Teratomas In Children Research Articles

Antenatal teratoma sacrococcygeal in a three month old children in Indonesia: a rare case report

Sacrococcygeal teratoma is a type of germinal cell tumor in children, usually observed in the prenatal or antenatal phases. In either phase, sacrococcygeal teratoma may cause complications that lead to increased risk of morbidity and mortality. A proper screening and management for sacrococcygeal in children are mandatory for the best outcome. Currently, surgical resection is the most promising treatment to manage antenatal sacrococcygeal teratoma in children. Three-month-old female children were brought to the hospital with a growing 8.4 cm mass since birth in her groin. The mass was painless and soft in consistency. Computed tomography (CT) scan revealed a dominant solid lesion accompanied by multiloculated fluid density arising from right gluteal muscle. The patient planned for surgical excision. Hyperkalemia was observed prior to the operation; hence an appropriate correction was needed before surgery. Germ cell tumors, though uncommon, may develop beyond the gonadal region, such as in the brain, neck, mediastinum, and retroperitoneum. In neonates and fetuses, these tumors frequently originate in the sacrococcygeal area, possibly resulting from the migration of primordial cells and the proliferation of totipotent stem cells in that region. Optimal disease burden outcomes for sacrococcygeal teratoma are often achieved through surgical resection. Sacrococcygeal teratoma, although rare, might possess a mortal threat to patient, hence proper diagnosis and treatment must be done to ensure the best clinical outcome.

Mediastinal teratoma in children: A case series of misdiagnoses in a high-endemic tuberculosis setting

Introduction and importanceMediastinal teratoma is a rare extragonadal teratoma that frequently manifests with non-specific symptoms and is commonly misdiagnosed, particularly in Indonesia, where tuberculosis (TB) is endemic. Case presentationHerein, we present two cases of children aged 19 months and 17 years old who were referred with chronic nonspecific symptoms of cough, tachypnea, chest pain, and hemoptysis. Both children were initially diagnosed with TB and both completed anti-tuberculosis treatment. After visiting several healthcare facilities, a mediastinal mass was finally diagnosed and they all underwent thoracotomy without any further complication. The histopathology findings revealed mature teratoma. All patients had satisfactory outcomes at follow-up visits. Clinical discussionsPatients presented with non-specific symptoms are often clinically diagnosed with TB. However, primary healthcare doctors should consider other differential diagnoses when a child has non-specific respiratory symptoms, especially when chest X-ray findings are nonspecific and TB workup is negative. ConclusionsThe diagnosis of mediastinal masses is still challenging in Indonesia, as the diagnosis requires a vast array of work-up examinations, therefore, early recognition and referral are crucial for management.

Development and validation of a nomogram for preoperative prediction of immature teratoma in children with teratoma: a retrospective, multicenter, diagnostic study.

Teratomas are the most common germ cell tumors in children, and histologically classified as mature teratomas (MTs) and immature teratomas (ITs). Preoperative IT identification can affect the surgical approach, the type of procedure, and future possible reproductive health. However, there is no complete diagnostic criterion for ITs nowadays. We aimed to establish and validate a nomogram based on clinical and computed tomography (CT) features for preoperative prediction of ITs in children. We retrospectively reviewed 519 teratoma patients from hospital I for training (n=364) and validation (n=155), and 113 patients from hospital II for external validation. Univariate and multivariate logistic regression analyses were performed on the training set to screen risk factors, including alpha-fetoprotein (AFP), age, gender, tumor site, size, tumor composition, calcification and fat. Then, a nomogram was established based on identified risk factors and validated on the validation set. The performance of the nomogram was evaluated in terms of discrimination, calibration and the clinical usefulness. Multivariate logistic regression showed that tumor composition, AFP, age, calcification and fat were independent risk factors for preoperative prediction of IT. The area under the receiver operating characteristic (ROC) curves (AUCs) for the nomogram on the training set, internal and external validation set were 0.92 (0.88-0.96), 0.91 (0.84-0.97) and 0.92 (0.86-0.97), respectively. The model demonstrated sensitivity of 80%, specificity of 90% at the cut-off value of 0.262. Whatever the set, the calibration curve indicated good calibration. Decision curve analysis (DCA) curves demonstrated that the nomogram had greater net benefits than either the treat-all tactics or the treat-none tactics within a large scope of threshold. The nomogram established based on clinical and CT findings had the favorable accuracy for the preoperative prediction of IT, and may help in clinical decision-making and risk stratification.

“Floating ball sign” in the diagnostic imaging of mature ovarian teratomas in children

The “floating ball sign” (FBS) is a rarely described visual phenomenon found in mature ovarian teratoma imaging. It is characterized by the presence of movable, spherical areas within the cystic component of a tumor. Such visualization is possible both in cross-sectional imaging and ultrasonography. To evaluate the incidence of FBS in the pediatric population with regard to patients’ age and tumor size. This is a retrospective study of pediatric patients operated on in a tertiary pediatric surgical center between January 2009 and December 2022 due to mature ovarian teratoma; the medical records were reviewed for the age at diagnosis, recurrences, tumor size, and their characteristics in preoperative imaging. Eighty-three patients (mean age 14, range 0–17) out of 91 met the inclusion criteria for the analysis. Eighty-seven operations on 90 ovaries were performed. Preoperatively 38 patients underwent CT, 13 MRI, and 39 received only the ultrasound examination. The FBS was identified in preoperative imaging diagnostics in 3 (3.3%) girls (14, 16 and 17 years of age). The average largest tumor dimension and volume were 142 mm and 1268 cc in the FBS group, and 73 mm and 252 cc in the remaining group, respectively. FBS tumors usually reach large sizes. Although the sign is rare in children, there are no scientific reports of its occurrence in the first life decade. Color flow mapping and cross-sectional imaging play a pertinent role in distinguishing this uncommon pattern from a malignant mass and enable the selection of an appropriate surgical approach.

Clinical characteristics and long-term management of prepubertal testicular teratomas: a retrospective, multicenter study

Prepubertal testicular teratomas are rare tumors with limited practical guidance for their management. This study aimed to analyze a large multicenter database to establish the optimal management of testicular teratomas. We retrospectively collected data on testicular teratomas in children younger than 12 years who underwent surgery without postoperative chemotherapy in three large professional children’s institutions in China between 2007 and 2021. The biological behavior and long-term outcomes of testicular teratomas were analyzed. In total, 487 children (with 393 mature teratomas and 94 immature teratomas) were included. Among mature teratomas, 375 cases were testis-sparing, 18 were orchiectomies, 346 were operated through the scrotal approach, and 47 underwent the inguinal approach. The median follow-up period was 70 months, and no recurrence or testicular atrophy was observed. Among the children with immature teratomas, 54 underwent testis-sparing surgery, 40 underwent orchiectomy, 43 were operated through the scrotal approach, and 51 were operated through the inguinal approach. Two cases of immature teratomas with cryptorchidism had local recurrence or metastasis within 1 year of the operation. The median follow-up duration was 76 months. No other patients had recurrence, metastasis, or testicular atrophy. Conclusion: Testicular-sparing surgery is the first treatment choice for prepubertal testicular teratomas, with the scrotal approach being a safe and well-tolerated strategy for these diseases. Additionally, patients with immature teratomas and cryptorchidism may have tumor recurrence or metastasis after surgery. Therefore, these patients should be closely followed up in the first year after surgery.What is Known:• There is a fundamental difference between testicular tumours in childhood and those in adulthood - not only in terms of the difference and incidence but also in terms of histology.• For surgical techniques, the inguinal approach is recommended for the treatment of testicular teratomas in children.What is New:• The scrotal approach being a safe and well-tolerated strategy for testicular teratomas in children.• Patients with immature teratomas and cryptorchidism may have tumor recurrence or metastasis after surgery. These patients should be closely followed up in the first year after surgery.

Ovarian Teratomas in Children and Adolescents: Our Own Experience and Review of Literature.

Background: Ovarian teratomas are the most common type of ovarian mass during childhood and adolescence. There is no clear guidance for the management of the ovarian teratomas in children and adolescents. It is necessary, however, to understand the feature of these tumours and the indications for operating on them, and to put subjective criteria for the management in elective or emergency presentations. Methods: Medical records of patients between the age of 12 and 20 years old that underwent surgery for ovarian teratomas at the Department of Obstetrics and Gynaecology in University Hospital of Ioannina, between January 2000 and August 2022, were reviewed. A medical database was searched between January 2000 and August 2022 with the following keywords: ovarian teratoma, paediatrics and adolescents. Results: We present the results of forty patients, with a mean age of 11.8 years of age. All patients had surgery, where three out of four underwent oophorectomy and only one out of four underwent ovary-sparing operation; similar results were found in the literature. Conclusion: Ovary-sparing treatment is more common recently compared with the past, such as MIS compared with laparotomy. Better-organised and -planned prospective multi-centre studies are necessary to gain a deeper knowledge of the physiology and prognostic factors of teratomas in children.

Mature ruptured sacrococcygeal teratoma in a 1-day old neonate

Sacrococcygeal teratomas (SCTs) are rare congenital tumors that are derived from embryonic germ cell layers [1]. They are the most common extragonadal germ cell tumors (GCTs) in the neonate, with a reported incidence of 1 in 35 000 births [2]. Teratomas are made of tissues that derive from three germinal layers (ectoderm, endoderm, and mesoderm). Sacrococcygeal teratomas are more common in girls, with a sex ratio of 1:4 [3]. The most frequent location of teratoma in children is the sacrococcygeal area [4]. Many sacrococcygeal teratoma cases are diagnosed prenatally with routine ultrasonography between the 22nd and the 34th week of gestation. However, access to routine prenatal ultrasound in low and middle income countries is limited [5]. Antenatal diagnosis is essential to the pregnancy management and to prevent neonatal death by identifying fetuses that are at a higher risk of complications and planning an adequate intervention when needed [6]. This case is reported to describe a North African neonate presenting with a sacrococcygeal teratoma at birth without prior antenatal diagnosis, and highlight the need for prenatal routine care in low and middle income countries.

MATURE TESTICULAR TERATOMA IN PEDIATRIC PATIENT: A CASE REPORT

Objective: To report our experience on management of testicular teratoma in pediatric patient. Case(s) presentation: A 2-years-old boy presented with progressive mass in his left testis. The mass was found 3 months ago but became larger in a few days. The patient had no other genitourinary complaint. Vital signs were within normal limits. A hard and tender mass in the left scrotum sized 5x4x2.5 cm was palpated from the physical examination. An imaging study with Computed Tomography (CT) Scan revealed an enhancement in the left scrotum mass area. There was no ring enhancement in pelvic and paraaortic lymph nodes. The laboratory examination within normal limit. Inguinal radical orchiectomy was performed, and histopathological examination revealed a mature testicular teratoma of the left testis. Discussion: Testicular teratoma in children is usually benign. Testicular germ cell tumors generally have a good prognosis with current therapy. Post-orchiectomy management depends on the histology type, staging, and tumor markers. Conclusion: Testicular teratoma is a rare case and can cause minimal symptoms until it grows significantly. Testicular teratoma should be considered in the differential diagnosis of non-traumatic painless progressive scrotal mass. Inguinal radical orchiectomy may be considered as the primary management.

Radio-pathological correlation of a retroperitoneal teratoma in a 2-year-old girl: a case report

ABSTRACTRetroperitoneal teratoma is a extragonadal germ cell tumor comprising 5% of all teratomas in children, and the third most common retroperitoneal neoplasm in children. This is a case report of a 2 years old girl who presented with abdominal distension and palpable mass. The imaging findings of the mass was characteristic of retroperitoneal teratoma which was confirmed by histopathology report following complete excision. Retroperitoneal tumor is an uncommon tumor in children with characteristic imaging findings. Computed tomography is mainly used to evaluate the extent of the disease. Most of the retroperitoneal tumors are benign and curable with complete surgical excision.

Teratoma in Children: Three cases experience in Sanglah Hospital, Bali, Indonesia

Teratoma in Children: Three cases experience in Sanglah Hospital, Bali, Indonesia

Teratoma in Children: Three cases experience in Sanglah Hospital, Bali, Indonesia

Teratomas are the most common germ cell tumor, and further classified into mature or immature. Immature teratoma comprise less than one percent of all teratomas and with the peak incidence at birth until four years. They were diagnosed by history taking, physical examination, laboratory, imaging, and pathological anatomy as a gold standard. This report presents our experience of diagnosed, giving treatment with or without surgery and chemotherapy in three patients with teratoma. We report three cases of teratoma, at age six months, eight months and four years old with site of cases are retroperitoneal immature teratoma, cervical teratoma and ovarian immature teratoma. History taking of these patients, they have same symptom such as enlargement of the mass. Two cases were noticed after birth and progressively getting bigger until six and eight months old. One case was noticed when the patient had abdominal pain and was suspected with appendicitis at first. The computed tomography (CT) scan of these cases showed a mass as a part of teratoma and confirmed with pathological anatomy. Two cases were immature, and one case was mature teratoma. Two patients undergone surgery resection and continue with chemotherapy (cisplatin, etoposide, and bleomycin) for 10-14 weeks showed a good result until now and showed no residual mass anymore form CT scan, but one patient did not undergo surgery and chemotherapy yet. Early diagnosis of teratomas is leading us to a definitive therapy and showed a good result.

Teratoma of the Neck on Fine Needle Aspiration Cytology: An Unusual Case Presentation

Teratomas are tumours which are derived from all the 3 germ cell layers: endoderm, mesoderm and ectoderm with varying proportions. Cervical teratomas in children are almost always benign but locally aggressive. They can present with respiratory distress and immediate excision is required. The cervical teratoma is an uncommon entity which are rarely reported in Indian medical literature particularly on FNA. We present a case of an anterior cervical teratoma in an infant which was diagnosed on the base of FNA material.

Single nucleotide polymorphism array and cytogenetic analyses of ovarian teratomas in children.

Teratomas are the most common tumors in the ovary during childhood. Previous studies suggested that they may be derived from germ cells at any developmental stage from premeiotic oogonia through meiotic oocytes to post-meiotic ova. The majority of mature teratomas reveal normal karyotypes and immature teratomas show higher frequency of chromosomal abnormalities. We analyzed fresh tissue samples from 25 primary ovarian teratomas and three extraovarian deposits using whole genome single nucleotide polymorphism (SNP) array and karyotype. SNP array detected five patterns of copy neutral loss of heterozygosity (CN-LOH): failure of meiosis I (type I) in 12 tumors, failure of meiosis II (type II) in six tumors, endoreduplication of a haploid ovum (type III) in two tumors, premeiotic error (type IV) in four tumors, and both meiotic I and meiotic II errors in one tumor (type V). Three tumors with type I error had a single chromosome showing meiotic II error, and two tumors with type II error had a single chromosome showing premature sister-chromatid separation in meiosis I. Lack of recombination in multiple chromosomes in meiosis I were common, chromosomes 17, 7, 8, 21, and 22 were most commonly involved. Abnormal karyotypes were observed in four teratomas including +3, del(3q), +7, +8, +12, and i(18q). The extraovarian deposits revealed the same CN-LOH pattern as the primary teratoma. In summary, SNP array reveals the origin of ovarian teratoma and we propose a new mechanism that consecutive meiotic I and II errors occur frequently in ovarian teratomas.

Testis-Preserving Tumor Enucleation Is Applicable in Children with Immature Testicular Teratoma

Introduction: This study investigated the biological characteristics of immature testicular teratoma in children and explored the feasibility of testis-preserving tumor enucleation. Methods: We retrospectively reviewed the cases of 23 children who received a pathologic diagnosis of immature testicular teratoma between January 2005 and December 2018. Ages ranged from 16 days to 13 months (mean: 6 months and 5 days). Painless testicular enlargement was the main clinical manifestation, and the course of disease ranged from 20 days to 4 months (mean: 1.4 months). The tumor volume ranged from 1.5 × 1.2 × 0.5 to 6 × 5 × 4.5 cm. Elevated levels of alpha-fetoprotein were measured in 21 patients. Preoperative ultrasound examination showed a cystic/solid mass with calcification. Results: Excision of the affected testis was done in 10 patients and testis-preserving tumor excision in 13 patients. Postoperative chemotherapy was not employed. Nineteen patients were followed up for 1–10 years, and all showed disease-free survival without recurrence or metastasis. Conclusion: Immature testicular teratoma is found predominantly in children aged <1 year, and its biological characteristics are different from those in adults. Immature testicular teratoma is largely benign in children and can be managed by testis-preserving tumor enucleation, as for other benign tumors (such as mature teratoma). Postoperative monitoring and follow-up are necessary.

Lack of genetic homozygosity in prepubertal teratomas: divergent pathogenesis distinct from that of teratomas in adolescents

AbstractIn adults, both immature and mature ovarian teratomas show frequent genetic homozygosity consistent with tumorigenesis involving germ cells after meiosis I. Investigation into genetic zygosity of various teratomas in children has been limited. Thirteen sacrococcygeal, 12 ovarian, and 3 testicular teratomas in children 18 years or younger were retrieved from our departmental archives and histologically reviewed. Tumor and paired normal tissues were microdissected and subjected to short tandem repeat (STR) genotyping. DNA genotyping was informative in 12 sacrococcygeal teratomas, 8 ovarian teratomas, and 3 testicular teratomas. Sacrococcygeal teratomas included seven mature teratomas, four immature teratomas, and one mixed germ cell tumor with patient age ranging from 0 days to 3 years. All but two patients were female. Ovarian teratomas included five mature and three immature teratomas with patient age ranging from 2 to 18 years. Testicular teratomas included two mature teratomas and one immature teratoma with patient age ranging from 3 months to 3 years. All sacrococcygeal, testicular, and ovarian teratomas in patients younger than 4 years showed no evidence of genetic homozygosity by STR genotyping. In contrast, all four ovarian teratomas in patients older than 9 years showed either partial or complete homozygosity. In conclusion, unlike adolescent and adult ovarian teratomas, prepubertal sacrococcygeal and gonadal teratomas lack genetic homozygosity, supporting the hypothesis that teratomas before puberty develop at an early stage of germ cell development different from that of teratomas in adolescents and adults.To investigate genetic homozygosity in pediatric teratomas, this study analyses 13 sacrococcygeal, 12 ovarian, and 3 testicular teratomas in children by short tandem repeat (STR) genotyping. While genetic homozygosity is frequent in adult ovarian teratomas, no evidence of genetic homozygosity is seen in patients younger than 4 years, arguing pediatric teratomas arise at an earlier stage of germ cell development.

Single-cell transcriptional profiling identifies a cluster of potential metastasis-associated UBE2C+ cells in immature ovarian teratoma

To dissect the disease heterogeneity and identify the underlying cellular and molecular events related to metastasis of immature ovarian teratoma in children, single-cell RNA sequencing was performed for a 2-year-old patient with liver metastases from immature ovarian teratoma. A total of 5976 cells were obtained for further analysis, with a median unique molecular identifier count of 6011 per cell and a median number of 1741 genes detected per cell. Fourteen clusters were recognized, with the main lineages comprising epithelial cells, macrophages, fibroblasts, glial cells, and dendritic cells. Ten subclusters of epithelial cells were further defined, originating from the urinary tract, esophagus, bronchus, lung, skin, and gastrointestinal tract. An undefined UBE2C + population in an active state of proliferation was also identified and its biological processes were related to meiosis and maturation of oocytes. Pseudotime analysis revealed different distributions of epithelial cells in the development trajectory. In conclusion, a cluster of UBE2C + epithelial cells in an active state of proliferation was identified in an immature ovarian teratoma in a child, and may contribute to metastasis by regulating epithelial–mesenchymal transition. These findings help toward understanding the origin of the malignant behaviors, offer a potential biomarker for early determination of the tumor nature, and provide new ideas for the therapy of immature ovarian teratoma in children.

Immature neck teratoma in the newborn

One of rare location of teratoma in children is head and neck region. Treatment options, including surgery, are determined by tumour location, its grade of differentiation, and patients age. This article presents case report of immature paratracheal neck teratoma in a 3-month old child, subjected for second-look surgery for residual tumour removal due to the risk of life-threatening complications.

GCT-60 - Sacrococcygeal teratoma in children: Audit on clinical outcomes from a single centre

GCT-60 - Sacrococcygeal teratoma in children: Audit on clinical outcomes from a single centre

Huge mediastinal teratoma in children: anesthesiological approach, surgical strategy and literature review

Teratomas of the anterior mediastinum are infrequent germ cell tumour. These tumours occur at all ages, but are rarely discovered before puberty. We report a case of anterior mediastinal mature teratoma in a baby girl aged 5 months who presented to us with recurrent infectious pneumonia associated with hemoptysis since one month. Computed tomographic scan of thorax revealed a large anterior mediastinal mass measuring 8.01×6.72×7.28 cm 3 with calcification within. The authors report this current case to emphasize the importance of the multidisciplinary care and perioperative approach between anaesthesiologist and surgeon to a successful management of a huge mediastinal mature teratoma in an infant. Tips, tricks and pitfalls are proposed in this paper for a surgical outcome effective and no clinical complication.

How to differentiate congenital pancreatic cysts and cystic pancreatic teratomas?

The differential diagnosis of congenital pancreatic cysts and mature cystic pancreatic teratomas is challenging due to the lack of reliable diagnostic tests or pathognomonic imaging findings. This study highlights the differences between these extremely rare entities with few published case reports. Based on our recent experience with two cases, we conducted an extensive review of literature including all reported cases of congenital pancreatic cysts and cystic pancreatic teratomas in children. We report two cases of large cystic abdominal mass detected by prenatal ultrasonography. Both neonates were asymptomatic after birth and were operated on by laparoscopy at the age of 1 year and 3 months, respectively. Histopathology demonstrated a congenital pancreatic cyst in the first case and a mature cystic teratoma in the second case. The post-operative course was uneventful for both children. We describe the clinical and imaging data of the 33 congenital pancreatic cysts and 10 mature cystic teratomas of the pancreas previously reported in the literature, and discuss diagnosis criteria and treatment strategies. Congenital pancreatic cysts and pancreatic teratomas are rare lesions in children. Clinical presentation is not specific and these lesions are often asymptomatic. Although associated malformations are evocative of congenital pancreatic cyst, the final diagnosis can only be confirmed by histopathological examination. Available treatments include ultrasound-guided puncture, enucleation, distal pancreatectomy, cystogastrostomy, and cysto-jejunostomy by the Roux-en-Y technique. Laparoscopic excision can be performed shortly after birth and is our preferred option.