Teratoma

20150424
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%
Introduction
Teratomas have been reported to contain hair, teeth, bone
(rarely: eyes,torso,and hands, feet, or other limbs)

usually benign

95%
mature/benign women
more commonly
5% immature/malignant men
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 unknown

embryonal cells Congenital

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
 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
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
Dermoid cyst
Spinal dermoid cysts
● benign ectopic growths of
neural tube closure
● lumbosacral region
Gonzalez-Crussi grading system
Grade 0 mature
mature (benign)
Grade 1 <10%
immature, probably benign
Grade 2 10-50%
immature, possibly malignant (cancerous)
Grade 3 >50%
frankly malignant

depends on amount of immature elements

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.
Introduction
The most commonly diagnosed fetal teratomas are
sacrococcygeal teratoma (Altman types I, II, and III) and
cervical (neck) teratoma.
 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
 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
Fetiform teratoma
● Fetus in fetu
● highly developed mature teratomas
● retroperitoneal teratomas

Teratoma theory

Parasitic twin theory anencephalic

http://en.wikipedia.org/wiki/Fetus_in_fetu
Case
http://www.nownews.com/n/2014/06/18/1282162
http://www.ettoday.
net/news/20140619/369401.htm
Treatment
● Surgery

non-invasive of surrounding tissues

● Chemotherapy

for malignant teratomas

● Follow-up
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