it didn’t bleed at all, we left it there and then we continued with the fibroid, but you can start if it is a simple subserous fibroid you can start first with the fibroid because with the tumor of ovary, at the end of the day the ideal is always to start with the simplest or the easiest or the most accessible so that the surgery is faster and more agile. Let’s start, look, she is a 36-year-old patient who has been pregnant for 5 years but has a teratoma on the right side, which you see here is the ovary, this is the lower pole of the ovary, this is the teratoma and she has an intramural myoma that is now we teach them. Ready, we have drained the teratoma, this is just the capsule, a lot of tissue came out of the teratoma, it is a fatty tissue that has a little hair there…

But most importantly, see the ovary was respected, it remains intact and we are just going to face it and close it. Ready, we have already managed to split the fibroid, see there are the pedicles, all we have to do is go to the base with the alligator to avoid bleeding and we are practically done and now we are going to tackle the muscles.

Why NOT remove the ovary?

It is very important, on many occasions we do virtual consultations or write to us on YouTube about: “Hey, the radiologist, the laboratory told me that I have a 10 cm cyst that looks trabeculated, mixed echogenicity,” etc. and then the first thing they tell the patient is: This tumor must be removed from your ovary. Because? Because it looks very irregular, it looks ugly, it has trabeculations inside, it has vesicles or it has papillae. Generally, there are some classifications or some tables that will give us the risk between greater or lesser, as we have said on many occasions, it is ideal to do an intraoperative, but if ultrasound or tomography we are certain that it is an image of a teratoma, the markers are negative, it is not necessary to remove the entire ovary, it is only necessary to remove the cyst, remove the capsule of that cyst very well and be left with whatever From an ovary, 30% or 40% or even more of the ovarian tissue may remain, like this one you are going to see… She preserved 70% of the ovarian tissue.

Why is it important to preserve the ovaries? Because for the reproductive issue it is always better to have both the first and second ovaries, if you remove one ovary, a tumor or a torsion or some other cyst could also arise in the contralateral ovary and then if it is necessary to remove the other ovary we will lose the endocrine function that is something very important.

What studies are needed for a virtual consultation?

The ideal is always that they go to an ultrasound to be given the images, the video if possible because it is much better to view the images or video in real time of what that tumor looks like than just an interpretation on paper. With an interpretation on paper, I generally always tell them, they have to come to check you out and be able to give you a presumptive diagnosis of what type of tumor it is, but the most important thing is: The most common is a simple cyst, the second is an endometriotic cyst and The third is a teratoma, so these three represent more than 85% of benign ovarian tumors and are very easy to differentiate.

Sometimes the endometriotic cyst can be slightly complicated with a hemorrhagic cyst and in hemorrhagic cysts many times the radiologist or general practitioner tells you: “Hey, this looks very ugly, you have to have surgery and it’s urgent!” Whether it is benign or malignant, it is urgent! First you have to have tumor markers, make a second choice of doctor or a second opinion and do a tomography or an MRI if we really have a suspicion that it could be a malignant cyst, so please, I invite you to call us , write to us, we can do virtual consultations but with your images and if not… Well, come to us and in an ultrasound in 80%, 90% of the cases we can tell you what type of tumor it is and depending on that the surgery conservative, if it is necessary to be intraoperative and above all to preserve the ovary in that tumor that is there, whether on the right side or the left side. Don’t remove your ovaries!


Now, there is no need to be afraid of a teratoma appearing a second time. We have always said: Once we have identified a tumor, whether benign, borderline, unilateral or bilateral, generally once you operate on the patient, gynecological controls should not be abandoned, that is, they must be done every year. an ultrasound check-up because, as I mentioned, this patient actually already had a pregnancy but the main problem was the fibroid, the bleeding, the pain, the distension and so she went for a gynecological check-up and the teratoma had not been identified until the tomography review.

So, on many occasions with large fibroid tumors we cannot visualize the ovaries very well. The ideal in these cases is to operate with experts, with someone who knows about the subject and as I always mention: Try not to remove the ovary.

If they are told in the first instance “Remove the ovary”, the ideal is to have a second or even a third opinion with the idea of doing conservative surgery, as far as possible.

Dr. Arturo Valdés
Dr. Arturo Valdés
Reproductive Medicine and Gynecological Endocrinology
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