Immature ovarian teratoma

Immature ovarian teratoma is an uncommon ovarian germ cell tumour. They differ from mature ovarian teratomas (dermoid cysts) both histologically by the presence of immature tissue, and clinically by their more malignant behaviour.


They are considerably less common than mature ovarian teratomas, representing less than 1% of ovarian teratomas1. They also affect a younger age group, occurring most often in the first 2 decades of life (accounting for 10-20% malignant ovarian tumours in this age group).

Clinical presentation

Presentation may be with a palpable pelvic mass or less commonly with abdominal pain 2.


An immature cystic teratoma is characterised by the presence of immature or embryonic  tissue, as well as the mature tissue elements seen in a mature teratoma. The proportion of immature neuroepithelium present correlates with the tumour grade (and hence prognosis) 5.

Macroscopically, immature teratomas are large, encapsulated masses which have a prominent solid component. As well as this, they may feature many of the components seen in a mature teratoma, such as hair, cartilage, bone and calcification.

  • ipsilateral mature cystic teratoma: ~25% 1
  • contralateral immature teratoma: ~10% 1

Radiographic features

The imaging appearance is typically of a large, heterogeneous mass with a prominent solid component. However, the spectrum of appearances ranges from a predominatly cystic to a predominantly solid mass. Immature teratomas tend to be larger than mature cystic teratomas at initial presentation.

Extension through the tumour capsule may be present.

Immature teratoma may metastasise to peritoneum, liver or lung. Metastasis to brain has also been reported 7.


Ultrasound appearance can be as a heterogeneous adnexal mass although is non-specific. Calcifications may be present.


The presence of a prominent solid component containing calcifications and small foci of fat is suggestive. Cystic components may contain serous, mucinous, or fatty sebaceous material. Haemorrhage may be present.

Treatment and prognosis

Treatment is generally with oophorectomy, and if distant metastases are present, postoperative chemotherapy. Chemotherapeutic retroconversion is a phenomenon where the teratoma or its metastasis post radiotherapy become more histologically mature than the primary lesion.

Prognosis depends on stage.

  • peritoneal rupture
  • torsion

Differential diagnosis

On imaging consider:

See also

Germ cell tumours
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Article Information

rID: 13656
Systems: Gynaecology, Oncology
Section: Pathology
Tags: cases, oncology
Synonyms or Alternate Spellings:
  • Malignant teratoma of the ovary
  • Immature teratoma of the ovary
  • Malignant ovarian teratoma
  • Immature ovarian teratomas
  • Malignant teratomas of the ovary
  • Immature teratomas of the ovary
  • Malignant ovarian teratomas
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    Immature teratoma
    Case 1
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    Case 2: with liver and peritoneal metastases
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