Immature Brain Teratoma of An Infant In A University Hospital: A Case Report

@#Teratomatous tumours of the head are rather uncommon. We report a 3-month-old child who presented with acute signs of raised intracranial pressure, needing craniectomy and subtotal tumour removal. The patient was diagnosed as intracranial immature teratoma grade 3, from the pathological study and elevated alpha-fetoprotein (AFP). Managing brain teratoma posed a challenge to the managing team due to the location of the tumour, the unavailability of standardized chemotherapy protocol and the dilemma of commencing adjuvant chemotherapy in a very young infant. The tumour was partially removed due to its critical location. And chemotherapy was delayed until the patient achieved 7 months of age. After four rounds of chemotherapy, the patient remained in remission for more than three years follow up.

A rare case of extragonadal immature teratoma mimicking as subserosal pedunculated myoma

Immature teratomas are usually derived from a malignant transformation of mature teratoma. The pure immature teratoma accounts for less than 1% of all ovarian cancers. It is the second most common germ cell malignancy and accounts for 10-20% of all ovarian malignancies seen in women younger than 20 years of age. Extragonadal origin are extremely rare and the most common extragonadal site of these teratomas is the omentum. We hereby describe a case report of a 29-year-old lady who presented with abdominal pain and her imaging with an ultrasound revealed a mass with features suggestive of a subserosal fibroid. She underwent a laproscopic myomectomy. A histopathologic diagnosis of Immature teratoma was made following her primary surgery. She subsequently underwent a staging laparotomy which was followed by chemotherapy. Immature teratomas predominantly occur in young patients, and preservation of fertility is an important factor in its management. Treatment should be initiated as soon as possible after surgery, preferably within 7-10 days, in those patients who require chemotherapy.

Growing teratoma syndrome: A case report / Philippine Journal of Obstetrics and Gynecology

@#Growing teratoma syndrome is a rare phenomenon. Presented is a case of a 36 year old, G2P2 (2002) who consulted for abdominal enlargement and subsequently underwent exploratory laparotomy, peritoneal fluid cytology, left salpingooophorectomy, right oophorocystectomy, infracolic omentectomy and random peritoneal biopsy. Histopathology revealed immature teratoma of the ovary, FIGO grade III, stage IIIC. She received adjuvant chemotherapy using Bleomycin, Etoposide, Cisplatin. After the second cycle of chemotherapy, new lesions were appreciated in the right ovary and at the cul de sac for which she underwent exploratory laparotomy, peritoneal fluid cytology, total hysterectomy with right salpingooophorectomy, tumor debulking, infragastric omentectomy, random peritoneal biopsy. Histopathologic study showed mature teratoma. No further treatment was given. Presently, patient has no evidence of disease for 5 months.

Gliomatosis peritonei arising in setting of immature teratoma of ovary: a case report

A 14 years old girl presented to the gynecology OPD with pain abdomen and huge abdominal lump since 2 months. On clinical examination, a large mass of 20x15 cm size was found extended upto the xiphoid process. Serum studies showed rise of CA-125 up to 406.9U/mL and LDH up to 310U/L. USG shows right ovarian cyst of 14.8x14.1x12.8 cm with internal calcification. MRI revealed a well encapsulated mass of 21x19x17cm with solid and cystic mass and upward peritoneal extension. Exploratory laparotomy was performed with right sided salpingo- ophorectomy with infracolic omentectomy, as the omentum appeared granular. She had an uneventful post-operative recovery. Subsequently HPE showed immature teratoma NORRIS grade 3 with co-existent peritoneal gliomatosis (grade 0). She is under regular follow-up and decided to give six cycles of combination chemotherapy with BEP at regional cancer hospital.

Teratoma ovárico maduro e inmaduro, a propósito de un caso / About a case of mature and immature ovarian teratoma

Resumen: CASO CLÍNICO: paciente de 30 años de edad, con diagnóstico de teratoma inmaduro, con deseos de preservar la fertilidad. Se indicó tratamiento quirúrgico conservador y quimioterapia coadyuvante, previa vitrificación de ovocitos. Un año después de finalizar la quimioterapia logró embarazarse mediante fecundación in vitro, realizada con sus propios óvulos desvitrificados. Después de tres años de la intervención quirúrgica se detectó otro quiste en el ovario contralateral, que se intervino y diagnosticó como teratoma maduro. CONCLUSIONES: el teratoma ovárico inmaduro es una neoplasia poco frecuente cuyo tratamiento aún se discute. Puesto que la mayoría de las pacientes son jóvenes debe intentarse la preservación de la fertilidad proponiéndoles la preservación de ovocitos. Debido a la alta tasa de recurrencia del tumor, casi siempre en forma de teratoma maduro, es importante el seguimiento estrecho después de finalizar el tratamiento.

Abstract: CLINICAL CASE: We present a peculiar case in which an immature teratoma is diagnosed by an ovarian torsion in a 30 year old patient. She wanted to preserve her fertility, so she underwent conservative surgical treatment, previous vitrification of her oocytes. One year after the end of the chemotherapeutic treatment, the patient became pregnant through in vitro fertilization performed with her own devitrified oocytes. Another cyst in the contralateral ovary was diagnosed three years after the surgical intervention so she was reintervenated, it was a mature teratoma. CONCLUSIONS: Immature ovarian teratoma is an uncommon pathology whose treatment is controversial. Since most patients are young, we should try to preserve fertility if the patient wishes, by offering cryopreservation of oocytes when indicated. Due to the high rate of recurrence, often in the form of mature teratoma, it is important to follow-up closely after the treatment.

Immature Gastric Teratoma in a Newborn: A Case Report

A teratoma is the most common germ cell tumor in children; however, a gastric teratoma is very rare. An immature gastric teratoma has malignant potential; therefore, it should be removed surgically and followed up routinely to assess for recurrence by performing imaging studies and estimating serum alpha-fetoprotein (AFP) level. We describe the case of a 2-day-old male neonate with abdominal distension and a palpable mass. He underwent surgical resection of a tumor that was diagnosed as an immature gastric teratoma.

Diagnostic Significance of Cellular Neuroglial Tissue in Ovarian Immature Teratoma

BACKGROUND: Immature teratoma (IT) is a tumor containing immature neuroectodermal tissue, primarily in the form of neuroepithelial tubules. However, the diagnosis of tumors containing only cellular neuroglial tissue (CNT) without distinct neuroepithelial tubules is often difficult, since the histological characteristics of immature neuroectodermal tissues remain unclear. Here, we examined the significance of CNT and tried to define immature neuroectodermal tissues by comparing the histological features of neuroglial tissues between mature teratoma (MT) and IT. METHODS: The histological features of neuroglial tissue, including the cellularity, border between the neuroglial and adjacent tissues, cellular composition, mitotic index, Ki-67 proliferation rate, presence or absence of tissue necrosis, vascularity, and endothelial hyperplasia, were compared between 91 MT and 35 IT cases. RESULTS: CNTs with a cellularity grade of ≥ 2 were observed in 96% of IT cases and 4% of MT cases (p < .001); however, CNT with a cellularity grade of 3 in MT cases was confined to the histologically distinct granular layer of mature cerebellar tissue. Moreover, CNT in IT exhibited significantly higher rates of Ki-67 proliferation, mitoses, and necrosis than those in MT (p < .001). Furthermore, an infiltrative border of neuroglial tissue and glomeruloid endothelial hyperplasia were significantly more frequent in IT cases than in MT cases (p < .001). CONCLUSIONS: Our results suggest that if CNT with a cellularity grade of ≥ 2 is not a component of cerebellar tissue, such cases should be diagnosed as IT containing immature neuroectodermal tissue, particularly if they exhibit an infiltrative border, mitoses, necrosis, and increased Ki-67 proliferation.

Teratoma inmaduro de ovario Reporte de un caso / Ovarian immature teratoma:case report

Introducción: El teratoma inmaduro de ovario es una patología poco frecuente que se lo encuentra en mujeres jóvenes. Son tumores compuestos a partir de las capas germinales en la que los estudios de imagen son de ayuda diagnóstica, pero el examen histopatológico establece el diagnóstico definitivo. Existe controversia en el pronóstico y dependiendo del estadio se elije tratamiento quirúrgico o quimioterapia. Caso: Presentamos el caso de una paciente de 11 años que acude a emergencia con dolor abdominal, fluido transvaginal, presencia de masa en fosa iliaca izquierda de aproximadamente 20 cm. La biopsia reporta Teratoma Inmaduro. Se realiza exéresis total del tumor coadyuvante quimioterapia, con evolución favorable. Discusión: Este es un caso poco frecuente de teratoma inmaduro con limitada información respecto al pronóstico y tratamiento. Se trata de una paciente joven con una tumoración de alto grado (Grado II), considerado un factor pronóstico adverso con un índice de sobrevida a los dos años del 50%. Sin embargo, la paciente tuvo una excelente respuesta a la quimioterapia y evolución.

Introduction: The immature ovarian teratoma is a rare disease that affects young women. These tumors grow up from germ layers, therefore, histopathologic reports make the final diagnosis. There is still controversy regarding prognosis. Depending on the stage, surgery and chemotherapy are the treatment options. Case report: We report the case of a 11 year-old patient who came to the emergency room complaining of abdominal pain, transvaginal fluid discharge and a 20 cm mass located in the left lower quadrant abdomen. Pathology reported Immature teratoma. The excision of the tumor with adjuvant chemotherapy was performed with a good outcome. Discusion: This is rare case of immature teratoma with limited references in the medical literature regarding prognosis and treatment, this is a young patient with a high grade tumor (Grade II) that is considered an adverse prognostic factor, with 50% survival rate within two years. Our patient had an excellent response to chemotherapy.

Síndrome de teratoma creciente: reporte de caso y revisión de la literatura / Growing teratoma syndrome: a case report and review of the literature

El síndrome de teratoma creciente (STC) es una condición poco común que se presenta en pacientes con tumores de células germinales no seminomatosos (TCGNS) de tipo teratoma inmaduro. Se caracteriza por la aparición de masas metastásicas que pueden alcanzar grandes volúmenes durante o después de la administración de la quimioterapia, asociado a la negativización de los marcadores tumorales. Histopatológicamente estas masas corresponden a un teratoma maduro. A continuación se presenta el caso de una paciente de 24 años, con diagnóstico de síndrome de teratoma creciente, incluyendo su evaluación, manejo quirúrgico y seguimiento a corto plazo.

The growing teratoma syndrome is a rare condition that occurs in patients with non-seminomatous germ cell immature teratoma. It is characterised by the appearance of metastatic masses that can reach large volumes during or after administration of chemotherapy, associated with the negative result for tumour markers. Histopathologically these masses correspond to a mature teratoma which is explained by a retroconversion phenomenon. The case is presented of a 24 year-old patient, diagnosed with growing teratoma syndrome, including her evaluation, surgical management, and short-term follow-up.

Malignant mixed germ cell tumours of ovary. A Report of two cases.

Malignant germ cell tumours of ovary comprise less than 5% of all ovarian neoplasms. Malignant mixed germ cell tumours are still rare. Most common combination in mixed germ cell tumours is that of Dysgerminoma & yolk sac tumour. Mixed tumours showing three germ cell components and four or five germ cell components are still rare. Here we report two cases of Malignant mixed germ cell tumours with a histologic combination of Immature teratoma, Dysgerminoma & Yolk sac tumour. Review of literature also showed such type of combination.

The imaging diagnosis of immature teratoma / 实用放射学杂志

Objective To investigate the imaging manifestation of immature teratoma.Methods Imaging features of 9 cases of immature teratoma.confirmed pathologically were retrospective analysed.Results All 9 cases were male,age ranging from 1 to 38 years,mean age 1 9.5 years,AFP increased varying degrees in six cases .(1)3 cases (mean age 25.5 years)located in the anterior mediastinum which CT characteristics included the following features:lesions were projecting to one side,with irregular shape,obvi-ous necrosis,mild enhancement,wrap or oppression the blood vessels,one case with superior vena cava and head arm vein tumor em-boli and mediastinal lymph node metastasis.(2)6 cases (mean age 9.5 years)located in the pineal region and tricorn region,which MR finding were as following :cystic or solid placeholders,tow cases with small calcification or fat,solid part and the capsule wall enhancement significantly,4 cases with nodular enhancement.Conclusion Immature teratoma tends to occur in the middle struc-ture,and appears in children and young adults frequently,necrosis and cystic changes are seen commonly.CT and MR are of high val-ue in diagnosing immature teratoma.

Teratoma inmaduro con gliomatosis peritoneal y embarazo / Immature teratoma with peritoneal gliomatosis in pregnancy

Presentamos el caso clínico de una paciente de 18 años sin antecedentes a destacar. Cursando las 30 semanas de embarazo se constata una tumoración abdominal que requirió tratamiento quirúrgico y se diagnosticó un teratoma inmaduro grado 3, asociado a gliomatosis peritoneal. Se realizó una cesárea al término y se instauró el tratamiento con quimioterapia presentando una recidiva a los siete meses que requirió tratamiento quirúrgico conservador y nuevo plan de quimioterapia estando actualmente libre de enfermedad y en seguimiento. Lo infrecuente de esta patología y asociada a embarazo, motivó su comunicación.

We report the case of a healthy 18-year old patient with adnexal mass diagnosed by her 30th week of pregnancy. It required surgical treatment and a grade 3 immature teratoma associated with peritoneal gliomatosis was diagnosed. A cesarean section was performed at term and subsequently chemotherapy was established. The patient presented a recurrence seven months later, which required fertility-sparing surgery and a new chemotherapy plan. The patient is currently disease-free and under surveillance. The infrequency of this disease and associated with pregnancy, led to their communication.

Case of immature mesenteric teratoma.

Mesenteric teratomas are extremely rare tumor arising from totipotent primordial cells, which displays a mixture of tissues of tridermal or bidermal origin. Immature teratoma in mesentery is still rarer. Here we report a case of immature mesenteric teratoma in a two day old neonate, which is youngest such patient except for one case, which has been diagnosed prenataly with the help of ultrasonography.

Growing Teratoma Syndrome of the Pineal Gland Recognized Very Early during Chemotherapy in a Child with a Non-Germinomatous Germ-Cell Tumor / 임상소아혈액종양

The growing teratoma syndrome (GTS) is defined as the development of mature low-grade elements in the absence of a recurrent non-germinomatous germ-cell tumor (NGGCT) after partial response to multimodal treatment. It is uncommon and may occur in intracranial NGGCTs. Here, we report that a 7-year-old boy with intracranial NGGCT presented with precocious puberty and developed growing teratoma syndrome only 2 weeks after the first cycle of chemotherapy.

Peritoneal and Nodal Gliomatosis with Endometriosis, Accompanied with Ovarian Immature Teratoma: A Case Study and Literature Review

Gliomatosis peritonei (GP) indicates the peritoneal implantation of mature neuroglial tissue and is usually accompanied by ovarian mature or immature teratoma. Here, we report a case of ovarian immature teratoma associated with gliomatosis involving the peritoneum, lymph nodes and Douglas' pouch, where gliomatosis coexisted with endometriosis. As far as we know, only seven cases of GP have been reported as coexisting with endometriosis. Eight cases with mature glial tissue in the lymph nodes, i.e., nodal gliomatosis, have been published either in association with GP or in its absence. Metaplasia of pluripotent coelomic stem cells has been suggested to be responsible for the pathogenesis of endometriosis and GP rather than implantation metastases of ovarian teratomatous tumor with varying maturation. This theory is also applied to GP independently of ovarian teratomatous tumors. To the best of our knowledge, nodal gliomatosis coexisting with GP and also involving endometriosis has not yet been reported.

Growing Teratoma Syndrome of the Pineal Gland Recognized Very Early during Chemotherapy in a Child with a Non-Germinomatous Germ-Cell Tumor / 임상소아혈액종양

The growing teratoma syndrome (GTS) is defined as the development of mature low-grade elements in the absence of a recurrent non-germinomatous germ-cell tumor (NGGCT) after partial response to multimodal treatment. It is uncommon and may occur in intracranial NGGCTs. Here, we report that a 7-year-old boy with intracranial NGGCT presented with precocious puberty and developed growing teratoma syndrome only 2 weeks after the first cycle of chemotherapy.

Immature teratoma of the ovary: A clinicopathological study of 28 cases.

Aim: Immature teratoma (IT) of the ovary represents 1% of all ovarian cancers and 20% of malignant ovarian germ cell tumors. This retrospective study of 28 such cases aims to look at its morphological spectrum and to study the correlation of the grade and stage of the tumor with prognosis. Materials and Methods: A retrospective study of 28 cases of IT of the ovary was done. Neuroepithelium was graded as grade I, II and III according to the standard criteria. The presence of immature mesenchyme was also looked for and similarly graded. Results: The median age for the cases was 19 years and abdominal pain was the commonest symptom. Neuroepithelium was seen in 26 cases (6 were grade I, 13 were grade II, and 7 were grade III); and two showed immature mesenchymal tissue (IM) only. IM was seen in all 28 cases, but no correlation with the grade of the IT of the ovary is found. The follow up is available in 23 cases ranging from 6 months to 78 months (median 33 months). Of these, 13 were stage I, 3 were stage II and 7 were stage III ITs. Out of 23 patients, 17 patients were alive without evidence of disease recurrence during the last follow up. Adverse events in the form of death and local recurrence occurred in 6 patients. One patient died of the disease at 7 months duration from the disease onset (stage III, grade II IT). Conclusion: Morphological spectrum of IT of ovary is varied. Immature mesenchyme was seen in all the cases of IT of ovary and its presence should prompt a careful search for immature neuroepithelium. Stage I IT of ovary has better prognosis. Combination of surgery and chemotherapy can give longer survival even in recurrent disease.

Two cases of immature teratoma / 대한산부인과학회지

About 20~30% of benign or malignant tumors of ovarian origin arise from embryonic cells, and only 3% represent malignancy. But under age of 20, 70% of ovarian tumors arise from embryonic cells, and over 1/3 of them are malignant tumors. Over all the ovarian tumors arising from embryonic cells, immature teratoma is germ cell tumor, components include immature tissues and cells derived from ectoderm, mesoderm, and endomermal origins. Most of the immature tissues are from neuroectodermal origins. The immature teratoma of the ovary is a rare tumor, representing less than 1% of all ovarian neoplasm. These tumors typically present in young age woman (mean age 10~20 years) with pelvic and abdominal pain. Nowadays newly developed combination chemotherapeutic agents such as bleomycin, etoposide, cisplatin give us great survival and disease free prognosis than before. We have experienced two cases of immature teratoma so we report them with a brief review of concerned literatures.

Growing teratoma syndrome in a post laparoscopic excision of ovarian immature teratoma / 부인종양

A 26-year-old girl was referred to us in December 2008 with progressive pelvic mass while on chemotherapy. In May 2008, she presented with large adnexal mass and high alpha-fetoprotein (AFP, 265.7 ng/mL; normal range, 0 to 10). She underwent laparoscopic right salpingo-oophorectomy with staging. Since histology was immature teratoma grade I, FIGO stage 1 she was kept on surveillance. In September 2008, she developed recurrent pelvic mass with AFP levels of 2,400 ng/mL. Three courses of chemotherapy (bleomycin-etoposide-cisplatin) were given. Post-chemotherapy AFP normalized but tumor size increased. CT-scan (abdomen-pelvis) showed a large pelvic mass with calcification specks; infiltrating the sigmoid colon and abdominal wall. With provisional diagnosis of growing teratoma syndrome she had exploratory laparotomy with excision of pelvic mass along with sigmoid colon, excision of right pelvic and subcutaneous deposits, omentectomy and sigmoid anastomosis. Left ovary, left tube and uterus appeared normal and were preserved. Histology of all masses showed mature teratoma, no immature elements. At six months follow up she is disease free and has resumed menstruation. Growing teratoma syndrome is a clinico-pathological presentation during/post-chemotherapy in malignant ovarian germ cell tumor where mature teratoma grows and requires complete surgical excision. Our case highlights the safety and adequacy concerns of laparoscopic management of malignant ovarian tumor. Literature review suggests good prospects of resumption of menses, child bearing and five year survival in case of growing teratoma syndrome.

A case of sequent occurrence of mature and immature teratomas in same patient / 대한산부인과학회지

Ovarian teratomas are the most common germ cell neoplasm. They include mature cystic teratomas, monodermal teratomas (neural tumors, struma ovarii, carcinoid tumors) and immature teratomas. Malignant transformation of mature teratoma is very rare event and a case of sequence occurance of mature teratoma and immature teratoma in same patient is not reported yet in Korea. A 17-year-old female was found to have a huge mature teratoma of the right ovary 3 years ago. That was treated with surgery. Three years later, Immature teratoma was discovered in left ovary and treated with surgery followed by chemotherapy. We experienced one case of sequent occurrence of mature teratoma and immature teratoma on both ovary in same patient. We present it with a brief of literature.