Teratoma tímico productor de beta-HCG: una causa infrecuente de pubertad precoz periférica / Beta-hCG-producing thymic teratoma: an uncommon cause of peripheral precocious puberty

INTRODUCCIÓN: Entre las causas de pubertad precoz periférica en el varón están los tumores secretores de betagonadotrofina coriónica humana (Β-HCG), como hepatoblastomas, disgerminomas, corio-carcinomas y teratomas inmaduros. En pediatría los teratomas mediastínicos son raros, representan el 7-10% de los teratomas extragonadales. OBJETIVO: Describir caso de un paciente que cursa con pubertad precoz periférica debida a teratoma tímico secretor de Β-HCG. CASO CLÍNICO: Escolar masculino de 7 años 10 meses consultó por cuadro de 3 meses de cambios de la voz, ginecomastia, aparición de vello pubiano y aumento de volumen genital. En exámenes destacaba edad ósea de 9 años, testosterona total 9,33ng/ml (< 0,4ng/ml), dehidroepiandrosterona sulfato (DHEAS), 17-hidroxi-progesterona (17-OH-P) y prueba de hormona adrenocorticotrofina (ACTH) normales, hormona luteinizante (LH) y hormona folículo estimulante (FSH) basales bajas, Β-HCG 39,5mU/ml (< 2,5 mUI/ml), alfa fetoproteína (α-FP) 11,2ng/ml (0,6-2,0 ng/ml). Estudio de imágenes para determinar origen de secreción de Β-HCG incluye: ecografía testicular y tomografla axial computarizada (TAC) torácica, abdominal y pelviana normales; resonancia cerebral y selar sin hallazgos significativos. Tomografía por emisión de positrones/tomografía computada (PET SCAN) evidenció imagen de tumor en mediastino antero-superior. Se resecó el tumor, cuya biopsia evidenció teratoma quístico inmaduro en timo. Evolución postoperatoria fue satisfactoria, con normalización de niveles hormonales. CONCLUSIÓN: La presentación de un teratoma en paciente pediátrico es infrecuente, aún más, si es inmaduro, su localización es tímica y es secretor de Β-HCG. Es relevante considerarlo dentro de diagnósticos diferenciales frente a pubertad precoz, de modo que pueda efectuarse un manejo oportuno.

INTRODUCTION: Among the causes of peripheral precocious puberty in men are the beta- human cho rionic gonadotropin (Β-HCG)-secreting tumors, such as hepatoblastomas, dysgerminomas, chorio carcinomas, and immature teratomas. In pediatrics, the mediastinal teratomas are rare, representing the 7-10% of extragonadal teratomas. OBJECTIVE: To describe the case of a patient with peripheral precocious puberty due to a Β-HCG -secreting thymic teratoma. CLINICAL CASE: A seven-years-old schoolboy presents a three-months history of voice changes, gynecomastia, pubic hair appearance, and increased genital volume. In the exams, bone age of nine years, total testosterone 9.33ng/ml (< 0.4ng/ml), dehydroepiandrosterone sulfate (DHEAS), 17-hydroxyprogesterone (17-OHP), and normal adrenocorticotropic hormone (ACTH) test stand out; luteinizing hormone (LH) and follicle stimulating hormone (FSH) with low basal levels, P-HCG 39.5mU/ml (< 2.5 mUI/ml), alpha feto protein (Α-FP) 11,2ng/ml (0.6-2.0 ng/ml). Imaging study to determine the origin of P-HCG secretion shows normal testicular ultrasound and thoracic, abdominal, and pelvic computerized axial tomo graphy (CAT); brain and sellar resonance without significant findings. The positron emission tomography/computed scan (PET SCAN) shows a tumor image in the anterosuperior mediastinum. The tumor is resected, and the biopsy shows an immature cystic teratoma in the thymus. Post-operatory evolution was satisfactory, with normalization of hormonal levels. CONCLUSION: The appearance of a teratoma in a pediatric patient is rare, even more if it is immature, with thymic location and Β-HCG- secretor. It is important to consider it within the differential diagnosis facing precocious puberty, as a better way to handle appropriately.

Immature teratoma with choriocarcinoma-like lesion of testis: case report of an unusual presentation.

An eighteen year old male presented with hemoptysis and superior vena caval syndrome. History and clinical examination revealed a testicular mass which was previously diagnosed as hematocele. Chest x-ray showed a four cm diameter shadow and several smaller shadows. Histological examination of the testicular mass established it as immature teratoma with choriocarcinoma-like lesion (CCLL)--a rare association in testicular tumours. Focal positivity for betaHCG was noted in the testicular tumour. Guided aspiration of the lung showed features of a metastatic non seminomatous germ cell tumour.

Intracranial immature teratoma with syncytiotrophoblasts and tumor marker positive intestinal lining cells

Intracranial teratomas are rare entities that can present as a pure type or as mixed germ cell tumor. Cases of mixed germ cell tumor composed of immature teratoma and choriocarcinoma have been reported. Also, immature teratoma can be mixed with only syncytiotrophoblasts. We report a case of immature teratoma with syncytiotrophoblasts of the brain discovered in a 3-year-old male baby. Serum human chorionic gonadotrophin (hCG) was normal and serum alpha-fetoprotein (AFP) was elevated. The tumor was mainly composed of intestinal glands, and neither endodermal sinus tumor nor embryonal carcinomatous elements were found. The cells lining the intestinal glands were positive for hCG and AFP. These findings suggest that the syncytiotrophoblasts are differentiated from the endoderm and AFP is not necessarily a marker exclusive to endodermal sinus tumor or embryonal carcinoma.

Tumores malignos de células germinativas do ovário: expressäo de enolase Neurônio-específica, alfa-1-antitripsina e alfa-1-antiquimotripsina / Malignant tumors of germinoma: expression of phosphopyruvate, alpha 1-antitrypsin and alpha 1-antichymotrypsin

Foi realizado um estudo imuno-histoquímico para verificar a expressäo de enolase neurônio-específica (NSE), alfa 1-antitripsina (AAT) e alfa 1-antiquimotripsina (AAQT) em tumores malignos de células germinativas do ovário. As reaçöes imuno-histoquímicas foram realizadas em tecidos previamente fixados em formol e embebidos em parafina de sete disgerminomas, três tumores do seio endodérmico, três teratomas imaturos e um oriocarcinoma. Todos os tumores, exceto o coriocarcinoma, expressaram NSE. As reaçös com anticorpos anti-AAT e AAQT foram positivas em todos os tipos histológicos dos tumores. Estes dados sugerem que NSE, AAT ou AAQT podem ser mais um marcador para os tumores de células germinativas do ovário.