Laparoscopic staging of ovarian immature teratomas: a report on three cases.

BACKGROUND

Ovarian malignant germ cell tumors (MGCT) tend to occur in younger women and are amenable to fertility sparing surgery. Traditionally, most ovarian cancers are staged via laparotomy; however, laparoscopy is a potential alternative to laparotomy for surgical staging in malignant germ cell tumors.

CASE: Three patients with immature teratoma were surgically staged with laparoscopy over a 1-year period at our institution. All patients underwent an initial surgery, unilateral salpingo-oophorectomy, for a complex adnexal mass that demonstrated immature teratoma on final pathology. Laparoscopic surgical staging was performed for all patients, with peritoneal and omental biopsies and pelvic and para-aortic lymph node dissection. Two patients with Stage IA disease secondary to negative biopsies and lymph nodes were observed. One patient was found to have omental disease; she underwent chemotherapy and remains in remission. As of last follow-up, no recurrences have been documented.

CONCLUSION

Laparoscopic surgical staging of immature teratomas discovered occult disease in one case allowing for appropriate treatment decisions based on minimally invasive surgical findings. Laparoscopy represents a viable, and potentially preferable, option for surgical staging in patients with immature teratoma not initially diagnosed on frozen section. Determination of adequacy of laparoscopic staging needs long-term surveillance and outcome results.