Benign Teratoma Research Articles

Performance of O-RADS MRI Score in Differentiating Benign From Malignant Ovarian Teratomas: MR Feature Analysis for Differentiating O-RADS 4 From O-RADS 2.

The aim of the study is to evaluate the performance of the ovarian-adnexal reporting and data system magnetic resonance imaging (O-RADS MRI) score and perform individual MRI feature analysis for differentiating between benign and malignant ovarian teratomas. In this institutional review board-approved retrospective study, consecutive patients with a pathology-proven fat-containing ovarian mass imaged with contrast-enhanced MRI (1.5T or 3T) from 2013 to 2022 were included. Two blinded radiologists independently evaluated masses per the O-RADS MRI lexicon, including having a "characteristic" or "large" Rokitansky nodule (RN). Additional features analyzed included the following: nodule size/percentage volume relative to total teratoma volume, presence of bulk/intravoxel fat in the nodule, diffusion restriction in the nodule, angular interface, nodule extension through the teratoma border, presence/type of nodule enhancement pattern (solid versus peripheral), and evidence for metastatic disease. An overall O-RADS MRI score was assigned. Patient and lesion features associated with malignancy were evaluated and used to create a malignant teratoma score. χ 2 , Fisher's exact tests, receiver operating characteristic curve, and κ analysis was performed. One hundred thirty-seven women (median age 34, range 9-84 years) with 123 benign and 14 malignant lesions were included. Mean teratoma size was 7.3 cm (malignant: 14.4 cm, benign: 6.5 cm). 18/123 (14.6%) of benign teratomas were assigned an O-RADS 4 based on the presence of a "large" (11/18) or "noncharacteristic" (12/18) RN. 12/14 malignant nodules occupied >25% of the total teratoma volume ( P = 0.09). Features associated with malignancy included the following: age <18 years, an enhancing noncharacteristic RN, teratoma size >12 cm, irregular cystic border, and extralesional extension; these were incorporated into a malignant teratoma score, with a score of 2 or more associated with area under the curve of 0.991 for reviewer 1 and 0.993 for reviewer 2. Peripheral enhancement in a RN was never seen with malignancy (64/123 benign, 0/14 malignant) and would have appropriated downgraded 9/18 overcalled O-RADS 4 benign teratomas. O-RADS MRI overcalled 15% (18/123) benign teratomas as O-RADS 4 but correctly captured all malignant teratomas. We propose defining a "characteristic" RN as an intravoxel or bulk fat-containing nodule. Observation of a peripheral rim of enhancement in a noncharacteristic RN allowed more accurate prediction of benignity and should be added to the MRI lexicon for improved O-RADS performance.

Prenatal Management of High Risk Fetal Sacrococcygeal Teratoma

Introduction: Fetal sacrococcygeal teratomas (SCGT), the most common fetal neoplasm diagnosed in fetuses, are a rare condition with an estimated incidence of 1 in 40,0000 live births. Fetal SCGT is usually suspected when characteristic findings are seen on ultrasound such as a mass that is cystic and/or solid and is located in the sacral region. MRI may also be used to more accurately characterize the tumor and to help distinguish between SCGTs and distal neural tube defects like sacral meningomyelocele. Despite advances in ultrasound and MRI, only approximately 50% are diagnosed prenatally. The detection of fetal SCGT is important because it changes pregnancy monitoring and management as it is associated with fetal hydrops, intrauterine death, polyhydramnios, mirror syndrome, and mortality rates as high as 43%. Once an SCGT has been identified, serial ultrasound evaluation of the fetus, placenta, and SCGT is important to identify early signs of fetal hydrops, fetal anemia, or cardiac failure and to intervene as appropriate. Case Report: A 40-year-old G5P4004 was referred to Maternal Fetal Medicine (MFM) due to findings of a 1 cm mass near the fetal bladder on first trimester ultrasound. She had a level II ultrasound performed by MFM at 16.2 weeks where a 3.6 x 2.3 x 2.6 cm mass was identified. This mass was adjacent to the sacrococcygeal region. Due to its location and characteristic appearance, with both cystic and solid components with high vascularity, a fetal sacrococcygeal teratoma was suspected. There were no signs of hydrops or fetal anemia. At this time, the recommendation for management was: ultrasounds every 2 weeks to assess for hydrops and fetal anemia, growth ultrasound every 4 weeks, an echocardiogram by pediatric cardiology at 22-24 weeks, a fetal MRI at 28 weeks, and delivery between 37-39 weeks or earlier pending clinical course. At 24.2 weeks, she developed polyhydramnios with a maximum vertical pocket (MVP) of 10.5 cm. She had also failed her 1-hour glucose tolerance test with a value of 287 mg/dL. Due to the new finding of polyhydramnios and diagnosis of gestational diabetes, her monitoring was increased to weekly, with biophysical profile (BPP) starting at 28 weeks and weekly nonstress tests (NST) at 32 weeks. A fetal MRI was performed at 26.4 weeks and showed a large lesion extending off the sacrococcygeal region measuring 9.6 x 6.3 x 7.7 cm that was composed of both solid and cystic components. By 32.2 weeks, she developed severe polyhydramnios with an AFI of 36.0 cm and accelerated fetal growth due to an AC &gt; 99th percentile. The last ultrasound she had at 34.2 weeks the SCGT measured 17.7 x 13.3 x 13.6 cm and severe polyhydramnios persisted. The patient went into preterm labor at 35.2 weeks and had a cesarean section due to known SCGT measuring greater than 5 cm. Immediately after delivery, the neonate was evaluated by the neonatal team and transferred to the Neonatal Intensive Care Unit. The infant had surgical resection of the mass and will have tumor markers, AFP and LDH, monitored for development of recurrent immature or mature teratoma. The pathology report confirmed the diagnosis for benign sacrococcygeal teratoma. Discussion: Failure to diagnose a fetal sacrococcygeal teratoma has potentially catastrophic consequences for the fetus and mother. Maternal complications include hyperemesis, preeclampsia, mirror syndrome, preterm labor, and HELLP syndrome. Significant obstetric complications can be as high as 81%. Intrauterine fetal complications include fetal hydrops from high-output failure, fetal anemia, intratumoral hemorrhage, polyhydramnios, genitourinary obstruction leaking to hydronephrosis and or hydroureter. SCGT size &gt;10 cm or tumor with rapid growth has &gt; 50% perinatal mortality. Tumor characteristics associated with higher mortality rates are early diagnosis, solid components, high vascularity, tumor size &gt; 10 cm, and rapid growth &gt; 150 cm3/week. Another way to risk stratify these patients is by calculating a tumor volume to fetal weight ratio (TFR), which if &gt; 0.12 at &lt; 24 weeks is predictive of an overall poor prognosis. When comparing this case to literature review of sacrococcygeal teratomas, the patient’s fetal SCGT would be classified as high risk of mortality due to the tumor characteristics of early diagnosis, TFR at 20 weeks being 0.16, large size, rapid growth, and pronounced vascularity. Overall, in this high risk case of SCGT, the close follow up and evidence-based management with utilization and collaboration of a multidisciplinary team including Maternal Fetal Medicine, NICU, and Pediatric Surgery in a tertiary center resulted in a successful outcome.

Prenatal Management of High Risk Fetal Sacrococcygeal Teratoma

Introduction: Fetal sacrococcygeal teratomas (SCGT), the most common fetal neoplasm diagnosed in fetuses, are a rare condition with an estimated incidence of 1 in 40,0000 live births. Fetal SCGT is usually suspected when characteristic findings are seen on ultrasound such as a mass that is cystic and/or solid and is located in the sacral region. MRI may also be used to more accurately characterize the tumor and to help distinguish between SCGTs and distal neural tube defects like sacral meningomyelocele. Despite advances in ultrasound and MRI, only approximately 50% are diagnosed prenatally. The detection of fetal SCGT is important because it changes pregnancy monitoring and management as it is associated with fetal hydrops, intrauterine death, polyhydramnios, mirror syndrome, and mortality rates as high as 43%. Once an SCGT has been identified, serial ultrasound evaluation of the fetus, placenta, and SCGT is important to identify early signs of fetal hydrops, fetal anemia, or cardiac failure and to intervene as appropriate. Case Report: A 40-year-old G5P4004 was referred to Maternal Fetal Medicine (MFM) due to findings of a 1 cm mass near the fetal bladder on first trimester ultrasound. She had a level II ultrasound performed by MFM at 16.2 weeks where a 3.6 x 2.3 x 2.6 cm mass was identified. This mass was adjacent to the sacrococcygeal region. Due to its location and characteristic appearance, with both cystic and solid components with high vascularity, a fetal sacrococcygeal teratoma was suspected. There were no signs of hydrops or fetal anemia. At this time, the recommendation for management was: ultrasounds every 2 weeks to assess for hydrops and fetal anemia, growth ultrasound every 4 weeks, an echocardiogram by pediatric cardiology at 22-24 weeks, a fetal MRI at 28 weeks, and delivery between 37-39 weeks or earlier pending clinical course. At 24.2 weeks, she developed polyhydramnios with a maximum vertical pocket (MVP) of 10.5 cm. She had also failed her 1-hour glucose tolerance test with a value of 287 mg/dL. Due to the new finding of polyhydramnios and diagnosis of gestational diabetes, her monitoring was increased to weekly, with biophysical profile (BPP) starting at 28 weeks and weekly nonstress tests (NST) at 32 weeks. A fetal MRI was performed at 26.4 weeks and showed a large lesion extending off the sacrococcygeal region measuring 9.6 x 6.3 x 7.7 cm that was composed of both solid and cystic components. By 32.2 weeks, she developed severe polyhydramnios with an AFI of 36.0 cm and accelerated fetal growth due to an AC &gt; 99th percentile. The last ultrasound she had at 34.2 weeks the SCGT measured 17.7 x 13.3 x 13.6 cm and severe polyhydramnios persisted. The patient went into preterm labor at 35.2 weeks and had a cesarean section due to known SCGT measuring greater than 5 cm. Immediately after delivery, the neonate was evaluated by the neonatal team and transferred to the Neonatal Intensive Care Unit. The infant had surgical resection of the mass and will have tumor markers, AFP and LDH, monitored for development of recurrent immature or mature teratoma. The pathology report confirmed the diagnosis for benign sacrococcygeal teratoma. Discussion: Failure to diagnose a fetal sacrococcygeal teratoma has potentially catastrophic consequences for the fetus and mother. Maternal complications include hyperemesis, preeclampsia, mirror syndrome, preterm labor, and HELLP syndrome. Significant obstetric complications can be as high as 81%. Intrauterine fetal complications include fetal hydrops from high-output failure, fetal anemia, intratumoral hemorrhage, polyhydramnios, genitourinary obstruction leaking to hydronephrosis and or hydroureter. SCGT size &gt;10 cm or tumor with rapid growth has &gt; 50% perinatal mortality. Tumor characteristics associated with higher mortality rates are early diagnosis, solid components, high vascularity, tumor size &gt; 10 cm, and rapid growth &gt; 150 cm3/week. Another way to risk stratify these patients is by calculating a tumor volume to fetal weight ratio (TFR), which if &gt; 0.12 at &lt; 24 weeks is predictive of an overall poor prognosis. When comparing this case to literature review of sacrococcygeal teratomas, the patient’s fetal SCGT would be classified as high risk of mortality due to the tumor characteristics of early diagnosis, TFR at 20 weeks being 0.16, large size, rapid growth, and pronounced vascularity. Overall, in this high risk case of SCGT, the close follow up and evidence-based management with utilization and collaboration of a multidisciplinary team including Maternal Fetal Medicine, NICU, and Pediatric Surgery in a tertiary center resulted in a successful outcome.

Non-Syndromic and Syndromic Defects in Children with Extracranial Germ Cell Tumors: Data of 2610 Children Registered with the German MAKEI 96/MAHO 98 Registry Compared to the General Population.

GCTs are developmental tumors and are likely to reflect ontogenetic and teratogenetic determinants. The objective of this study was to identify syndromes with or without congenital anomalies and non-syndromic defects as potential risk factors. Patients with extracranial GCTs (eGCTs) registered in MAKEI 96/MAHO 98 between 1996 and 2017 were included. According to Teilum's holistic concept, malignant and benign teratomas were registered. We used a case-control study design with Orphanet as a reference group for syndromic defects and the Mainz birth registry (EUROCAT) for congenital anomalies at birth. Co-occurring genetic syndromes and/or congenital anomalies were assessed accordingly. Odds ratios and 95% confidence intervals were calculated and p-values for Fisher's exact test with Bonferroni correction if needed. A strong association was confirmed for Swyer (OR 338.6, 95% CI 43.7-2623.6) and Currarino syndrome (OR 34.2, 95% CI 13.2-88.6). We additionally found 16 isolated cases of eGCT with a wide range of syndromes. However, these were not found to be significantly associated following Bonferroni correction. Most of these cases pertained to girls. Regarding non-syndromic defects, no association with eGCTs could be identified. In our study, we confirmed a strong association for Swyer and Currarino syndromes with additional congenital anomalies.

Mature cystic teratoma with co-existent mucinous cystadenocarcinoma: describing a diagnostic challenge—a case report

BackgroundMature cystic teratoma co-existing with a mucinous cystadenocarcinoma is a rare tumor that few cases have been reported until now. In these cases, either a benign teratoma is malignantly transformed into adenocarcinoma or a collision tumor is formed between a mature cystic teratoma and a mucinous tumor, which is either primarily originated from epithelial-stromal surface of the ovary, or secondary to a primary gastrointestinal tract tumor. The significance of individualizing the two tumors has a remarkable effect on further therapeutic management.Case presentationIn this case, a mature cystic teratoma is co-existed with a mucinous cystadenocarcinoma in the same ovary in a 33-year-old Iranian female. Computed Tomography (CT) Scan with additional contrast of the left ovarian mass suggested a teratoma, whereas examination of resected ovarian mass reported an adenocarcinoma with a cystic teratoma. A dermoid cyst with another multi-septate cystic lesion including mucoid material was revealed in the gross examination of the surgical specimen. Histopathological examination revealed a mature cystic teratoma in association with a well-differentiated mucinous cystadenocarcinoma. The latter showed a CK7−/CK20 + immune profile. Due to the lack of clinical, radiological, and biochemical discoveries attributed to a primary lower gastrointestinal tract tumor, the immune profile proposed the chance of adenocarcinomatous transformation of a benign teratoma.ConclusionsThis case shows the significance of large sampling, precise recording of the gross aspects, histopathological examination, immunohistochemical analysis, and the help of radiological and clinical results to correctly diagnose uncommon tumors.

Successful Surgical Management of Giant Mediastinal Teratoma – A Case Report of a Difficult Case without Any Post-Operative Complication

Introduction. Mediastinal teratoma is a rare germ cell tumor, located in anterior mediastinum and is lack of population-based study. It usually occurs in the age of 20-40 years, accounting for 15% of anterior mediastinal masses in adults and 25% of anterior mediastinal masses in children. It is frequently diagnosed accidentally on chest imaging due to its asymptomatic nature. Hereby, we presented a case of giant anterior mediastinum teratoma with complete surgical excision without any post-operative complication. This case is unique due to its uneventful result after excision. From our literature research, we successfully avoid the potential post operative complications of resecting this tumor such as bleeding, wound dehiscence and even death. It is due to early diagnosis, treatment and good intraoperative management of lesion &amp; hemodynamics. Case Report. A 21-year old male was referred from pulmonologist oncologist to our Thoracic Surgical Unit with complains of dyspnea and chest pain. Physical examination showed no lung sounds in (R) hemithorax and was dull to percussion, ictus cordis shifted 2 fingerbreadths towards left-side. Chest X-ray showed a large well-defined lesion in (R) hemithorax and chest CT-scan with contrast showed hypodense mass on (R) hemithorax adhering &amp; compressing the lung, diaphragm, pericardium &amp; chest wall, with estimation size of 60 x 20 x 12 cm, lesion displaced the heart. Patient was then treated with complete surgical excision and found a huge cystic tumor with a size of 60 x 20 x 12 cm adhering to all parts of (R) lung, diaphragm and pericardium. He underwent (R) pneumonectomy due to adhesion. Histologic examination was consistent with mature teratoma. Patient showed no complication after surgery and was discharged uneventfully from our hospital after 5 days. Discussion. Approximately 95% of benign teratomas arise in the anterior mediastinum. The tumor grows progressively, mostly asymptomatic, dyspnea and substernal chest pain are the most common symptoms if present. Productive Cough of hair or sebum is a pathognomonic sign. Chest radiograph typically reveals a well-circumscribed anterior mediastinal mass that often protrudes into one of the lung, they are usually large at the time of diagnosis. Complete surgical excision is a treatment of choice of mediastinal teratoma, which can be performed through median sternotomy or thoracotomy or thoracoscopy. Some patients require additional procedures (eg, lobectomy, pericardiectomy) for complete tumor resection. Conclusion. There is still limited data on mediastinal teratoma. Early referral &amp; treatment show good prognosis. Benign Mediastinal Teratomas was tricky to be diagnosed, when it is diagnosed, it is usually very large in size. Complete Surgical Excision can be performed safely without any complications.

Identification of Germline FOXE1 and Somatic MAPK Pathway Gene Alterations in Patients with Malignant Struma Ovarii, Cleft Palate and Thyroid Cancer.

Germline variants in the FOXE1 transcription factor have been associated with thyroid ectopy, cleft palate (CP) and thyroid cancer (TC). Here, we aimed to clarify the role of FOXE1 in Portuguese families (F1 and F2) with members diagnosed with malignant struma ovarii (MSO), an ovarian teratoma with ectopic malignant thyroid tissue, papillary TC (PTC) and CP. Two rare germline heterozygous variants in the FOXE1 promoter were identified: F1) c.-522G>C, in the proband (MSO) and her mother (asymptomatic); F2) c.9C>T, in the proband (PTC), her sister and her mother (CP). Functional studies using rat normal thyroid (PCCL3) and human PTC (TPC-1) cells revealed that c.9C>T decreased FOXE1 promoter transcriptional activity in both cell models, while c.-522G>C led to opposing activities in the two models, when compared to the wild type. Immunohistochemistry and RT-qPCR analyses of patients' thyroid tumours revealed lower FOXE1 expression compared to adjacent normal and hyperplastic thyroid tissues. The patient with MSO also harboured a novel germline AXIN1 variant, presenting a loss of heterozygosity in its benign and malignant teratoma tissues and observable β-catenin cytoplasmic accumulation. The sequencing of the F1 (MSO) and F2 (PTC) probands' tumours unveiled somatic BRAF and HRAS variants, respectively. Germline FOXE1 and AXIN1 variants might have a role in thyroid ectopy and cleft palate, which, together with MAPK pathway activation, may contribute to tumours' malignant transformation.

Initial surveillance in men with marker negative clinical stage IIA non-seminomatous germ cell tumours.

To assess whether extended surveillance with repeated computed tomography (CT) scans for patients with clinical stage IIA (CS IIA; <2 cm abdominal node involvement) and negative markers (Mk-) non-seminomatous germ cell tumours (NSGCTs) can identify those with true CS I. To assess the rate of benign lymph nodes, teratoma, and viable cancer in retroperitoneal lymph node dissection (RPLND) histopathology for patients with CS IIA Mk- NSGCT. Observational prospective population-based study of patients diagnosed 2008-2019 with CS IIA Mk- NSGCT in the Swedish and Norwegian Testicular Cancer Group (SWENOTECA) registry. Patients were managed with surveillance, with CT scans, and tumour markers every sixth week for a maximum of 18 weeks. Patients with radiological regression were treated as CS I, if progression with chemotherapy, and remaining CS IIA Mk- disease with RPLND. The end-point was the number and percentage of patients down-staged to CS I on surveillance and rate of RPLND histopathology presented as benign, teratoma, or viable cancer. Overall, 126 patients with CS IIA Mk- NSGCT were included but 41 received therapy upfront. After surveillance for a median (range) of 6 (6-18) weeks, 23/85 (27%) patients were in true CS I and four (5%) progressed. Of the remaining 58 patients with lasting CS IIA Mk- NSGCT, 16 received chemotherapy and 42 underwent RPLND. The RPLND histopathology revealed benign lymph nodes in 11 (26%), teratoma in two (6%), and viable cancer in 29 (70%) patients. Surveillance with repeated CT scans can identify patients in true CS I, thus avoiding overtreatment. The RPLND histopathology in patients with CS IIA Mk- NSGCT had a high rate of cancer and a low rate of teratoma.

A curious case of benign ovarian teratoma with multiple malignant tranformations: A histopathologists quagmire

Mature cystic teratomas of ovary are common benign germ cell tumors that constitute about 20% of all the ovarian tumors. These tumors however have a rare potential for malignant transformation 0.17-2% and therefore there is a requirement for intraoperative diagnosis to establish an appropriate line of treatment. Incidence of mature cystic teratoma undergoing multiple types of malignant transformation in the same patient is extremely rare and only a small number of such cases have been published in literature. Histopathology and immunohistochemistry are the gold standard for diagnosis and remains the mainstay for defining the treatment course and prognosis.

The Sonographic Diagnosis and Clinical Management of a Fetal Sacrococcygeal Teratoma: A Case Report

A sacrococcygeal teratoma (SCT) is one of the most common fetal extragonadal germ cell neoplasms and carries high risk of maternal and perinatal complications. An example of a fetal SCT, associated with polyhydramnios, is presented in this case report. An antenatal surveillance sonogram revealed an increase in the size of the teratoma size and the amniotic fluid index. The patient underwent Cesarean delivery and postnatally, the infant’s teratoma was surgically excised. The pathologic examination of the specimen revealed a benign mature teratoma. This case demonstrated the important role that serial sonography had in monitoring this fetal pathology. Prenatal fetal sonographic assessment can play an important role for patients who need counseling and surgical planning.

Malignant struma ovarii- Report of a rare case

Struma ovarii is a highly specialized form of mature ovarian teratoma in which the ovary contains &amp;#62;50% of thyroid tissue. It accounts for 1 – 3% of benign teratomas of the ovary. Malignant transformation is observed in 5-37% cases of struma ovarii. Peak age of incidence 4 - 5th decade with excellent prognosis. We report a rare form of malignant struma ovarii, composed of a follicular variant of papillary thyroid carcinoma with capsular invasion. A65-year-old hypertensive postmenopausal female presented with complaints of pain in abdomen, pelvic mass, frequent micturition, since 3 days. A pelvic sonogram showed an enlarged heterogenous right ovarian mass of sized 12 x 9 x 5 cm, with solid cystic lesion. Left ovary was unilocular and cystic of sized 5.5 x 4 x 3 cm. The uterus and cervix appeared to be normal. She underwent an exploratory laparotomy, and a total abdominal hysterectomy with bilateral salpingo-oophorectomy. Based on histopathological and radiological features an impression of follicular variant of papillary carcinoma of thyroid with capsular invasion was favoured. : The patient was successfully treated with total abdominal hysterectomy with bilateral salpingo-oopherectomy. There are no sign of recurrence and metastasis two months after surgery. Patient is under regular follow up. : Malignant struma ovarii is a medical rarity and very few studies have been reported.

Rare and Unusual Cause of Adults Epistaxis

Mature teratomas, or teratoid tumors, or benign teratomas, of the nasal cavity and sinuses are exceptional the diagnosis is histopathological and shows within the lesion different types of tissue: fat, glial, muscular, cartilaginous, bone and respiratory. Teratomas are rare congenital neoplasms that originate from pluripotent cells. In this article, we report the first case of a nasal teratoma. We also discuss methods for diagnosing and treating upper respiratory teratomas, and include a brief literature review.

Adipose Tissue-Derived Stromal/Stem Cells Transplantation with Cholecalciferol Supplementation in Recent-Onset Type 1 Diabetes Patients: Twelve Months Follow-Up.

To evaluate safety and therapeutic effect along 12 months of allogenic adipose tissue-derived stromal/stem cells (ASCs) transplantation with cholecalciferol (VITD) in patients with recent-onset type 1 diabetes (T1D). Prospective, phase II, open trial, pilot study in which patients with recent onset T1D received ASCs (1xKgx106 cells) and VITD 2000UI/day for 12 months (group 1) and were compared to controls with standard insulin therapy (group 2). Adverse events, C-peptide area under the curve (CPAUC), insulin dose, HbA1c and frequency of FoxP3+ in CD4+ or CD8+ T-cells(flow cytometry) were evaluated at baseline(T0), after 3(T3), 6(T6) and 12 months(T12). Eleven patients completed follow up (7:group 1;4:group 2). Group 1 had lower insulin requirement at T3(0.24±0.18vs0.53±0.23UI/kg,p=0.04), T6(0.24±0.15vs0.66±0.33 UI/kg,p=0.04) and T12(0.39±0.15vs0.74±0.29 UI/Kg,p=0.04).HbA1c was lower at T6 (50.57±8.56vs72.25±10.34 mmol/mol,p=0.01), without differences at T12 (57.14±11.98 in group 1 vs. 73.5±14.57 mmol/min in group 2, p=0.16). CPAUC was not significantly different between groups at T0(p=0.07), higher in group 1 at T3(p=0.04) and T6(p=0.006), but similar at T12(p=0.23). IDAA1c was significantly lower in group 1 than group 2 at T3,T6 and T12 (p=0.006, 0.006 and 0.042, respectively). IDDA1c was inversely correlated to FoxP3 expression in CD4 and CD8+ T cells at T6 (p<0.001 and p=0.01, respectively). In group 1, one patient had recurrence of a benign teratoma that was surgically removed, not associated to the intervention. ASCs with VITD without immunosuppression were safe and associated lower insulin requirements, better glycemic control, and transient better pancreatic function in recent onset T1D, but the potential benefits were not sustained.

Integrated genomic analysis reveals aberrations in WNT signaling in germ cell tumors of childhood and adolescence

Germ cell tumors (GCTs) are neoplasms of the testis, ovary and extragonadal sites that occur in infants, children, adolescents and adults. Post-pubertal (type II) malignant GCTs may present as seminoma, non-seminoma or mixed histologies. In contrast, pre-pubertal (type I) GCTs are limited to (benign) teratoma and (malignant) yolk sac tumor (YST). Epidemiologic and molecular data have shown that pre- and post-pubertal GCTs arise by distinct mechanisms. Dedicated studies of the genomic landscape of type I and II GCT in children and adolescents are lacking. Here we present an integrated genomic analysis of extracranial GCTs across the age spectrum from 0–24 years. Activation of the WNT pathway by somatic mutation, copy-number alteration, and differential promoter methylation is a prominent feature of GCTs in children, adolescents and young adults, and is associated with poor clinical outcomes. Significantly, we find that small molecule WNT inhibitors can suppress GCT cells both in vitro and in vivo. These results highlight the importance of WNT pathway signaling in GCTs across all ages and provide a foundation for future efforts to develop targeted therapies for these cancers.

Cervical Benign Teratoma: Case Report and Review of Literature.

The online version contains supplementary material available at 10.1007/s12070-023-03748-8.

Case Report of Endometrial Polyp with Bilateral Cystic Teratoma Ovary

Benign ovarian teratomas or dermoid cysts are the commonest germ cell tumour of ovaries, accounting for 10 to 15% of all ovarian tumours. The common age of presentation includes women's reproductive age group and post-menopausal age. These lesions can be benign, like mature teratoma or malignant, like immature teratoma, yolk sac tumour, and mixed germ cell neoplasm. These lesions are usually asymptomatic, or they can present with varying symptoms and signs. Diagnosis includes imaging and measurement of levels of tumour markers. Here we report a case of a 48-year-old woman who presented with menorrhagia for four years. The patient initially underwent dilation and curettage for similar complaints in the past, following which her cycles regularized. Later the patient was started on medications for the recurrence of symptoms. Examination revealed no abnormalities. The patient was further investigated with ultrasound and MRI pelvis and proceeded with bilateral salpingo-oopherectomy. Biopsy revealed features suggestive of benign ovarian teratoma. The patient has managed accordingly and is in regular follow-up. Benign ovarian tumours are mostly asymptomatic or present with nonspecific symptoms, of which abdominal pain and mass are seen in many cases. The commonest of these tumours is a benign mature cystic teratoma or dermoid cyst, which is bilateral. Though only one per cent contain a secondary malignancy arising from one of their components, early recognition and timely intervention are necessary to avoid untoward complications. Therefore, we recommend follow-up of such cases with radiological and blood investigations.

A carcinoid arising within an ovarian teratoma: a case report

Benign teratoma is the most common germ cell tumour found in the ovary. One to three percent of these are found to harbour somatic neoplasms,1 of which squamous cell carcinoma, adenocarcinoma and sarcoma account for 95%.2 The first report of a carcinoid presenting in bronchial mucosa, within a teratoma was made in 20183 and we present a similar rare case in a 54 year old female. The patient underwent a total laparoscopic hysterectomy and bilateral salpingo-oophorectomy. Macroscopically the left ovary measured 45 mm, with a smooth external surface and contained two cysts.

CT FINDINGS OF THREE GIANT MEDIASTINAL TUMORS IN YOUNG AGE

Background : Mediastinal teratoma and other mediastinal tumors are very challenging to be distinguished from other mediastinal tumors. Mediastinal tumors can be optimally evaluated with computed tomography (CT). In this paper we present three young male patients with similar symptom of chronic chest pain and chronic cough. Materials and Methods: Conducting a literature review and medical records. Results : All patients in this case are young age male, below two decades. All chest CT shows giant mass, but they have different enhancing pattern, different amount of solid, cystic, calcification component. To make correct diagnosis of the mediastinal mass is important because of treatment planning difference, surgery or chemoteraphy. The first case shows benign teratoma with characteristic of heterogenous mass with large amount of fat, with presence of solid and calcification component. The second case shows malignant germ cell tumor with feature of heterogenous mass with predominantly solid component and small amount of fat. It also shows metastatic process in lung and bone. The third case shows Hodgkin lymphoma with slight enhanced mass that narrowed pulmonary artery and caused pericardial effusion. Conclusion: Various features of mediatinal tumors can be distinguished with CT modality.

ODP493 Malignant Struma Ovarii with Papillary Thyroid Carcinoma and concomitant High Risk Thyroid Nodule

Abstract Introduction Struma ovarii is a rare teratoma consisting of &amp;gt;50% thyroid tissue. Malignant transformation very seldomly occurs; most pathology shows papillary thyroid carcinoma. The risk and prevalence of concurrent thyroid gland neoplasm is unclear. Thyroid cancer surveillance post-oophorectomy in these patients may be pertinent but has not yet been established. Case Report A nulliparous 54 year-old woman with one year of menopause without HRT had pelvic and back pain. Imaging detected bilateral ovarian teratomas. Pathology from laparoscopic bilateral salpingo-oophorectomy revealed a 10.7×9.9×10.9cm noninvasive struma ovarii with focal papillary thyroid carcinoma of the left ovary and a benign teratoma of the right ovary. Importantly, the patient had a known thyroid nodule. Two years prior, a FNA of the 1.4cm hypoechoic, hypervascular nodule in the left lower pole yielded benign (Bethesda 2) cytology. After struma ovarii resection, thyroid ultrasound showed highly suspicious TIRAD5. She denied symptoms of hyper- or hypothyroidism and had a normal TSH. She consequently underwent two FNA biopsies, both of which were non-diagnostic. The patient deferred further attempts. History of an initial benign biopsy and stability of the nodule size provide some reassurance. With the patient's reluctance for surgery, serial thyroglobulin (Tg) and ultrasounds will be followed. Post-operative Tg was normal with negative Tg antibody. If Tg becomes markedly elevated, a thyroidectomy will be indicated. Discussion Given the TIRAD5 nodule, this patient's risk of thyroid malignancy is 60-70%. This is compounded with her setting of malignant struma ovarii, which may imply genetic predisposition for thyroid carcinogenesis. Since cytology could not be obtained on the two recent biopsies, definitive pathology by diagnostic lobectomy or thyroidectomy may be considered. A total thyroidectomy would provide the advantage of following Tg for cancer surveillance of both thyroid and ovarian malignancies. There is scant evidence on the treatment of malignant struma ovarii. A few small case series and a pooled review of 57 cases of low-risk (confined to the ovary) malignant struma ovarii in which 50 patients did not undergo thyroidectomy/I-131 ablation showed only a 7.5% recurrence rate at 25 years (Marti et al Thyroid 2012 Apr; 22 (4): 400-406). Hence, this study recommends reserving prophylactic thyroidectomy for patients with extra-ovarian extension or metastases. Treatment of malignant struma ovarii may be extrapolated from those used in differentiated thyroid cancer; high-risk lesions would be those measuring &amp;gt;4cm, have local or distant invasion, or have a BRAF mutation (indicating an aggressive tumor). In conclusion, conservative measures of the thyroid gland with a suspicious nodule may be acceptable in patients with noninvasive malignant struma ovarii, provided strict adherence to cancer surveillance of Tg with both thyroid and pelvic sonography. Presentation: No date and time listed

Management of Sacrococcygeal Teratoma in a Center Hospital Environment in Senegal

Sacrococcygeal teratoma (TSC) is an embryonic tumor with high potential for congenital malignant transformation. It is rare and therefore considered a neonatal surgical emergency. The authors report a case of sacrococcygeal teratoma whose mother did not follow up during pregnancy and the delivery took place at home and who comes for consultation six months after his birth. It emerges from this case that the delay in diagnosis was due to the lack of financial means in the periphery, the extreme surgery could be performed with simple post-operative follow-ups. The result of the anatomopathological examination of the surgical specimen concluded to a benign teratoma. The patient could not be reassessed in the medium and long term because he is lost of seen.