Adult Teratoma Research Articles

Intramedullary cervical teratoma in an adult

Background and context Mature teratomas are extremely rare spinal tumors, and in the cervical spine presentation in an adult it is even more infrequent. To the best of our knowledge, only five previous intramedullary teratomas in an adult cervical spine have been reported. Purpose Here, we present another case of a cervical intramedullary mature teratoma in an adult and review the literature. Study design and setting Case report and review of the literature. Patient sample Thirty-four-year old man with initial symptoms of numbness of his left fingers, and later brachialgia of the whole arm. The diagnosis from initial manifestation of symptoms was relatively long (11 years). Method Case review and Medline/Internet search using key word adult, teratoma, cervical spine, and intramedullary. Result Case report presented. Only five cases of intramedullary cervical teratoma were found in the world literature. Conclusion Cervical intramedullary teratomas in adults are rare entities. The indolent nature of the condition often leads to late presentation. Surgery can result in good outcome and complete cure. This is, to our knowledge, only the sixth case of cervical teratoma in an adult.

AN ADULT MAN PRESENTING WITH HEMOPTYSIS DUE TO MATURE TERATOMA WITH RUPTURE INTO THE BRONCHUS AND PERICARDIUM AND COMPLICATED BY HAEMOPHILUS INFLUENZAE INFECTION

INTRODUCTION: Mediastinal mature teratomas (MTT) in adults are uncommon typically asymptomatic tumors that arise in the anterior mediastinum. Usually, they are benign and resectable. Seldomly, they rupture into adjacent cardiothoracic structures. Hemoptysis as a presenting symptom is rare. Among adults, bacterial infection complicating MMT rupture has not been described. We report a man who presented with hemoptysis and infected MMT.

Diagnosis and treatment of sacrococcygeal teratoma in adults: analysis of 17 cases

To investigate the diagnosis and treatment of sacrococcygeal teratoma in adults. The clinical data of 17 patients with sacrococcygeal teratoma confirmed by pathological examination, 9 males and 8 females, aged 20 - 53, were analyzed retrospectively. Correct diagnosis was made pre-operatively in 13 of the 17 patients. Two cases were misdiagnosed as with leiomyoma, and 2 cases as with sacrococcygeal cyst. Pathological examination confirmed the diagnosis of teratoma in all 17 cases. Thirteen patients were followed up for 1 - 5 years post-operatively. Malignant change was seen in 1 case, and 1 patient died 1 year after operation. Two patients suffered a relapse and then fully recovered after re-operation, and the other 15 patients all recovered without relapse. Sacrococcygeal teratoma in adults usually has no typical clinical symptom and signs and is often misdiagnosed. The pathologic examination is the base to make a definite diagnosis. Complete excision is necessary to prevent local recurrence and potential malignant transformation. The sacrococcygeal approach or combined abdominal-sacral approach is recommended.

サルモネラ感染を合併した成人仙尾部成熟奇形腫の１例

Salmonellaは経口感染し食中毒を引きおこすが，まれに腸管外に感染病巣を形成する．今回，仙尾部奇形腫がSalmonellaの感染病巣になった1例を経験したので報告する．症例は20歳の女性で，尾骨部に疼痛があり，症状が増強し前医を受診した．CTで骨盤部に嚢胞性腫瘤を認め卵巣嚢腫を疑い緊急手術となった．卵巣は異常なく骨盤腔に嚢胞があり，切開し血膿性の内容740ml吸引した．培養よりSalmonella O7群が検出された．術後には菌陰性となり退院した．しかし，翌月再び尾骨痛，発熱が出現し当院に紹介受診となった．CT·MRIで仙骨前面に大きさ約10cmの嚢胞性腫瘤を認めた．嚢胞感染と考え傍尾骨から経皮的嚢胞穿刺ドレナージをした．培養でSalmonella O7群が再度検出された．ドレナージ後残存する嚢胞に対し仙尾部奇形腫を疑い経仙骨的に尾骨とともに摘出した．病理組織学的検査で3胚葉成分を認め成熟奇形腫と診断した．

VID-06.02: Retroperitoneal lymph node dissection for testicular teratoma in a patient with horseshoe kidney

Mature testicular teratoma in adults could have both clinical and histological malignant evolution. In this video, we will present RPLND for left mature testicular teratoma with retroperitoneal deposits in a patient with horseshoe kidney.

An Overview of Testicular Germ Cell Tumors

More than 90% of testicular neoplasms originate from germ cells. Testicular germ cell tumors (GCTs) are a heterogeneous group of neoplasms with diverse histopathology and clinical behavior. To help the readers distinguish various subtypes of GCTs, to highlight the clinical manifestations and pathologic features of these tumors, and to review several newly developed immunohistochemical markers for GCTs. Review of the pertinent literature and our experience. The etiology of GCTs is largely unknown. Cytogenetic studies suggest a different pathogenesis for each group of infantile/prepubertal GCTs, postpubertal GCTs, and spermatocytic seminoma. Unclassified intratubular germ cell neoplasia is the precursor of all GCTs, excluding spermatocytic seminoma and infantile/prepubertal GCTs. Seminoma, the most common GCT in adults, does not occur before 5 years of age. Spermatocytic seminoma, a tumor of elderly men, typically has an indolent clinical behavior, but rarely it undergoes sarcomatous transformation associated with an aggressive behavior. Embryonal carcinoma is the most common component in mixed GCTs. Eighty percent or more of embryonal carcinoma component and vascular invasion are recognized predictors of occult metastasis for clinical stage I mixed GCTs. Most patients with prepubertal yolk sac tumor, the most common pediatric GCT, have stage I disease at presentation. Most choriocarcinomas present with metastatic symptoms because of the propensity for rapid hematogenous dissemination. Teratomas in children regardless of maturity and dermoid cysts in adults are benign; in contrast, teratomas in adults have a malignant behavior. With appropriate therapy, the majority of testicular GCTs are curable.

Sacrococcygeal teratoma [SCT] in adults: Report Of A Case And Literature Review

Background: Sacrococcygeal teratomas [SCT] are derived from embryonic germ-cell layers and are mostly encountered in infants. In adults, this entity is extremely rare and always worrisome for malignancy. Methods: The authors present a case of a 42-year-old woman with the pathologic diagnosis of SCT. The clinical presentation, the histologic findings and the patients' clinical outcome are described. A review of the literature on SCT in adults is also presented. Results: In this patient, who had no evidence of recurrence after adequate resection, examination of the specimen showed mature SCT. Conclusion: Although rare in adults, SCT should be considered in the differential diagnosis of patients with a pelvic mass presenting with obstructive symptoms. Modern imaging techniques may be helpful to delineate the extent of the mass, and surgical removal is generally indicated at the time of detection. Sacrococcygeal mature teratoma is surgically curable if the lesion is completely resected. The presence of malignant transformation is associated with a less favorable outcome. SUMMARY The sacrococcygeal area is the most frequent site of teratoma in infancy. This tumor rarely presents in adulthood, and is confined mostly to the intrapelvic space. Most common are benign, also called mature teratomas. We report a case of adult saccroccocygeal teratoma treated in our hospital, and a literature overview.Introduction The sacrococcygeal area is the most frequent site of teratoma in infancy [ 1]. A female, rather than male, predominance exists [ 2, 3]. This tumor rarely presents in adulthood. Unlike teratomas in infants, which are externally visible in 90% of cases, sacrococcygeal teratomas in adults are confined mostly to the intrapelvic space [ 4]. Most common are benign,

Malignant Teratoma of the Thyroid: Case Report

Teratomas in the neck are rare neoplasms. Most of them occur in infants less than 1 year and are benign. In contrast, thyroid teratomas in adults are malignant and have fatal outcomes because of spread of tumor refractory to treatment. We report a case of a primary thyroid malignant teratoma in a 37-year-old woman. She was treated successfully with a combination of surgery, postoperative cis-platinum-based chemotherapy, and radiation therapy to the neck. Although the time of follow-up is short (24 months), we attribute her successful outcome to the use of this intensive therapeutic approach.

Adenocarcinomas arising from primary retroperitoneal teratoma in an adult female patient

Presented herein is a case of primary retroperitoneal teratoma with adenocarcinomatous transformation predominantly composed of signet ring cell carcinoma and intestinal-type adenocarcinoma in a 36-year-old woman. Retroperitoneum is an infrequent location for teratoma in adults and malignant transformation is exceptionally rare. Clinical manifestations, radiological studies, laboratory investigation, and pathological findings of this case are described. To the best of the authors' knowledge, 16 adult cases of primary retroperitoneal teratoma with malignant change have been reported in the literature. Herein is reported the first case of malignant teratoma with prominent component of signet ring cell carcinoma.

Benign Thyroid Teratomas Manifest Painful Cystic and Solid Composite Nodules: Three Case Reports and a Review of the Literature

Benign thyroid teratomas are rare in adolescents and adults. We report on three cases of benign thyroid teratomas that presented as painful tumors in the neck after puberty. The tumor adjacent to the thyroid in each case showed rapid enlargement with predominant cystic lesions within several months. Ultrasonography and computed tomography revealed few findings suggesting the origin of the tumor. Cytological examination and culture of the aspirate failed to show cells originating from the thyroid or infectious findings, but revealed a small population of columnar epithelial cells or squamous epithelial cells. Chemical analysis of the aspirate showed levels of pancreatic enzymes higher than those in serum. The accumulation of cystic fluid in each case was refractory to drainage treatment or percutaneous ethanol injection therapy. The patients subsequently underwent resection of the tumor, and microscopic examination revealed various types of tissue including pancreas, adipose, cartilage, muscle, and skin, and the cystic wall was lined by gastric, intestinal, respiratory, and stratified squamous epithelium. Surgical resection was curative, and subsequent histologic examination revealed mature benign teratomas of the thyroid. The main characteristic of our cases presented the painful tumors due to the enlarged cystic formation lined by a variety of different types of epithelium, which agreed with previous cases of benign thyroid teratomas in adolescents and adults.

Positronenemissionstomographie (PET) zur Diagnostik und zum Therapiemonitoring bei urologischen Tumoren

Positron emission tomography (PET) using ((18)F)2-fluoro-D-2-desoxyglucose (FDG) has been shown to be a highly sensitive and specific imaging modality in the diagnosis of primary and recurrent tumors and in the control of therapies in numerous non-urologic cancers. It was the aim of this review to validate the significance of PET as a diagnostic tool in malignant tumors of the urogenital tract. A systematic review of the current literature concerning the role of PET for malignant tumors of the kidney, testicles, prostate, and bladder was carried out. The role of FDG PET for renal cell cancer can be seen in the detection of recurrences after definitive local therapy and metastases. The higher sensitivity of PET in comparison to other therapeutic modalities (CT, ultrasound, MRI) in recurrent and metastatic renal cell cancer suggests a supplemental role of this diagnostic procedure to complement other imaging modalities.The clinical value of PET is established for the identification of vital tumor tissue after chemotherapy of seminomatous germ cell tumors. This diagnostic method has little significance for primary tumor staging and diagnosis of non-seminomatous germ cell tumor because of the high probability of false-negative results in adult teratomas. FDG PET is not sensitive enough in the diagnosis of primary or recurrent tumors in prostate or bladder cancer. Also PET did not prove to be superior to conventional bone scintigram in the detection of mostly osteoblastic metastases in prostate cancer. The recent use of alternative tracers, which are partly not eliminated by urinary secretion (acetate, choline) has increased the sensitivity and specificity of PET also in this tumor entity so that further clinical investigations are needed to validate these technical modifications in their significance for this imaging modality. PET appears to be sufficiently evaluated only for the diagnostic follow-up of patients with seminomatous germ cell tumors after chemotherapy to regard it is the diagnostic tool of first choice. For all other tumors of the urogenital tract this proof is still awaited.

Sacrococcygeal teratoma and teratocarcinoma

Although relatively rare, teratomas represent the most common neoplasm of the newborn period and the sacrococcygeal position is the most frequent extragonadal site. Teratomas are tumors that contain elements derived from more than one of the embryonic germ layers and generally all three. Roughly 60% of all sacrococcygeal teratomas contain only benign mature tissue while the remainder of tumors is divided between embryonic and malignant tissue. Fetal interventions including in utero tumor debulking, complete resection, or percutaneous coagulation of the main blood supply with radiofrequency ablation have been attempted under defined circumstances. Prompt recognition and complete surgical excision, regardless of tumor size or patient age is crucial to outcome. Teratomas and teratocarcinomas are congenital presacral lesions, which comprise 66% of all retrorectal tumors and cysts in adults. Diagnosis of retrorectal teratoma in adults is challenging, requiring thorough knowledge of pelvic anatomy and a high index of suspicion. Finally, occasionally teratocarcinomas are advanced and not resectable at presentation. Radiotherapy may have a role in palliation, but chemotherapy has not been found useful.

Mature teratoma arising in intraabdominal undescended testis in an infant with previous inguinal exploration: Case report and review of intraabdominal testicular tumors in children

The authors report the youngest case of postoperative intraabdominal mature testicular teratoma in a 5-year-old boy after previous exploration for impalpable testis. A total of 26 cases of intraabdominal testicular tumor in children including our case were reviewed and discussed from both the English- and the Japanese-language literature. The average age was 2.5 years, and, in the 13 children younger than 1 year there were no malignant teratomas, although there was one immature teratoma. Four of these had undergone previous inguinal exploration in which 3 patients except our patient were more than 10 years old. This case report confirms the importance of finding an intraabdominal testis at operation for impalpable testis. Early detection of the testicular location near the internal inguinal ring in these patients supports the hypothesis that the intraabdominal testicular teratoma itself may have been the primary cause of the undescended testis. Furthermore, it is suspected that many of the intraabdominal testicular malignant teratomas in adults may have arisen from these mature testicular teratomas in infants. J Pediatr Surg 37:1236-1238. Copyright 2002, Elsevier Science (USA). All rights reserved.

Adult primary teratoma of the testis--report on 5 cases in clinical stage I disease.

Testis pure teratoma accounts for 2.7% to 3% of all germ cell tumors in adult where it behaves as a malignant neoplasm. Pure teratoma of the testis presents in clinical stage I disease in 44% of the patients whose risk of having pathological stage II disease is 16.7% to 19.2%. Herein we report on 5 cases of adult pure teratoma of the testis presenting itself in clinical stage I disease. From September 1976 to February 2000, 75 patients underwent orchidectomy for clinical stage I nonseminomatous germ cell cancer of the testis. Testis pure teratoma was detected in 5 patients (7%). Testis tumor markers were evaluated in all cases. Patients underwent imaging examination to detect the clinical stage of the disease. Treatment options after orchidectomy included retroperitoneal lymph node dissection (RPLND) in 4 patients and surveillance in 1. The average age of the patients was 31 years (range 24-45). The tumor was on the left sided in 3 cases (60%) and right in 2 (40%). Tumor average size was 3.2 cm (rang 1-6). Histopathology detected the following subtypes: mature teratoma in 3 cases (60%), immature teratoma in 1 (20%) and teratoma with malignant transformation in (20%). All patients were at clinical stage I disease. Germ cell cancer microscopic metastatic disease including embryonal carcinoma was detected in I dissected lymph node of 1/4 patients (25%). Average follow up was 166 months (range 93-249). All patients were alive and disease free and no relapses were detected during the follow up period. Primary pure teratoma of the testis does not respond to chemotherapy nor does it to radiation therapy. The disease treatment options after orchidectomy for patients with clinical stage I disease include RPLND or surveillance with their relative risks and benefits. RPLND is the chosen treatment because it is both staging and treating. A close a long term follow up is required since pure teratoma metastatic disease may clinically develop after more than 10 years.

術式決定にヘリカルＣＴが有用であった成人仙尾部奇形腫の一例

仙尾部奇形腫は新生児期に発見され手術されることが多く,成人例は稀である.われわれは手術体位や到達法の選択において,嚢胞造影併用ヘリカルCTの多断面再構成像(MPR)及び三次元像(3D)が有用であった成人仙尾部成熟型奇形腫の1例を経験したので報告する.症例は52歳の男性で,殿部の圧迫感を主訴に受診した.注腸,MRIなどの検査所見により仙尾部嚢胞性腫瘍と診断した.術前施行した嚢胞造影併用ヘリカルCTのMPRにて任意の断面にて腫瘍及び周囲臓器を観察,3Dにて仙尾骨及び骨盤との関係をシュミレーションし,体位,到達法を決定した.体位はjack-knife位とし経仙骨的に腫瘍及び尾骨と第5仙椎を摘出したが,容易に,確実に手術が訂能であった.患者は術後,排便排尿機能障害を呈することもなく良好に経過した.

Sacrococcygeal teratoma in adults

The sacrococcygeal area is the most frequent site of teratoma in infants, but it is a rare location for teratoma in adults. The authors report two patients in their sixth decade of life with the pathologic diagnosis of sacrococcygeal teratoma. The clinical presentations, the histologic findings, and the patients' clinical outcomes are described. A review of the literature on sacrococcygeal teratoma in adults is also presented. In the first patient, who had no evidence of recurrence after adequate resection, examination of the specimens showed mature teratoma. The second patient had mature teratoma with adenocarcinomatous component and possible leptomeningeal involvement. She died 2 months after the operation. Although rare in adults, sacrococcygeal teratoma should be considered in the differential diagnosis of patients with a pelvic mass presenting with obstructive symptoms. These two cases suggest that sacrococcygeal mature teratoma is surgically curable if teratoma is completely resected. The presence of leptomeningeal involvement and malignant transformation are associated with a less favorable outcome.

LONG-TERM RESULTS FOLLOWING ADJUVANT CHEMOTHERAPY IN PATIENTS WITH CLINICAL STAGE I TESTICULAR NONSEMINOMATOUS MALIGNANT GERM CELL TUMORS WITH HIGH RISK FACTORS

Purpose We determine the efficacy and safety of 2 cycles of adjuvant chemotherapy after orchiectomy in patients with high risk clinical stage I nonseminomatous germ cell tumor of the testis as an alternative to retroperitoneal lymphadenectomy or watchful waiting. Materials and Methods A total of 60 consecutive patients with clinical stage I nonseminomatous germ cell tumor of the testis and 1 or more risk factors were entered into this prospective study. Criteria for high risk were embryonal cell carcinoma, tumor invasion of blood or lymph vessels, or tumor stage pT2 or greater. Chemotherapy consisted of 2 cycles of cisplatin, vinblastine and bleomycin or bleomycin, etoposide and cisplatin. Results Of the 60 patients 1 refused chemotherapy and 1 was lost to followup 1.5 years after treatment. The remaining 58 patients have been followed for a median of 93 months (range 32 to 146). World Health Organization grade 4 toxicity was observed in 9 of the 116 chemotherapy cycles, and consisted mainly of transient neutropenia and thrombocytopenia. No significant long-term sequelae were detected. There was 1 relapse after 22 months in a patient with adult teratoma in the ipsilateral region of the iliac vessels who remained disease-free 85 months after surgical excision of the lesion. Another patient had a seminoma in the contralateral testicle with interaortocaval lymph node metastases 7.5 years after adjuvant chemotherapy. The remaining 56 men are without relapse or contralateral tumor to date. Conclusions We recommend adjuvant chemotherapy as an efficient therapeutic alternative to retroperitoneal lymphadenectomy for high risk nonseminomatous germ cell tumor of the testis.

Extra-Ovarian Mature Teratoma Arising From the Posterior Cul de Sac

Teratomas are germ cell neoplasias consisting of tissue from the three layers of the developing embryo (ectoderm, mesoderm, and endoderm). These tumors are most commonly found within the ovary; extra-ovarian mature teratomas in adults are considered to be rare. A 64-year-old woman, gravida 4 para 4, had an 8×7 cm solid pelvic mass posterior to the uterus by examination and radiologic studies. On exploratory laparotomy, an extra-ovarian mature teratoma arising from the peritoneum in the posterior cul de sac was found. This is the first reported case of extra-ovarian mature teratoma arising from the peritoneum in the posterior cul de sac. Even though extra-ovarian teratomas are rare in adults, they should be considered in the differential diagnosis in a woman with a pelvic mass of unclear origin. (J GYNECOL SURG 15:159, 1999)

Adult primary pure teratoma of the testis. The Indiana experience

Pure testicular teratoma in adults is a relatively rare malignant tumor with the ability to invade and metastasize. Pure teratoma generally is believed to be less aggressive and less likely to progress, to present in lower stages, and to have better survival rates then other forms of germ cell tumor. Consequently, clinical stage A patients with pure testicular teratoma commonly have been considered to be managed best by surveillance. A computerized database search identified 41 patients presenting to Indian University with pure teratoma in the orchiectomy specimen. These patients were further subdivided into four groups based on clinical stage, as follows: Group I, 18 patients with clinical Stage A disease; Group II, 4 patients with clinical Stages A-B1 disease based on questionable computed tomography findings; Group III, 3 patients with clinical Stage B1 disease; Group IV, 16 patients with advanced stage (B3-C) disease. The experience with these patients was reviewed. The overall risk of lymph node metastasis in retroperitoneal lymph node dissection (RPLND) and the risk of relapse after RPLND for patients with low stage pure testicular teratoma (groups I-III) were 40 and 16%, respectively. In patients with clinical Stage A teratoma, the risk of retroperitoneal metastasis in RPLND was 16.7% and the relapse rate was 11.1%. In addition, nearly 37% of referred patients with pure teratoma presented with advanced disease. These data provide additional confirmation of the metastatic potential of pure testicular teratoma. The proper management of the adult clinical stage A patient with primary pure teratoma of the testis should not necessarily differ from the management of any other histologic type of nonseminomatous testicular tumor. Accordingly, histologic diagnosis of pure teratoma should not mandate surveillance. Instead, patients must be given adequate information regarding management options, as are all other patients presenting with clinical Stage A nonseminoma.

Organ Preserving Surgery in Testicular Epidermoid Cysts

Our experience with 18 patients with simple epidermoid cysts of the testis (monodermal teratoma) is reported. In all patients the tumor was enucleated completely and 2 biopsies of the adjacent parenchyma were obtained for exclusion of associated germ cell cancer, scar or carcinoma in situ. There was no evidence of malignancy in any biopsy specimen. Preoperative evaluation included physical examination, testicular sonography, and determination of alpha-fetoprotein and beta-human chorionic gonadotropin levels. Although epidermoid cyst was strongly suggested by sonography, the ultrasonic appearance was not specific and inguinal testicular exploration was required. In 1 patient multiple epidermoid cysts of the right testis were associated with an adult teratoma containing embryonal carcinoma and choriocarcinoma of the left testicle. To our knowledge no similar case has been described in the literature. Based on our results and our experience, we consider tumor enucleation and biopsy of the adjacent parenchyma as adequate treatment for the benign epidermoid cyst. The literature concerning organ sparing surgery in testicular epidermoid cysts is reviewed.