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10-Year Analysis of Benign Ovarian Teratomas: Outcomes and Follow-Up

Teratomas are a type of germ cell tumor that contain embryonic germ layers (ectoderm, mesoderm, or endoderm) and contain tissue that is foreign to the anatomic site. Teratomas overall are not rare and make up approximately 3 per cent of all childhood tumors. These tumors are typically classified histologically as mature teratoma, immature teratoma, or malignant germ cell tumors. Generally, mature and immature teratomas are considered histologically benign and account for nearly 80 per cent of all teratomas.1 These tumors can occur in many different locations within the body, but one of the most common types is ovarian teratoma. Although complete surgical resection remains the standard of care for ovarian teratomas, evidence-based recommendations for postoperative follow-up are lacking. Anecdotally, patients may receive no longterm follow-up in some centers, whereas at other institutions, patients may receive long-term care for several years. Our aim is to review the outcomes of patients who underwent surgical therapy for benign ovarian teratomas at a large metropolitan children’s hospital in an effort to generate an appropriate algorithm for the follow-up of these patients. After obtaining Institutional Review Board approval, a single-center retrospective review was performed at the Ann and Robert H. Lurie Children’s Hospital of Chicago, a free-standing major metropolitan children’s hospital. The electronic medical record was queried for all pediatric patients who had a CPT code indicating a diagnosis of teratoma from January 1, 2005 to January 1, 2015. The charts were then reviewed individually to identify those patients who had a diagnosis of ovarian teratoma. The initial query of the electronic medical records revealed 86 patients with a diagnosis of teratoma or benign teratoma. A total of 21 patients were excluded for not meeting the inclusion criteria, resulting in 65 patients with a pathologic diagnosis of a benign ovarian teratoma. Of these, four patients had immature ovarian teratomas and 61 had mature ovarian teratomas. Patient age ranged from two days to 21 years (Table 1). There was a significant difference in the initial alpha fetoprotein (AFP) level between the groups (Table 1). Patients with immature ovarian teratomas had a median initial AFP of 54.6 IU/mL and those with mature ovarian teratomas had a median AFP of 1.6 IU/mL (P < 0.0003). Additionally, the mature group had a single AFP of >40,000 IU/mL. None of the patients with elevated AFP levels were infants. There were no significant differences in follow-up time (P 4 0.895). There was a single recurrence in the immature ovarian teratoma group, resulting in an overall recurrence rate of 1.5 per cent. There were no recurrences in patients with ovarian teratomas with mature features (P 4 0.061). The recurrence of the immature ovarian teratoma occurred seven months after surgery in a 13-year-old female with an initial AFP level of 1978 IU/mL. Postoperative AFP levels were not elevated, even during the recurrence. On review of the clinical follow-up provided after surgical resection, we identified a wide range of strategies. Nine providers used more than 10 different follow-up algorithms; the most common strategy consisted of an ultrasound and AFP testing every three months for the first year, then every six months for the following two years, and then yearly until five years after surgery. When recurrence was The abstract for this manuscript was presented at the Academic Surgical Congress Annual Conference on Thursday February 4th, 2016. Address correspondence and reprint requests to Brian P. Blackwood, Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 East Chicago Avenue, Box 63, Chicago, IL 60611. E-mail: brian_p_blackwood@rush.edu. BB was responsible for writing approximately 75% of the manuscript, data collection and analysis, and study design. CH was responsible for writing approximately 5% of the manuscript, study design, and final manuscript preparation. MB was responsible for writing approximately 20% of the manuscript, study design, data analysis, and final manuscript preparation.