Teratomas of the Brain and
Head and Neck
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacade...
We present examples of teratomas found
in the brain and extracranial head and
neck taken from our teaching files,
collecte...
Histologic Classification
• Mature
type:
composed
of
fully
differentiated adult-type tissues, absent or
low mitoses
• Imma...
Tumor Markers
• Malignant yolk sac endoderm can be an
aggressive component of teratomas and
these patients may have elevat...
Clinical Features
• 90% of teratomas are found below 20
years of age (most: 10-12 years)
• Male-to-female ratio: 2.5:1
• 8...
General Imaging Features of
Teratomas
• Heterogeneous appearance
– Presence of fat, cysts (mucous-laden),
calcium (bone an...
Congenital Teratoma
Intracranial
teratomas
are rare, accounting for
0.5-2.0% of intracranial
tumors. They comprise
50% of ...
Congenital Teratoma
Teratomas
are
typically
benign tumors containing
elements of all 3 germinal
layers: ectoderm, mesoderm...
Pineal Teratoma

Tissue rests are typically found in the midline, specifically, the pineal,
suprasellar and 3rd ventricle ...
Pineal Teratoma

Another example of pineal teratoma seen on sagittal T1 (left), axial post-Gd
T1 (middle) and axial T2 (ri...
Suprasellar Teratoma

Differential diagnosis for a T1 bright and T2 dark includes
aneurysm, dermoid, lipoma and craniophar...
Suprasellar Teratoma

Large suprasellar mostly cystic mass (left: T1 coronal, right: T2
axial) initially believed to be a ...
Suprasellar Teratoma
Intracranial
teratomas
usually
manifest
in
younger children – adult
presentation is unusual.
Left: Su...
Suprasellar Teratoma

Example of childhood suprasellar teratomas. Axial
non-contrast CT (left) and sagittal T1 image (righ...
Intraventricular Teratoma

Axial non-contrast CT (left), axial T2 (middle) and coronal post-Gd T1
(right) images in intrav...
Cerebellar Teratoma

Teratomas are classified by cell/tissue types as mature or immature, and
graded histologically from 0...
Facial Teratoma

Differential diagnosis for a facial teratoma includes lymphatic malformation,
arteriovenous malformation,...
Facial Teratoma

Axial T2 (left), axial T1 (middle) and sagittal T1 (left) images of a heterogeneous
mass in the left faci...
Facial Teratoma

Head and neck teratomas commonly occur in the anterior midline, usually in
the oropharynx or nasopharynx,...
Upper Neck Teratoma

Cervical teratomas typically present at birth as firm ovoid masses with
palpable cystic areas.
Calcif...
Upper Neck Teratoma

Presenting symptoms of cervical teratomas include respiratory distress,
feeding difficulties and tort...
Cervical Teratoma

Above: Post-contrast axial CT image (left) and ultrasound image (right) of a
cervical teratoma. Note tr...
Lower Neck Teratoma

Teratomas comprise 9% of head and neck tumors in children.
Above: Radiograph (left) and axial CT imag...
Conclusion
Teratomas involving the head and neck
are rare tumors characteristically involving
the midline, nearly always h...
References
•
•
•
•
•
•
•
•
•
•
•
•

Tobias S, Valarezo J, Meir K, et al. Giant cavernous sinus teratoma: a clinical
exampl...
Thank you
For more details please visit
www.indiandentalacademy.com

www.indiandentalacademy.com
Upcoming SlideShare
Loading in …5
×

Teratomas exhibit-arrs-nx power-lite /certified fixed orthodontic courses by Indian dental academy

806 views

Published on


The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
806
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
12
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Teratomas exhibit-arrs-nx power-lite /certified fixed orthodontic courses by Indian dental academy

  1. 1. Teratomas of the Brain and Head and Neck INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. We present examples of teratomas found in the brain and extracranial head and neck taken from our teaching files, collected over a 10-year period. Along with the imaging findings we discuss important clinical and pathological information regarding these lesions. Because of the presence of cysts and calcifications, both CT and MRI provide critical information that helps in formulating a differential diagnosis. www.indiandentalacademy.com
  3. 3. Histologic Classification • Mature type: composed of fully differentiated adult-type tissues, absent or low mitoses • Immature type: fetal-type incompletely differentiated tissues • Malignant type: contains cancerous tissues such as sarcomas, carcinomas and other embryonal malignancies www.indiandentalacademy.com
  4. 4. Tumor Markers • Malignant yolk sac endoderm can be an aggressive component of teratomas and these patients may have elevated levels of AFP or beta-HCG in serum and/or CSF • Transcription factors GATA-4 and GATA-6 may also be elevated in mature and immature teratomas www.indiandentalacademy.com
  5. 5. Clinical Features • 90% of teratomas are found below 20 years of age (most: 10-12 years) • Male-to-female ratio: 2.5:1 • 80% occur around region of 3rd ventricle; thus most symptoms are due to hydrocephalus and increased intracranial pressure www.indiandentalacademy.com
  6. 6. General Imaging Features of Teratomas • Heterogeneous appearance – Presence of fat, cysts (mucous-laden), calcium (bone and chondroid nodules), soft tissues • Enhancing soft tissues – Present in all types of tumors – Enhancement of capsule – Heterogeneous enhancement of soft tissue components www.indiandentalacademy.com
  7. 7. Congenital Teratoma Intracranial teratomas are rare, accounting for 0.5-2.0% of intracranial tumors. They comprise 50% of congenital brain tumors (those presenting in the first 60 days of life). Above: Contrast enhanced CT of congenital teratoma shows a centrally located heterogeneous mass containing cystic/solid components and severe hydrocephalus. www.indiandentalacademy.com
  8. 8. Congenital Teratoma Teratomas are typically benign tumors containing elements of all 3 germinal layers: ectoderm, mesoderm and endoderm. They develop from embryonic cells which become “misinvolved” during formation of the primitive streak in the 3rd week of life. Some of these cells become “misenfolded” as intracranial rests of tissue. Above: Axial T1 (left) and T2 (right) images of a congenital teratoma (arrows). The mass is centrally located and has a heterogeneous appearance. There is hydrocephalus. www.indiandentalacademy.com
  9. 9. Pineal Teratoma Tissue rests are typically found in the midline, specifically, the pineal, suprasellar and 3rd ventricle regions. Above: Contrast enhanced CT (left) and pre- (middle) and post-Gd (right) T1 images. There is peripheral enhancement on CT (arrows) and mild heterogeneous enhancement (arrows) on MRI. Ventricular air was introduced by a ventriculostomy. www.indiandentalacademy.com
  10. 10. Pineal Teratoma Another example of pineal teratoma seen on sagittal T1 (left), axial post-Gd T1 (middle) and axial T2 (right) images. There is heterogeneous signal from cystic and solid components, capsular (arrow) and tumoral enhancement. www.indiandentalacademy.com
  11. 11. Suprasellar Teratoma Differential diagnosis for a T1 bright and T2 dark includes aneurysm, dermoid, lipoma and craniopharyngioma. Above: Coronal T1 (left) and T2 (right) images of a suprasellar teratoma with considerable fatty contents. www.indiandentalacademy.com
  12. 12. Suprasellar Teratoma Large suprasellar mostly cystic mass (left: T1 coronal, right: T2 axial) initially believed to be a craniopharyngioma but proven to be a teratoma. www.indiandentalacademy.com
  13. 13. Suprasellar Teratoma Intracranial teratomas usually manifest in younger children – adult presentation is unusual. Left: Suprasellar teratoma in a child. Axial FLAIR (top left) and T2 (top right) images show bright lesion. T1 sagittal images without (bottom left) and with (bottom right) Gd show heterogeneous enhancement of mass. www.indiandentalacademy.com
  14. 14. Suprasellar Teratoma Example of childhood suprasellar teratomas. Axial non-contrast CT (left) and sagittal T1 image (right) demonstrate fat (arrows) in both lesions. www.indiandentalacademy.com
  15. 15. Intraventricular Teratoma Axial non-contrast CT (left), axial T2 (middle) and coronal post-Gd T1 (right) images in intraventricular teratoma. Fat, cysts and calcifications (arrows) are present. The tumor shows central www.indiandentalacademy.com heterogeneous enhancement. Note associated hydrocephalus.
  16. 16. Cerebellar Teratoma Teratomas are classified by cell/tissue types as mature or immature, and graded histologically from 0-3, with grade increasing with amount of immature tissues. Grade 0: only mature tissues. Grade 3: large amounts of immature tissues. Above: Cerebellum is an unusual location for teratoma. Axial contrast enhanced CT (left), axial T2 (middle) and sagittal T1 (right) images show a www.indiandentalacademy.com heterogeneous mass containing fat (arrows).
  17. 17. Facial Teratoma Differential diagnosis for a facial teratoma includes lymphatic malformation, arteriovenous malformation, hemangioma, neuroblastoma, and dermoid cyst. Above: Axial T1 pre- (left) and post-Gd (right) images show a heterogeneous cystic mass in the region of the left parotid tail with a www.indiandentalacademy.com heterogeneously enhancing solid component (arrows).
  18. 18. Facial Teratoma Axial T2 (left), axial T1 (middle) and sagittal T1 (left) images of a heterogeneous mass in the left facial region with cystic and solid components, which proved to be a teratoma. www.indiandentalacademy.com
  19. 19. Facial Teratoma Head and neck teratomas commonly occur in the anterior midline, usually in the oropharynx or nasopharynx, but may also involve the orbit, temporal fossa, and face. Some teratomas, especially those arising in the nasopharynx, may traverse the skull base and have extensive intracranial extension. Above: Axial CECT of a child with a large exophytic heterogeneous mass, which was originating from www.indiandentalacademy.com the presence of fat adjacent the oropharynx. Note to the coarse calcifications (arrow). C/O Dr. Bernadette Koch
  20. 20. Upper Neck Teratoma Cervical teratomas typically present at birth as firm ovoid masses with palpable cystic areas. Calcifications are seen on plain radiographs in up to 45% of teratomas. Above: Lateral radiograph (left) shows coarse calcifications (arrow) in an anterior upper neck teratoma in a child. Axial CT images (middle and right) of the same patient show macroscopic fat (arrows) in addition to the www.indiandentalacademy.com calcifications.
  21. 21. Upper Neck Teratoma Presenting symptoms of cervical teratomas include respiratory distress, feeding difficulties and torticollis. Axial CECT image of the upper neck shows a large complex mass on the right side with cystic components and heterogeneous enhancement. Note presence of endotracheal www.indiandentalacademy.com tube. C/O Dr. Bernadette Koch
  22. 22. Cervical Teratoma Above: Post-contrast axial CT image (left) and ultrasound image (right) of a cervical teratoma. Note tracheal narrowing and deviation, and presence of calcification seen in both studies (arrows). www.indiandentalacademy.com
  23. 23. Lower Neck Teratoma Teratomas comprise 9% of head and neck tumors in children. Above: Radiograph (left) and axial CT image (right) of a teratoma arising from the region of the thyroid gland, extending inferiorly into the superior mediastinum. Note leftward tracheal deviation and coarse calcifications www.indiandentalacademy.com within the mass on the CT image (arrow).
  24. 24. Conclusion Teratomas involving the head and neck are rare tumors characteristically involving the midline, nearly always having a heterogeneous appearance and often containing fat and/or calcifications. www.indiandentalacademy.com
  25. 25. References • • • • • • • • • • • • Tobias S, Valarezo J, Meir K, et al. Giant cavernous sinus teratoma: a clinical example of a rare entity: case report. Neurosurgery 2001; 48:1367-71 Moore K. Oculomotor nerve teratoma. AJNR Am J Neuroradiol 2001; 22:1566-69 Sinha VD, Dharker SR, and Pandey CL. Congenital intracranial teratoma of the lateral ventricle. Neurol India 2001; 49:170-73 Sandow BA, Dory CE, Aguiar MA, and Abuhamad AZ. Best cases from the AFIP: Congenital intracranial teratoma. Radiographics 2004; 24:1165-1170 Gobel U, Schneider DT, Calaminus GH, et al. Germ-cell tumors in childhood and adolescence. GPOH MAKEI and the MAHO study groups. Ann Oncol 2000; 11(3):263-271 Siltanen S, Heikkila P, Bielinska M, et al. Transcription factor GATA-6 is expressed in malignant endoderm of pediatric yolk sac tumors and in teratomas. Pediatr Res 2003; 54(4):542-546 Moore K. Oculomotor nerve teratoma. AJNR Am J Neuroradiol 2001; 22:1566-69 Scheraga JL, Wasenko JJ, and Davis RL. MR of intracranial extension of nasopharyngeal teratoma. AJNR Am J Neuroradiol 1996; 17:1494 Sano K. Intracranial dysembryogenetic tumors: pathogenesis and their order of malignancy. Neurosurg Rev 2001; 24:162-67 Carr MM, Thorner P, and Phillips JH. Congenital teratomas of the head and neck. The Journal of Otolaryngology 1997; 26:246-52 Chaudhary N, Malik KPS, Gupta A, et al. Synchronous cystic teratomas of the craniofacial region. The Journal of Laryngology and Otology 2003; 117:824-26 Lanzino G, Kaptain GJ, Jane JA, Lin KYK. Successful excision of a large immature teratoma involving the cranial base: report of a case with long-term follow-up. Neurosurgery 1998; 42: 389-93 www.indiandentalacademy.com
  26. 26. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

×