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Teratoma

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Teratoma

  1. 1. Teratoma 20150424
  2. 2. Introduction ● due to abnormal differentiation of fetal germ cells that arise from the fetal yolk sac ● Teratomas are typically found in the midline or gonads. Sacrococcygeal - 40% Ovary - 25% Testicle - 12% Brain - 5% Other (including the neck and mediastinum) - 18%
  3. 3. Introduction Teratomas have been reported to contain hair, teeth, bone (rarely: eyes,torso,and hands, feet, or other limbs) usually benign mature/benign immature/malignant women men more commonly 95% 5%
  4. 4. Introduction ● Congenital (unknown: germ cells) ● nonseminomatous germ cell tumor (N.S.G.C.T.) ● abnormal development of pluripotent cells ● germ cells and embryonal cells ● ectoderm, endoderm, and mesoderm germ cells testes or ovaries embryonal cells Congenital unknown
  5. 5. Mature teratoma ● grade 0 teratoma ● solid, cystic, or a combination ● skin, muscle, and bone ● generally benign Dermoid cyst Skin may surround a cyst and grow abundant hair
  6. 6. Dermoid cyst ● a cystic teratoma ● grows slowly and contains mature tissue ● always benign rare malignant in adult: squamous cell carcinoma in infants and children: endodermal sinus tumor
  7. 7. Dermoid cyst Ovarian dermoid cysts ● totipotential germ cells differentiated abnormally ● Complications: torsion, rupture and infection Periorbital dermoid cysts ● in young children ● near the lateral aspect of the eyebrow ● can recur if not completely excised
  8. 8. Dermoid cyst Spinal dermoid cysts ● benign ectopic growths of neural tube closure ● lumbosacral region
  9. 9. Gonzalez-Crussi grading system Grade 0 mature (benign) Grade 1 immature, probably benign Grade 2 immature, possibly malignant (cancerous) Grade 3 frankly malignant depends on amount of immature elements <10% 10-50% >50% mature
  10. 10. Diagnosis ● Prenatal ultrasound ● Prenatal MRI ● “steal syndrome” fetus' blood flow is redirected toward the teratoma ● AFP Some teratomas contain yolk sac elements, which secrete AFP.
  11. 11. Introduction The most commonly diagnosed fetal teratomas are sacrococcygeal teratoma (Altman types I, II, and III) and cervical (neck) teratoma.
  12. 12. Fetal Sacrococcygeal Teratoma ● the most common congenital germ cell tumor ● 1 in 35,000-40,000 ● female predominance (3:1-4:1 ratio) ● prenatally diagnosed: 30-50% ● 36-41% require fetal intervention ● survival rate of prenatally diagnosed SCT is 47-83% ● 50% have long-term morbidity obstructive uropathy, bowel and bladder incontinence http://emedicine.medscape.com/article/2109544-overview#showall
  13. 13. Cervical teratoma ● 1:20,000-40,000 ● 50% presence of calcification ● 20-40% polyhydramnios ● hyper-extended to flexed towards a side ● neonatal airway obstruction http://radiopaedia.org/articles/congenital-cervical-teratoma
  14. 14. Fetiform teratoma ● Fetus in fetu ● highly developed mature teratomas ● retroperitoneal teratomas Teratoma theory Parasitic twin theory http://en.wikipedia.org/wiki/Fetus_in_fetu anencephalic
  15. 15. Case
  16. 16. http://www.nownews.com/n/2014/06/18/1282162
  17. 17. http://www.ettoday. net/news/20140619/369401.htm
  18. 18. Treatment ● Surgery non-invasive of surrounding tissues ● Chemotherapy for malignant teratomas ● Follow-up
  19. 19. Introduction http://en.wikipedia.org/wiki/Dermoid_cyst http://en.wikipedia.org/wiki/Teratoma http://emedicine.medscape.com/article/939938- overview#a0104 http://www.iap-ad.org/lectures/sudan/Germ%20cell%20tumours.pdf https://www.youtube.com/watch?v=9qoohmd-kUM http://en.wikipedia. org/wiki/Sacrococcygeal_teratoma

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