Testicular Teratomas In Children- Case Series

Testicular tumors are very uncommon in children and teratomas are the commonest of these tumors. We are reporting our experience with five cases of testicular teratomas in the last 25 years.

Teratomas on the palate and tongue with cleft palate: a case report / 华西口腔医学杂志

Teratomas is a germ cell tumors, which is rare in the upper palatal and lingual. This article presents a patient with teratomas on the palate and tongue accompanied with cleft palate. The clinical manifestations and histopathological characteristics of teratomas are discussed according to relevant literatures.

Dientes fuera de la cavidad oral, un hallazgo infrecuente / Teeth outside the oral cavity, an uncommon finding

Los dientes derivan de tres estructuras embriológicas importantes: las células de la cresta neural, el mesodermo y el ectodermo bucal. Asimismo, los teratomas son lesiones tumorales que se desarrollan a partir de las células germinales de las tres capas germinativas embrionarias y que pueden dar lugar a la formación de estructuras dentales, adiposas, pilosas, óseas, cartilaginosas en localizaciones anatómicas aberrantes pudiendo aparecer en los pulmones, los ovarios, los testículos, la región hipofisiaria y pineal. Se trata de lesiones generalmente asintomáticas y subclínicas que tienden a aparecer en las primeras tres décadas de la vida y son comúnmente diagnosticadas de forma accidental mediante estudios imagenológicos como la tomografía axial computarizada o la resonancia magnética. Se describe el caso de una paciente de 28 años a quien se le realizó la extirpación de una masa tumoral en el ovario con el diagnóstico presuntivo de teratoma, y al realizar su apertura se encontraron órganos dentarios en su interior. El objetivo principal de este artículo es explicar el proceso embrionario que da lugar a losdientes y las circunstancias patológicas que pueden ocasionar que esteproceso odontogénico se suscite en sitios anatómicos aberrantes yatípicos ajenos a la cavidad bucal.

Teeth are derived from three important embryological structures: the neural crest cells, oral mesoderm and ectoderm. Also, teratomas aretumoral lesions that are developed from the germ cells of the threeembryonic germinative layers and that can give rise to the formation of dental, adipose, hairy, bony, cartilaginous structures in aberrant anatomical locations that can appear in lungs, ovaries, testicles, pituitary and pineal region. These are usually asymptomatic and subclinical lesions that tend to appear in the first three decades of lifeand are commonly diagnosed accidentally by imaging studies such ascomputed tomograph or magnetic resonance imaging. We describe thecase of a 28-year-old patient who was removed from a tumor mass in theovary with a presumptive diagnosis of teratoma and when they openedit, dental organs were found inside. The main objective of this articleis to explain the embryonic process that gives rise to the teeth and thepathological circumstances that can cause this odontogenic process toarise in anatomical aberrant and atypical sites outside the oral cavity.

The management of immature testicular teratomas in children / 中华泌尿外科杂志

Objective To summarize the management of immature testicular teratomas in children.Methods The clinical data of 19 children (age between 16 days to 13 months) with immature testicular teratomas were retrospectively analyzed.There were 10 cases in left and 9 cases in right side.The main presentation was painless scrotal mass.The size of the tumor was 1.5 cm × 1.2 cm × 0.5 cm-6.0 cm × 5.0 cm × 4.5 cm.Abnormal alpha fetopmtein (AFP)concentrations were detected in 17 patients before surgery.Results Testis-sparing surgeries were done in 11 patients,and the other 8 patients underwent testicle resection because of tumor severely invading testis.Fifteen cases were followed up for 1-10 years.All of them were alive.Conclusions Immature testicular teratomas was rare and almost presenting in children younger than 1 year old.The biological behavior of immature testicular teratomas in children was benign.Testicular-sparing surgery was possible.Close follow-up should be done postoperatively.

Comparative study of ultrasonic and pathologic features of ovarian teratoma / 中华医学超声杂志（电子版）

Objective To compare the sonographic and histopathological features of ovarian teratoma. Methods The sonographic and histopathological features were retrospectively analyzed and summarized in 35 cases of patients (40 cases of ovarian teratomas) with ovarian teratoma proved by surgery and pathology in Fuxing Hospital, Capital Medical University from January 2005 to December 2013. Results There were three types on ultrasound: the cystic type (10/40, 25.0%), the solid type (5/40, 12.5%), and the cyst-solid type (25/40, 62.5%). The histopathological findings of the tumors were classified into two types: ovarian mature teratoma (36/40, 90.0%) and ovarian immature teratoma (4/40, 10.0%). In the ovarian mature teratoma group, the majority of the tumor were filled with oil, hair, skin and its appendages. The ovarian struma (1/40, 2.5%) could also be seen in this type, which was mainly filled with thyroid tissue.In the ovarian immature teratoma group, immature tissue mainly consisted of the primitive neural tube under the similar histopathological background with mature teratoma. In comparison of ultrasonography and pathology, the ultrasonographic features of immature teratoma and mature teratoma were similar. Both of them appeared as the solid type and the cyst-solid type. Conclusions In comparison of ultrasonography and pathology, ovarian teratoma's internal echo and its tissue structure are closely correlated. The cystic type was usually found in mature teratoma, and the solid type and the cyst-solid type can be found in either mature teratoma or immature teratoma.

The analysis of CT manifestations of misdiagnosed or missed ovarian cystic mature teratomas / 实用放射学杂志

Objective To analyze CT findings of misdiagnosed or missed ovarian cystic mature teratomas to improve the diagnosis.Methods CT images of 145 cases were retrospectively reviewed.Among them,29 cases of ovarian cystic teratomas were misdiagnosed or missed.Results Five cases of struma ovarii were diagnosed as cyctadenocarcinoma,7 cases of cystic mature teratoma were misdiagnosed as cyst in 2 cases,ovarian endometrial cyst in 2 cases and cystadenoma in 3 cases.17 cases of cystic mature teratoma weremissed diagnosis, in which there were torsion in 7 cases,infection in 4 cases,bleeding in 3 cases,endometriosis cyst,serous cystadenoma and tuberculosis in 1 case respectively.Conclusion Understanding the atypical misdiagnosed or missed CT manifestation of ovarian cystic mature teratomas permits a more specific and accurate diagnosis,which may be useful for preoperative diagnosis.

Primary mature cystic teratoma with carcinoid mimicking an adrenal tumor: Report of a rare association and review of literature.

Teratomas are neoplasms comprising of tissues derived from more than one germ layer. Most common sites are gonads, sacrococcygeal, mediastinal, retroperitoneal, and pineal region. Here, we report a case of 2½‑year‑old previously healthy female toddlerwho presented with fever and right upper quadrant abdominal pain. Magnetic resonance imaging (MRI) of the abdomen revealed a right suprarenal nonenhancing cystic mass. Focal calcification was seen in the inferomedial aspect of the cyst. Complete surgical resection of the right adrenal gland was done. The patient had an uneventful postoperative course and was free of recurrence at 8 months follow‑up. Primary retroperitoneal teratomas of the adrenal gland are very uncommon (4% of all primary teratomas) and can mimic a primary adrenal tumor, hence should be included in the differential diagnosis of adrenal masses.

Research progress of anti-N-methyl-D-aspartate receptor encephalitis / 中华实用儿科临床杂志

Anti-N-methyl-D-aspartate receptor (NMDAR) antibody encephalitis is an autoimmune encephalitis manifesting subacutely with prominent aberrant movements and psychiatric symptoms,which associated with antibodies against NR1 or NR2 subunits of the NMDAR.The disease is not rare,early diagnosis and immune treatment can improve prognosis and reduce the recurrence.The epidemiology,mechanisms,clinical presentation,treatment and prognosis of the disease were reviewed in order to enhance the cognition of anti-NMDAR encephalitis.

Clinical analysis of testicular tumor in 76 children / 中华实用儿科临床杂志

Objective To summarize the management and diagnosis of testicular tumors in children.Methods The clinical characteristics, diagnosis, treatment and outcome of patients with pediatric testicular tumors, who were referred to Department of Pediatric Surgery, Shengjing Hospital of China Medical University from January 2003 to December 2013 ,were analyzed retrospectively.Results All of the 76 prepubertal patients were diagnosed initially with a painless scrotal mass.The mean age of the patients at diagnosis ranged from 1 to 156 months[mean(32.3 ±4.4) months].There were 39 cases(51.3％) with ages of0-1 years,18 cases (23.7％) with ages of 1-3 years,10 cases (13.2％) with ages of ＞ 3-7 years,9 cases(11.8％) with ages of ＞ 7-14 years.There were 37 cases in left side and 39 cases in right.And there were 59 cases (77.6％)of benign tumors and 17 cases(22.4％)of malignant tumors.Of the benign tumors,42 cases(55.2％)were teratomas, including 34 cases of mature teratoma and 8 cases of immature teratoma;11 cases were epidermoid cyst;11 cases were other benign tumors as lymphangioma.Among the 17 cases of malignant tumors, 16 cases (21.1％) were yolk sac tumors, which were I stage;1 case was embryoma.Thirty-three patients had abnormal alpha fetoprotein (AFP)concentrations before surgery,including 9 patients with mature teratoma,7 patients with immature teratoma, 16 patients with yolk sac tumors, 1 patient with embryonal carcinoma of testis.Of the 59 cases of benign tumors,testis-sparing surgery was done in 50 tumors, the other 9 patients underwent testis-excising because of tumor severely oppressing testis.All the 17 cases of malignant tumors underwent testis-excising.There were 76 cases in the follow-up.One patient with yolk sac tumor died for pulmonary metastasis during the follow-up.Others were alive and free of tumor recurrence.Conclusions The age range of the prepubertal testicular onset was 1 year or younger, most of the tumors were benign, and the most common subtype was teratoma.AFP highly expressed in yolk sac tumors, it was help to diagnosis.Testis-sparing surgery should be performed for the benign tumors and testis-excising for the malignant tumors.

Aspectos éticos en el empleo de las células madre / Ethical aspects in the use of stem cells

En los animales superiores, las células madre pueden ser embrionarias y somáticas o adultas, según su estado evolutivo. En la actualidad se mantiene una extraordinaria polémica sobre qué células madre utilizar: las embrionarias o las adultas, debate en el que se han incluido aspectos científicos, éticos, religiosos, sociales y políticos. Un aspecto del debate científico está relacionado con la capacidad generativa de tumores por las células embrionarias. También se ha señalado que los beneficios de las células embrionarias se han exagerado y que en su lugar podrían utilizarse células madre adultas, con las que no existen restricciones éticas ni se ha comprobado la generación de tumores. Desde el punto de vista ético, se ha argumentado que el uso de las células madre embrionarias humanas implica la destrucción de embriones y se ha considerado que la vida comienza en el mismo momento de la unión del espermatozoide con el óvulo. Lo que equivaldría a la destrucción de una vida humana, algo no justificable. Otros no están de acuerdo con estos criterios, y plantean que su uso para salvar vidas mediante la investigación o la terapéutica estaría justificado. Recientemente se ha logrado la obtención de células madre embrionarias denominadas “células madre éticas”, pues este nuevo método eliminaría el dilema ético de destruir embriones. Algunos han planteado que estos resultados son preliminares, posiblemente exagerados, y la eficiencia del método es muy baja. Otros señalan que resulta más ético trabajar con embriones que de todas formas se van a destruir.

In the superior animals, the stem cells may be embryonary and somatic, or adults, according to their evolutive state. At present, there is an extraordinary polemic about the stem cells that should be used: the embryonary or the adults. Scientific, religious, social and political aspects have been included in this debate. An aspect of the scientific discussion is related to the tumour-producing capacity of the embryonary cells. It has also been stated that the benefits of the embryonary cells have been exaggerated, and that adult stem cells should be used instead, since they do not have ethical restrictions and do not generate tumours. From the ethical point of view, it has been explained that the use of human embryonary stem cells leads to the destruction of embryos and, as it is considered that life begins in the very moment the spermatozoid joins the ovule, it would mean the extermination of a life, which is something intolerable. Others do not agree with this criterion and express that their use to save lives by investigation or biopsy would be justified. Recently, there have been obtained embryonary stem cells so-called “ethical stem cells”. This new method would eradicate the ethical dilemma of destroying embryos. Some have stated that these are preliminary and possibly exaggerated results, and that the efficiency of the method is very low, while others say that it is more ethical to work with embryos that will be destroyed anyway.

The operating approaches of laparoscopic resection for ovarian benign cystic teratomas / 中国微创外科杂志

Objective To study the operating approaches of laparoscopic resection of ovarian benign cystic teratomas. Methods 67 patients underwent operative laparoscopy for ovarian cystic teratomas(23 ovarian cystectomies,44 oophorectomies or adnexectomies),including 27 patients who had cysts more than 8cm in diameter.In operation, a plastic bag was used and the abdominal cavity was abundantly flushed with warm physiologic saline.The larger cysts were aspirated to reduce the cysts and extracted through abdominal wall incision. Results Cyst rupture occurred in 17 cases (17/44) when cystectomy was performed. No cyst spillage occurred in all the oophorectomies and adexectomies.The mean operating time was (34?19)min.Blood loss was 3ml～7ml.No complications occurred and none of the patients needed conversion from laparoscopy to laparotomy.chemical peritonitis wes not seen in any of the patiants. Conclusions Laparoscopic surgery is safe and feasible for ovarian benign cystic teratomas and allows the removal of larger ovarian cysts.

Imaging Diagnosis of Spinal Teratomas / 实用放射学杂志

Objective To study the imaging characters of spinal teratomas.Methods 10 cases of spinal teratomas were analyzed with clinical and radiography. 8 cases intramedullary, 2 cases extramedullary. 10 cases had MR examination. Results The location of spinal teratomas in 5 cases was in lumbar, 3 cases in thorax, 1 case in thoracolumbar, 1 case in cervical. 7 cases were multicyst type, 3 cases were singlecyst type. 10 cases of MR image showed mix signal intensity. The contrast enhancement T 1WI with fat saturation presented disappear fat signal of spinal teratomas. The teratomas heterogeneous enhancement was found in 10 cases with MR examination. 3 cases lumbosacral area of spinal teratomas united tethercord. Conclusion Neuroradiological features of spinal teratomas has specific manifestation. The T 1WI fat saturation scan is a availability nicety method for spinal teratomas.