Adult Teratoma Research Articles

Surgical resection of large sacrococcygeal teratoma in adults: Report of two cases

Surgical resection of large sacrococcygeal teratoma in adults: Report of two cases

More Cases of Benign Testicular Teratomas are Detected in Adults than in Children. A Clinicopathological Study of 543 Testicular Germ Cell Tumor Cases.

Benign testicular teratomas are always thought to be pediatric neoplasms and previously all the teratoid tumors in the adult testis regarded as malignant. Recently, three publications reported benign testicular teratomas in adulthood and the latest WHO classification refers them as "prepubertal type of teratomas" which rarely appear in adulthood. These neoplasms behave benign and seemingly analogous independently whether they appear in pre- or postpubertal patients. The aim of our study was to investigate the frequency of benign testicular teratomas both in children and adults. 593 cases of testicular neoplasms were found in a period of 17years ranging from 1998 to 2014 in the archive of our department (Department of Pathology, Medical Center, Pécs University). 543 cases diagnosed as germ cell tumor which have all been further evaluated in conjunction with the clinical data available. Of all germ cell tumor cases 14 (2.5%) were pure teratomas. Ten out of 14 were the WHO-defined "conventional" teratoma, 4 of the 14 were the "benign or the so called prepubertal type" from which three occurred in adult patients. Only one of the 14 occurred in childhood, indicating that benign prepubertal type teratomas -which are regarded generally as childhood tumors- are more frequently detected in adults than in children. Benign adult testicular teratomas comprised 21% of all pure teratoma cases in our series. Practicioners in the field have to be aware of its existence also in adulthood to avoid overtreatment and not to expose their patients to unnecessary chemotherapy, retroperitoneal lymphadenectomy (RLA) and the potential complications of these interventions.

Evidence of a dual histogenetic pathway of sacrococcygeal teratomas.

Sacrococcygeal teratomas are rare tumours that occur most frequently in neonates, although adult cases also occur. The molecular pathogenesis of these tumours and their long-term prognosis is uncertain. We investigated the i(12p) status of a large number of primary sacrococcygeal teratomas in both children and adults, including cases with malignant germ cell tumour elements. Fifty-four sacrococcygeal teratoma specimens from 52 patients were identified, and available follow-up information was obtained. Fluorescence in-situ hybridization analysis was performed to identify isochromosome 12p [i(12p)] abnormalities on paraffin blocks of the tumours. Among the 48 paediatric patients, there were 44 teratomas and four tumours with combined teratoma and yolk sac tumour (one of whom also had primitive neuroectodermal tumour). The teratomas included 37 mature teratomas and 11 immature teratomas (four grade 1, two grade 2, and five grade 3). The 44 teratomas lacking a yolk sac tumour component were all negative for i(12p). The four tumours with a yolk sac tumour component were all positive for i(12p). The four adult cases all lacked non-teratomatous germ cell tumour components, immature elements, and i(12p). Follow-up information was available for 32 patients. Two patients with teratoma had recurrence, but were alive with no evidence of disease after long-term follow-up. One patient with combined teratoma and yolk sac tumour had recurrence 7 months after resection. The other patients were alive with no evidence of disease at last follow-up. Our data suggest that paediatric sacrococcygeal teratomas should be considered as two distinct groups with divergent histogenetic pathways. The prognosis of these tumours is excellent, despite rare recurrence.

Spinal intradural extramedullary mature cystic teratoma in an adult: A rare tumor with review of literature.

Background:Spinal intradural extramedullary teratoma is a rare condition, more common in children than in adults often with a history of spinal dysraphism.Method:We reviewed the literature and Pubmed advanced search showed nine results of intradural extramedullary teratoma in adults which included five independent case reports and three cases in a case series. We reported a rare case of intradural extramedullary teratoma in an adult located opposite L4 vertebra with neither spinal dysraphism nor any history of the prior spinal procedure.Results:The occurrence of teratomas in the spine is extremely rare. Further, spinal intradural extramedullary teratoma is more common in children but a rare entity in adults.Conclusion:Although uncommon, spinal cord neoplasm should be considered in the differential diagnosis of backache or radicular pain associated with neurological deficits even in absence of spinal dysraphism or any spinal procedure.

Sacrococcygeal teratoma with recto-sigmoid fecolith in adult

Sacrococcygeal tumors are present most frequently in infancy and childhood. Incidence in the newborn is 1 in 40000 with a female to male ratio of 10:1. It is rare in adults. Less than a hundred cases of teratoma in adults have been documented in literature. Constipation is a common complain; that is refractory to treatment or results in complications such as fecal impaction warrants consideration of occult causes. In most cases, it is diagnosed in childhood, with most descriptions being found in the pediatric literature. It is extremely uncommon for the syndrome to present in adulthood. We report a case of sacrococcygeal teratoma in adult, which has treated in our hospital. The presented case has shown a large thin walled cystic pre-sacral, retro-rectal cystic mass along the intra-luminal recto-sigmoid rounded ball of fecolith. Here, we highlighted the association of sacrococcygeal cystic teratoma in adult male with fecolith, which is rarely documented. So, we should also search the cause of constipation in adulthood, not only in paediatric age-group; that is refractory to treatment or results in complications such as fecal impaction.

成人に発症した原発性後腹膜囊胞性成熟奇形腫の2切除例

成人発症の原発性後腹膜囊胞性成熟奇形腫は極めてまれな疾患である．外科的切除を施行し上記診断に至った2症例を経験した．症例1は49歳の女性で，30歳妊娠時に仙骨前面に7×6 cmの腫瘍を指摘されたが出産のため経過観察となった．出産後は通院が中断していた．49歳時に尿閉を主訴に当院紹介となった．骨盤内に17 cmに増大した腫瘍を認め尾骨合併腫瘍切除術を施行した．症例2は23歳の女性で，23歳の帝王切開時に後腹膜腫瘍を認めた．その後の精査で仙骨前面に9×7 cmの分葉状囊胞性腫瘍を認め尾骨合併腫瘍切除術を施行した．術後病理組織学的診断はどちらも囊胞性成熟奇形腫であり悪性所見は認められなかった．成人発症の原発性後腹膜囊胞性成熟奇形腫は極めてまれな疾患である．悪性転化症例は予後不良だが，転化前ならば切除により良好な予後が得られており，発見された際は迅速な外科的切除を行うべきである．

Cervico mediastinal teratoma in adult: A very rare presentation.

Teratoma is a rare presentation in adult, specifically in cervico-mediastinal region. We reported two adult patients with diagnosis of cervico-mediastinal teratoma and operated them. In adult patients who present with cervico-mediastinal mass, benign teratoma could be one of a differential diagnosis although it is a rare presentation.

Prise en charge des tératomes testiculaires : mise au point par le Comité de cancérologie de l’Association française d’urologie groupe organes génitaux externes (CCAFU-OGE)

The objective of this article was to focus on the pathological, clinical and therapeutic aspects of the different forms of testicular teratoma in adults. The multidisciplinary working group has conducted a literature search on Pubmed with keywords: adult teratoma; malignant transformation; growing teratoma; chemotherapy; surgery with focus on the different forms of adult testicular teratoma. Teratomas of the adults are malignant and subdivided into localized and metastatic forms that may be distinguished under exclusive teratoma form, growing teratoma or teratoma with malignant transformation. The management is based on an enlarged surgical excision (testis and metastasis) with, in metastatic forms, a chemotherapy adjusted with histology. Extended follow-up beyond 10 years is necessary because of the risk of late relapse. Testicular teratoma is a rare tumor, which is considered malignant with a potential of metastasis. The treatment is based mainly on surgical management.

Sacrococcygeal –teratoma in adults: A case report and review of literature

Sacrococcygealteratoma (SCT) is known as a disease of infants but is rare in adults.. This is an uncommon location of teratoma in adults and malignant transformation has been rarely described. The clinical, radiological and histopathological characteristics of this case are described.Although complete surgical resection is the standard of care, with malignant transformation SCTs havea poor outcome.We report here the case of a 53 yr old female with sacrococcygeal teratoma

腹腔鏡補助下経腹・仙骨的摘出術を施行した成人仙尾部奇形腫の1例

腹腔鏡補助下経腹・仙骨的摘出術を施行した成人仙尾部奇形腫の1例

Peritoneal cylindromatosis – a rare teratomatous dissemination

neal cylindromatosis was presented. A young woman was admitted to hospital after removal of a right ovarian cystic tumour. Multiple histological reexaminations suggested the presence of a dermoid cyst, i.e. adult teratoma ad ditionally with granulosa cell tumour and endometrioid cancer. Six years after complete removal of neoplastic foci, a routine examination revealed multiple nodular lesions inside the pelvis and in the pelvic peritoneum. Multiple histological studies confirmed the presence of a cylindroma. Based on the broad histochemistry and immunohistochemistry (periodic acid Shiff, Ber-EP4, p63, CKAE1/AE3, CEA positive, as opposed to negative results with inhibin, calretinin, CK7 and only focally positive for EMA; Ki 67 mitotic index did not exceed 5% of cells), granulosa cell tumour and endometrioid cancer was excluded. A comparison of the surgical material with the specimens taken from the primary lesion operated eight years earlier showed a similarity of histological images. Our case of peritoneal dissemination of eccrine cylindroma arising from dermoid cyst suggests the introduction of the term peritoneal cylindromatosis for similar cases.

An unusual cause of neonatal apnoea (Discussion and Diagnosis)

The Case Presentation can be found on page 772. DISCUSSION While apnoea is a common problem in preterm infants, in term neonates, apnoea should always raise concern for a pathologic cause. This differential diagnosis of apnoea in the term neonate is broad. As episodes are usually brief, it can be difficult to classify occurrences as central, obstructive or mixed. Initial work-up should focus on identifying potentially treatable, life-threatening conditions such as sepsis, metabolic disturbances, accidental or intentional poisoning, abusive head injury, seizures and cardiovascular causes. To my knowledge, neonatal apnoea has not been previously described in the literature as presentation of gastric teratoma. Although the overall prevalence of neonatal teratomas is unknown, themost common form, sacrococcygeal teratoma, occurs once in every 14,900 live births (1). While rare, neonatal teratomas represent the most common congenital tumours and comprise 35% of neonatal tumours (2). The majority of teratomas in children and adults arise from gonadal sites; however, teratomas in neonates most commonly arise from extra-gonadal sites such as the sacrococcygeal area and mediastinum. Gastric teratomas account for less than one percentage of neonatal teratomas (3). To date, there are nine reported cases of neonatal gastric teratomas in the literature. Clinical presentations described by previous authors include severe anaemia, gastrointestinal bleeding, abdominal distension and respiratory distress (4–6). Neonatal teratomas are usually benign; therefore, complications are related to mass effect rather than malignant potential. Surgical resection is curative, but complete resection is often challenging due to the location of these tumours. Alpha-fetoprotein (AFP) should be followed as a marker of incomplete resection or recurrence (7). Interpretation of serum AFP in the neonatal period is challenging as levels are normally elevated at birth and decline over the first year of life. In this patient, serum AFP was 3225 ng/mL prior to resection, 40.5 ng/mL at 2 months and 1.5 ng/mL at 1 year of age. Yearly MRI has not shown evidence of recurrence. The patient is now 5-year old. He is growing appropriately and performing well in school.

Giant primary retroperitoneal teratoma in an adult female patient: A case report

The retroperitoneum is an uncommon location for teratoma in adults. The current study presents the case of a rare giant primary retroperitoneal teratoma in a 55-year-old female. The clinical manifestations, diagnosis and surgical treatment procedure of this case are retrospectively reviewed. The patient presented with a complaint of an abdominal palpable mass and fullness for 1 month. The patient suffered a massive hemorrhage during the first exploratory laparotomyand only a small section of the tumor was resected. Pathology revealed a mature retroperitoneal teratoma. Eleven months after the first surgery, the tumor was resected successfully at the second laparotomy. The surgical specimen was a large tumor mass measuring 22×18×10 cm in size and weighing 6 kg. At follow-up, the patient was in a stable condition. This case study highlights the importance of imaging for the development of a pre-operative strategy and performing a safe surgical excision in giant retroperitoneal teratoma cases.

Primary carcinoid tumor in a retroperitoneal mature teratoma: report of a case

Primary retroperitoneal teratoma in an adult is rare, as is the occurrence of a malignant tumor within a mature teratoma, known as "malignant transformation". A 24-year-old woman was admitted to our hospital for investigation of an abdominal mass. Computed tomography and magnetic resonance imaging revealed a multilocular mass in the right upper abdomen. The tumor consisted of fat, soft tissue, and bone, with a slightly enhanced solid component. The tumor was diagnosed preoperatively as a retroperitoneal mature teratoma with an immature component, and excised. Histologically, it was composed mainly of mature fat, soft tissue, and bone, accompanied by a solid component of prostate-like tissue. In addition, a latent carcinoid tumor was recognized in the middle of the tumor. The tumor was finally diagnosed as a primary carcinoid tumor within the retroperitoneal mature teratoma. The patient has been followed-up for 24 months since her operation without any evidence of recurrence. We report this case to highlight the possibility of malignant transformation in adult retroperitoneal teratoma, even when the preoperative diagnosis is benign mature teratoma.

A benign teratoma presenting as an obstruction of the nasal cavity: a case report

IntroductionTeratoma refers to a neoplasm that recapitulates all three germ layers. Teratomas may be histologically mature and oncologically benign. Teratomas may also be histologically immature while being oncologically benign, or they may harbor malignant components and have the potential to exhibit an aggressive biological behavior. Teratomas of the head and neck are extremely rare and usually present in the neonatal period. As a general rule, pediatric teratomas of the head and neck tend to be oncologically benign, whereas adult teratomas tend to be histologically and oncologically malignant. Most of these teratomas are found in the cervical region and nasopharynx. Calcification within the mass is often evident.Case presentationA 27-year-old Caucasian man complaining of a nasal obstruction was admitted to our clinic in January 2006. A transnasal endoscopic examination revealed a mass arising from the nasal septum which was completely removed using an endoscopic approach. Histologically, it was determined to be a benign teratoma.ConclusionHerein, we present a rare case, along with a review of the related literature, in order to emphasize that a benign teratoma of the nasal septum should not be ignored.

胃憩室内胃癌を合併した成人胃奇形腫の1例

胃憩室内胃癌を合併した成人胃奇形腫の1例

Malignant Immature Teratoma of the Larynx and Trachea with Functional Osteocutaneous Free Flap Reconstruction

Malignant Immature Teratoma of the Larynx and Trachea with Functional Osteocutaneous Free Flap Reconstruction

Pure testicular teratoma in adults: Experience in the treatment of 49 consecutive cases

The aim of the present study is to analyse fate and survival in patients with pure testicular teratoma (PTT) according to clinical stage (CS) and applied therapy. Among a survey of 1275 patients with nonseminomatous germ cell testicular tumors (NSGCT) observed from January 1982 and June 2005, we indentified 49 (4%) patients with PTT. In CS I, 3 (15%) of 20 patients on surveillance relapsed. Complete response (CR) is achieved with chemotherapy in 1 patient and combined with postchemotherapy retroperitoneal lymphadenectomy (PC RPLA) in 2 patients (fibrosis 1, teratoma 1). Four patients managed with primary RPLA had universal survival. Among 4 patients treated initially with primary chemotherapy due to persistently elevated serum tumor markers (STMs) postorchiectomy, 1 patient died at 18 months. In CS I, 27 (96%) of 28 patients are alive and free of disease (AFD) at median follow-up (MFU) of 161.6 months. In the PC group, 1 patient with partial response (PR) is lost to follow-up at 6 months, 1 patient died of disease at 27 months. Eight patients achieved CR with induction chemotherapy, whereas only 1 patient relapsed at 24 months and is rendered free of disease with RPLA (teratoma). Twelve patients underwent PC RPLA due to PR following induction chemotherapy, combined with thoracic cytoreductive surgery in 2 patients. RP histology demonstrated the finding of fibrosis in 2, teratoma in 8, teratoma with malignant transformation in 1, and vital carcinoma in 1. The patients with fibrosis, teratoma and teratoma with malignant transformation are AFD, whereas the patient with vital carcinoma on desperation RPLA died. According to initial CS IIB, IIC and III PC surgery was indicated in 20%, 91% and 50%, relapse rate was 0%, 18% and 20%, with disease specific survival (DS ) in 100%, 90% and 100%, respectively. At MFU of 189.7 months, 19 (95%) of 20 fully available patients are AFD. Overall, 46 (94%) patients had no evidence of disease (NED) at last follow-up. These data underscore the metastatic potential of PTT. A significant proportion (32%) of patients with low-stage PTT had RP disease. Furthermore, a high proportion (36%) presented initially with advanced disease and demonstrated a considerable risk of relapse despite complete resection or favorable histologic features in the resected surgical specimen.

OLIGODENDROGLIOMA ARISING IN A MATURE CYSTIC OVARIAN TERATOMA IN A CHILD

In childhood mature cystic teratomas are the most common type of ovarian germ cell tumors. Tumors of neuroepithelial origin are extremely rare in mature teratomas. To the authors’ knowledge, this is the first case report oligodendroglioma arising in a mature cystic ovarian teratoma in children. A 13-year-old girl presented with a history of pelvic pain for 2 months. An ultrasound examination showed a monolateral multicystic, calcific ovarian mass, measuring approximately 6 × 5 cm, arising in the left over and adnexia, suggesting a teratoma. An exploratorative laparotomy and ooferectomy were performed. On histopatological examination, various samples from cystic areas had mature tissues from all 3 germ cell layers, including skin, bone, bronchial structures, and cerebellum. Sections from solid areas showed uniform population of monotonous, rounded cells with indistinct cytoplasm and having perinuclear halo (fried-egg appearance) on a fibrillary, neuropilic background. Microcalcifications as calcospherites were noted in the stroma. Based on the typical morphological features, the cased was diagnosed as mature cystic teratoma with low-grade oligodendroglioma. To the authors’ knowledge, there are a few reports in the literature of an oligodendroglioma arising in an ovarian teratoma in adults and this presented patient is the first case in childhood.

Adult cervical intramedullary teratoma: first reported immature case

Intramedullary teratomas, particularly adult cervicothoracic lesions, are extremely rare. Up to now only 6 cases of intramedullary cervical teratomas have been reported in adults, and all of these were histologically mature. The authors present the case of a 35-year-old man with progressive myelopathic symptoms who was admitted through an outpatient clinic and was surgically treated. The characteristics, diagnosis, epidemiology, and treatment of cervical intramedullary teratomas in adults are also reviewed. Postoperative MR imaging showed that the tumor had been near totally removed, and severely adherent tissue remained ventrocranially with tiny focal enhancement on follow-up MR imaging. Pathological examinations revealed immature teratoma without any malignant component. Adjuvant therapy was not performed. Although no change in neurological findings and symptoms was apparent postoperatively, lesion regrowth was demonstrated on MR imaging 4 months after surgery. At 8 months postoperatively, myelopathic symptoms had developed and a huge intramedullary tumor recurred according to MR imaging. This case is the seventh reported instance of intramedullary cervical teratoma in an adult, and the first case report of the immature type with malignant features.