Extragonadal immature teratoma of the uterus

With fewer than 20 cases of extragonadal teratomas since 1929, treatment guidelines remain unclear.

A 27-year-old nulliparous female presented with vaginal bleeding and malodorous discharge. Transvaginal ultrasound and pelvic MRI revealed a 4 cm prolapsing echogenic cervical mass that was FDG avid on PET CT. Biopsy confirmed a grade 1 polypoid immature teratoma arising from either the uterus or cervix. She underwent a total laparoscopic hysterectomy, bilateral salpingectomy, omentectomy, and primary optimal tumor debulking to R0. Bilaterally ovaries appeared grossly normal and were preserved. On final pathology, the patient was staged using FIGO ovarian cancer criteria as Stage IIIA2 grade 2 immature teratoma of the uterus. The patient received three cycles of bleomycin, etoposide, and cisplatin. The patient is 11 months post-surgery and currently undergoing surveillance.

Given the rarity of uterine immature teratomas, management of this case was extrapolated from existing recommendations for immature ovarian teratomas. Unlike in prior case reports where surgical approach was via an exploratory laparotomy, our patient underwent optimal debulking via minimally invasive surgery with ovarian preservation and adjuvant chemotherapy. Given the chemosensitive nature of germ cell tumors, further fertility sparing options for extragonadal immature teratoma may be further explored.