Adult Teratoma Research Articles

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.

Size and status of metastases after inductive chemotherapy of germ-cell tumors. Indication for salvage operation.

Secondary resection of metastases remaining after inductive chemotherapy of advanced germ-cell tumors has thus far been obligatory. The absence of malignant components in one-third of all residual tumors and the high risk of the operation have led several authors to reconsider the criteria for this approach. In a retrospective study of 153 cases (127 evaluable) we investigated the histology of the primary tumor and the size of the residual tumor with regard to residual histology and outcome. Patients were divided into the following three groups according to the histology of the primary tumor: group I, pure seminoma (16 patients); group II, nonseminoma without teratoma (32 patients); and group III, nonseminoma with teratoma (79 patients). Among the 16 purely seminomatous tumors, the residual masses ranged from 2 to 12 cm; 12 consisted of necrotic tissue only, 3 contained malignant germ-cell elements, and 1 contained adult teratoma. The residuals of primarily teratoma-free nonseminomas measured 2-16 cm; the smallest residual tumor containing active malignant elements measured 4 cm, and the diameter of the largest necrotic residue was 6 cm. Four residuals contained mature teratoma. The size of residuals from teratomatous primary tumors was 3-24 cm; the smallest malignant tumor measured 5 cm, and the diameter of the largest purely necrotic mass was 8 cm. According to our results, a secondary operation may be omitted if the residual mass of a primary seminoma is smaller than 5 cm or if that of a primary nonseminoma without teratoma is less than 3 cm in diameter.(ABSTRACT TRUNCATED AT 250 WORDS)

High-Grade Immature Teratoma of the Testis in Infancy

Teratomas of the testis in infants are rare tumors which often display immature elements, disturbing in their histologic appearance. Although the presence of similar histologic features worsens prognosis in testicular teratomas in adults and in teratomas of infants and children presenting at other anatomic sites, the presence of immature elements in testicular teratomas of infancy does not appear to affect prognosis. Therefore, orchiectomy alone is adequate therapy for these neoplasms. The case of an 8-month-old infant with a teratoma of testis is presented.

Intratubular germ cell neoplasia in testicular teratomas and epidermoid cysts. Correlation with prognosis and possible biologic significance

The clinicopathologic features of 4 testicular teratomas in infants, 13 testicular epidermoid cysts in adults, and 8 pure teratomas in adults were compared. Intratubular germ cell neoplasia (ITGCN, carcinoma in situ) was observed in 88% of the teratomas in adults; 63% of the patients in this group had metastases and 37% died. No ITGCN was observed in infant testes with teratomas or adult testes with epidermoid cysts; all of the neoplasms in the latter two groups behaved as benign tumors. ITGCN is associated with malignant potential (P = 0.0004; Fisher's exact test). These tumors comprise a spectrum of clinicopathologic entities that probably reflect differences in pathogenesis.

Differentiated teratoma of testis metastasizing as differentiated teratoma in adult

An unusual case of adult teratoma of testis metastasizing in benign form in a thirty-one-year-old man is reported and the literature reviewed.

BENIGN TERATOMA OF THE ADULT THYROID GLAND -ACASE REPORT AND REVIEW OF THE LITERATURE-

Teratomas in the neck are rare neoplasms, and most occur in neonates. Only twenty cases of cervical teratomas in adults have been reported in the world literature. A case of mature benign teratoma of the thyroid gland in adult is reported and discussed with a review of the literature. The patient was a 33-year-old female who complained of occipital pain. She was pointed out a hard mass with uneven surface and good movability in the left thyroid lobe which measured 1.6×1.0cm. A shell shaped irregular carcification was observed on the neck X-ray. The echography demonstrated a hyperechoic mass with acoustic shadow. Then, a clinical diagnosis was adenomatous goiter. However, fine-needle aspiration cytology suspected of anaplastic carcinoma. Subtotal thyroidectomy and modified radical neck dissection were performed. At operation the tumor was found to be located in the left thyroid lobe and measured 1.4×1.4×1.1cm. Cut sections of the tumor revealed gray-white solid tissues surrounding red-brown medullary portion. Microscopic examination demonstrated the mature tumor in the thyroid gland derived from three germ layers, including the cartilage, bone, bone marrow, vessel, fibrous tissue, thyroid tissue and stratified squamous epithelium. So this tumor was diagnosed as mature benign teratoma in the thyroid gland. This case is the sixth one in the Japanese literature.

Testicular germ cell tumors in HLA-genotype non-twin brothers

The diagnosis of metastatic testicular carcinoma in a thirty-three-year-old man and his nineteen-year-old brother is reported. Histologically, the tumor of the older brother consisted predominantly of embryonal carcinoma with minor components of seminoma and adult teratoma; the tumor of the younger brother consisted entirely of embryonal carcinoma. Since previous reports suggest the possibility that the HLA genotype may be a factor in the etiology of testicular cancer, we typed the parents and four children of this family. The two affected brothers shared a paternal HLA-A3,Cω-,B7,DR2 haplotype that had not been transmitted to the two other living siblings. Analysis of the distribution of HLA haplotypes of the affected non-twin brothers of this family and those of three other non-twin pairs of brothers that have been reported showed that the affected pairs in each family shared one HLA haplotype. The differences between the expected and the observed distribution of HLA haplotypes in the four sibling pairs is not statistically significant, perhaps because of the small number of patients typed. Two of the four pairs shared a common haplotype. Additional family studies are required to establish a genetic origin of testicular tumors and to determine whether or not a “testicular carcinoma disease” gene is linked to the HLA complex. A large number of multicase families will be required for linkage analysis.

Combination chemotherapy including VP-16 for poor prognosis germ cell neoplasms

Fifteen patients with germ cell neoplasms (9 testicular primary, 4 extragonadal, 2 adult teratoma syndrome) with features indicative of a poor prognosis were treated with chemotherapy followed by surgery. In patients with testicular primary sites, 2 patients have relapsed and all 9 remain alive (median follow-up 36 months). In patients with extragonadal tumors 2/4 are alive without disease, and both patients with the adult teratoma syndrome have died. Combination chemotherapy and surgery can be employed successfully in this subset of patients with germ cell neoplasms.

Bulky Germinal Tumors: Comparison of Different Induction Regimens and Significance of Residual Disease

In order to study the efficacy of three different chemotherapy regimens and the prognostic significance of residual disease after chemotherapy, we analyzed 84 patients with bulky germinal tumors. Chemotherapy, consisting of vinblastine, bleomycin/adriamycin, cisplatin (VB/AP) was administered sequentially to 37 patients. 19 patients were treated with the cisplatin, vinblastine, bleomycin (PVB) regimen and 17 patients with cisplatin, vinblastine, bleomycin, ifosfamide (PVBI). The initial complete remission (iCR) was 71% (52 of 73) with a relapse rate of 29% (15 of 52). 10 of 73 (14%) patients achieved partial response and 11 of 73 (15%) showed progression due to multidrug resistance. There was no statistically significant difference in iCR, continuous complete remission (cCR), relapse and survival between the PVB, PVBI and VB/AP regimens. In 50 patients, the residual tumor after chemotherapy was examined histologically. cCR was achieved in 75% (15 of 20) of patients with necrosis or fibrosis, in 50% (5 of 10) with adult teratoma and in 25% (5 of 20) with malignant tumor. Comparison of survival curves according to residual histology revealed statistically significant differences (p = 0.02). Our findings suggest that in patients with germinal bulk disease PVBI-regimen and VB/AD-therapy are not superior to the standard regimen. Residual disease seems to be an important prognosticator.

Combined chemotherapy and surgery in treatment of advanced germ-cell tumors.

Forty-eight selected patients with GCT who were suspected of having residual disease after two or three chemotherapy inductions underwent an attempt at resection of this residual tumor. In 37 patients all gross disease was resected: 11 had malignant tissue, eight adult teratoma, and 18 no residual neoplasm, and 9, 7 and 17, respectively, remain free of disease. Patients in whom complete resection was not possible generally did poorly. Elevated serum tumor markers following the completion of preoperative chemotherapy indicated residual malignant disease and poor probability for complete resection. Twenty-nine percent of patients with negative preoperative markers had malignancy at the time of surgery, but disease was resectable in most of these patients. The key for success is, first, the response to chemotherapy and, second, complete resection of residual disease. It is recommended that patients with initially bulky metastases (diameter greater than 5 cm) be first managed by chemotherapy, employing successive close inductions, and subsequently explored with intent to resect residual disease. When the resected specimen shows malignant elements, the patients should receive additional inductions, otherwise, maintenance chemotherapy is employed.

Teratomas in children and young adults.

A review of all teratomas seen at the University of Wisconsin Hospital between 1965 and 1977 revealed that sacrococcygeal and presacral teratomas were most common. In these cases survival was best in infants less than one year old, with the exception of two cases of malignant medulloepithelioma. Testicular teratomas were predominant in the young adult male, and survival was poor. Pathology and treatment of teratomas are discussed, with an accompanying discussion of congenital anomalies associated with teratomas.

Primary malignant teratoma of the thyroid.Case report and literature review of cervical teratomas in adults

A case of primary malignant teratoma of the thyroid in a gravid 37-year-old female is reported and the literature on cervical teratomas in adults reviewed. The patient was treated by total thyroidectomy and left radical neck dissection followed by cervical and mediastinal radiotherapy and chemotherapy. She fied of recurrent tumor and related complications 9 months after discovery of the lesion. This is the 6th case of primary teratoma of the thyroid and the 9th case of cervical teratoma reported in a adult. These tumors are characteristically large, rapidly growing and highly malignant. The longest survival reported is 10 months. The differentiation of this lesion from carcinosarcomas of the thyroid is discussed.

Treatment of testicular tumors: analysis of 57 cases (author's transl)

Fifty-seven patients with germinal tumor of the testis treated from 1963 to 1972 were followedthrough 1975.Twenty-eight patients with pure seminoma were treated by high inguinal orchiectomy and para-aortic lymph node irradiation of an average of 3, 500r. Of the 28 patients two had retroperitoneal lymph node dissection.Twenty-two patients with non-seminomatous malignant tumor of the testis had high inguinal orchiectomy. As an additional treatment, of the 22 patients seven received irradiation to the para-aortic lymph nodes and six underwent retroperitoneal lymph node dissection, five of which were followed by irradiation. For non-seminomatous malignancy, an average of 4, 400r was given. Seven patients with adult teratoma had orchiectomy or resection of the tumor, and no other treatment was performed.Five-year relative survival rates calculated by actuarial method were 94% (standard error 5%, effective sample size 28) for pure seminoma and 50% (standard error 11%, effective sample size 22) for non-seminomatous malignant group. The difference of survival rates between the two groups was statistically significant. Patients with adult teratoma showed 100% survival.Crude survival rate of patients with metastasis manifested by physical or X-ray examination before treatment was significantly lower than that of patients with negative findings. Patients with seminoma invading periorchium or patients with non-seminomatous malignancy complaining of testicular pain had a tendency to show lower crude survivals.

Gastric localization of endodermal sinus tumour.

The rare, malignant germ cell tumour, endodermal sinus tumour, may also have an extragonadal localization. A case of gastric localization is presented. Palliative resection of the bleeding tumour was performed, including partial hepatectomy. A cavity developed between the abdomen and the left half of the thorax, which became infected postoperatively, resulting in septicaemia and death in the course of renewed attempts at drainage. At autopsy an adult teratoma was found in the one testis, just as teratomata had been removed three years previously from both lung hila. It is suggested that the endodermal sinus tumour in the stomach may have been a metastasis from one of these teratomata or a stage in a multiple teratoid anlage.

MATURATION IN HUMAN TUMOURS

Tumour maturation may occur in man and, like spontaneous tumour regression, not necessarily for the same reason in all cases. There is evidence for its occurrence particularly in the embryonal sarcomas of children and in some teratomas in adults. It has been reported most frequently in neuroblastomas where spontaneous regression is also well known; and further examples include a change towards a more benign state in metastases from teratomas of the testicle. The implications of behaviour patterns such as this in the study of malignant disease are of great importance. Our understanding of the cancer process must be affected by evidence that it is capable at times of being controlled, of undergoing regression, and of reversing direction to form a benign residuum. The series of observations referred to here are incompatible with the old and rigid belief in cancer as an irreversible malignant transformation occurring in normal cells directing them into a state of permanent autonomy. These observations also hold out an interesting prospect for advance in therapeutics.

Teratoma of Testis in an Infant

No AccessJournal of Urology1 Nov 1968Teratoma of Testis in an Infant Elwin E. Fraley, and Alfred S. Ketcham Elwin E. FraleyElwin E. Fraley More articles by this author , and Alfred S. KetchamAlfred S. Ketcham More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)62591-6AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Teratoma of Testis in an Infant." The Journal of Urology, 100(5), pp. 659–660 © 1968 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByGARRETT J, CARTWRIGHT P, SNOW B and COFFIN C (2018) CYSTIC TESTICULAR LESIONS IN THE PEDIATRIC POPULATIONJournal of Urology, VOL. 163, NO. 3, (928-936), Online publication date: 1-Mar-2000.Dunn D, Hertel B and Kennedy R (2018) The Management of Mature Teratoria of the TesticleJournal of Urology, VOL. 117, NO. 2, (259-261), Online publication date: 1-Feb-1977.Kedia K and Fraley E (2018) Adult Teratoma of the Testis Metastasizing as Adult Teratoma: Case Report and Review of LiteratureJournal of Urology, VOL. 114, NO. 4, (636-638), Online publication date: 1-Oct-1975.McCullough D, Carlton C and Seybold H (2018) Testicular Tumors in Infants and Children: Report of 5 Cases and Evaluation of Different Modes of TherapyJournal of Urology, VOL. 105, NO. 1, (140-148), Online publication date: 1-Jan-1971. Volume 100Issue 5November 1968Page: 659-660 Advertisement Copyright & Permissions© 1968 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Elwin E. Fraley More articles by this author Alfred S. Ketcham More articles by this author Expand All Advertisement PDF DownloadLoading ...

ADULT TERATOMA OF THE GASSERIAN REGION.

ADULT TERATOMA OF THE GASSERIAN REGION.

Adult Teratoma of the Testicle Metastasizing as Adult Teratoma

Adult Teratoma of the Testicle Metastasizing as Adult Teratoma

Sacrococcygeal teratomas: a preliminary report of two cases in adults.

Summary and Conclusions Two cases of benign sacrococcygeal teratomas in adults have been presented. Delay in diagnosis leads to tardiness of treatment. Although malignant degeneration of these tumors in adults has been reported, apparently it is rare. No uniform treatment of teratomas in adults has been advocated. Both of our patients will shortly undergo operation.

Treatment of Malignant Tumors of the Testis

The incidence of malignant testicular tumors is relatively low. It has been estimated by Cade that they constitute 1 to 1.5 per cent of all malignant tumors in males and that they make up about 3 per cent of neoplasms of the genito-urinary tract. Pack and LeFevre reported an incidence of 1 per cent among 16,565 patients with malignant tumors seen at Memorial Hospital, New York, while Dean at the same institute in 1935 found 2.09 per cent of all malignant neoplasms in males to be testicular tumors. In regard to all male hospital admissions, it may be mentioned that Tanner in 1922 found one testicular tumor for every 2,000 patients. The present study is based on the tumors of the testis treated at the University of Minnesota Hospitals from 1926 to 1943 inclusive. The total number amounted to 100 and they were placed in three groups: 34 cases were not classified as to type, while 37 were seminomas and 29 were carcinomatous mixed tumors. Etiology The average age in this series was for seminoma 37.6 years and for carcinomatous mixed tumors 29.4 years. This is in agreement with the statement of Cade that teratomatous tumors occur chiefly between twenty and forty years, and the seminomas between thirty and fifty. A history of trauma was obtained in 15 per cent of the cases. This is somewhat lower than in series reported by other authors. Russell Howard obtained a history of trauma in 5 cases out of 27, Nash and Leddy in 21 out of 103. The figures of some authors are as high as 50 per cent. Cryptorchidism was present in 8 cases. Nash and Leddy reported an incidence of 8.7 per cent and Dean found 35 cases in a series of 245, or 14.3 per cent. Hydrocele was observed in 6 patients, and in 3 of these a malignant tumor of the testis was discovered during the operation for hydrocele. Classification Classification of malignant tumors of the testis is a confused subject, and opinions vary greatly. At the University of Minnesota Hospitals we follow E. T. Bell's classification. Bell states: “Testicular tumors may be divided into four groups: adult teratomas, carcinomatous mixed tumors, seminomas, and chorionepitheliomas. “1. Adult teratomas may be typical dermoid cysts containing hair, fatty material, teeth, etc., or they may consist of many small cysts separated by solid tissue. These tumors are rare, develop slowly over many years, and offer relatively good prognosis. “2. Carcinomatous mixed tumors are soft cellular growths consisting chiefly of epithelium in form of cysts or solid masses of carcinomatous structure. Cartilage and myxomatous tissue may be found scattered through the tumor. “3. Seminoma is the most common form of testicular neoplasm. It consists chiefly of rounded or polyhedral clear cells arranged in thick solid cords and bearing some resemblance to testicular tubules. Little or no cartilage is present. “4. Chorionepithelioma is a malignant tumor arising from chorionic epithelium.