Intracranial Mature Teratoma in an Adult Patient: A Case Report

Introduction: Primary intracranial teratoma is a subtype of germ cell tumors, classified into three subtypes. They occur very rarely, with only several reported individual cases in adults. Case Description We present a patient with an intermittent headache in the right frontal region. Magnetic resonance imaging (MRI) revealed a right sided high frontal parasagittal mass that compressed the falx, the right lateral ventricle, as well as the brain parenchyma. Patient underwent surgical treatment. Histopathological analysis described mature teratoma. Four months after the surgical treatment there were no signs of residual intracranial mass or relapse. Discussion Primary intracranial teratoma in adults has a nonspecific clinical presentation. MRI reveals a solitary irregular mass with multilocularity and mixed signals derived from different tissues. The patients age, biochemical markers, and patohistological analysis are necessary to confirm the diagnosis. Conclusion Teratoma treatment strategy still remains controversial. It includes radical resection whenever possible. Since the residual portion of mature teratoma may contain part of immature or malignant tissue, tumor recurrence after surgical removal is possible. Also, new tumor mass could occur at other sites intracranial after the initial one was removed. Thus, although patients usually recover, they should be followed-up for a long period of time.

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Trigeminal Cave Brain Metastasis from Prostate Adenocarcinoma: Case Report and Review of the Literature

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0038-1676525 ◽

2018 ◽

Vol 37 (04) ◽

pp. 330-333

Author(s):

João Zanatta ◽

Laisa Zanella ◽

Guilherme Kurtz ◽

Bárbara Gabardo ◽

Alex Roman ◽

...

Keyword(s):

Prostate Cancer ◽

Brain Metastases ◽

Prostate Specific Antigen ◽

Cranial Nerve ◽

Specific Antigen ◽

Prostate Adenocarcinoma ◽

Brain Parenchyma ◽

Surgical Removal ◽

Magnetic Resonance Imaging Mri ◽

The Right

The present study presents the case of a 66-year-old patient diagnosed with prostate adenocarcinoma 4 years earlier and treated with prostatectomy, radiotherapy, chemotherapy and hormone therapy but still displaying high prostate-specific antigen (PSA) levels. The patient complaints were double vision and headaches. Upon physical examination, he displayed 6th cranial nerve paresis and 5th cranial nerve paresthesia. A magnetic resonance imaging (MRI) exam was performed, which revealed a mass on the right trigeminal cave. The patient underwent surgical removal of the tumor, and the pathological analysis of the specimen established metastatic prostate cancer as the diagnosis.Brain metastases from prostate cancer are extremely rare and mark advanced disease, with immune system failure and blood-brain barrier breach. Prostate-specific antigen levels do not correlate with the possibility of metastatic disease. Prostate adenocarcinoma is the histologic type most commonly associated with brain metastases, with the meninges being more frequently affected, followed by the brain parenchyma. The neurological symptoms more often displayed are non-focal, such as headaches and mental confusion. Surgery associated with radiotherapy is the most validated treatment.

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Granulomatous orchitis: case report and review of the literature

Journal of International Medical Research ◽

10.1177/03000605211003773 ◽

2021 ◽

Vol 49 (5) ◽

pp. 030006052110037

Author(s):

Liu Liang ◽

Wang Jiajia ◽

Li Shoubin ◽

Qi Yufeng ◽

Wang Gang ◽

...

Keyword(s):

Color Doppler ◽

Radical Resection ◽

Blood Flow Imaging ◽

Low Intensity ◽

Disease Characteristics ◽

History Of ◽

Magnetic Resonance Imaging Mri ◽

The Right ◽

Combined Spinal Epidural Anesthesia ◽

Spinal Epidural

We report the disease characteristics, diagnosis, and treatment of granulomatous orchitis. A 38-year-old man presented with a history of intermittent swelling, pain, and discomfort in the right testicle of 3 days’ duration. Unenhanced magnetic resonance imaging (MRI) of the testis and scrotum revealed an oval mass in the right testis measuring approximately 17 mm in diameter, with clear borders and a target ring-like appearance from periphery to center. T1-weighted imaging (T1WI) showed uniform low-intensity signals, and T2WI showed mixed high- and low-intensity signals. Diffusion-weighted imaging (DWI) signals were iso-intense, and the outer ring on enhanced scans showed progressive enhancement. We performed radical resection of the right testis under combined spinal–epidural anesthesia. The pathological diagnosis was granulomatous right orchitis. Two months postoperatively, ultrasonography showed no testis and epididymal echo signals in the right scrotum, and no obvious abnormalities; color Doppler blood flow imaging (CDFI) findings were normal. Granulomatous orchitis is rare in clinical practice, and the cause is unknown. The disease involves non-specific inflammation; however, it is currently believed that antibiotics and steroids are ineffective for conservative treatment, and orchiectomy should be actively performed.

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Intracranial teratomas in children: the role and timing of surgical removal

Journal of Neurosurgery Pediatrics ◽

10.3171/ped.2008.2.11.331 ◽

2008 ◽

Vol 2 (5) ◽

pp. 331-338 ◽

Cited By ~ 20

Author(s):

Rémy Noudel ◽

Mathieu Vinchon ◽

Patrick Dhellemmes ◽

Claude Fabien Litré ◽

Pascal Rousseaux

Keyword(s):

Germ Cell ◽

Mature Teratoma ◽

Tumor Resection ◽

Germ Cell Tumors ◽

Timing Of Surgery ◽

Surgical Removal ◽

Primary Therapy ◽

Large Tumor ◽

Oncological Treatment ◽

Malignant Germ Cell Tumors

Object In this study, the authors report their experience with the surgical treatment of intracranial teratomas with an emphasis on the indications for delayed resection after oncological treatment. Methods The authors retrospectively reviewed the cases of 14 children with intracranial teratomas. The mean age at diagnosis was 10.5 years (range 2 days–18 years), and 11 patients were male. The final histological analysis revealed pure mature teratoma in 5 cases, mixed teratoma with germinoma in 3 cases, and nongerminomatous malignant germ cell tumor in 6 cases. Thirteen patients underwent tumor resection, and these patients were divided into 2 subgroups according to the timing of surgery. In Group A, 10 patients underwent resection as the primary treatment because no tumor markers were detected in 4 patients, a teratomatous component was revealed on biopsy sampling in 3 patients, and a large tumor volume in 3 patients. In Group B, 3 patients underwent removal of residual pure mature teratoma after oncological treatment. Results Seven of the 8 patients (87.5%) with pure mature teratomas or with mixed teratoma and germinoma are currently alive (mean follow-up of 9 years); the eighth patient died of postoperative meningitis. Two of the 6 patients (33%) with mixed nongerminomatous malignant germ cell tumors died of tumor progression regardless of the timing of surgery. Conclusions The results of this study support the belief that microsurgical removal is the only effective treatment for intracranial teratomas. Surgery may be performed as the primary therapy when there is evidence of a noninvasive teratoma, and as a secondary therapy if there is only a partial response to neoadjuvant therapy or if progression is observed in mixed malignant germ cell tumors.

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Mature teratoma with aspergilloma

East and Central African Journal of Surgery ◽

10.4314/ecajs.v23i3.6 ◽

2019 ◽

Vol 23 (3) ◽

pp. 119-122

Author(s):

Abebe Bezabih ◽

Asfaw Atnafu

Keyword(s):

Surgical Treatment ◽

Germ Cell ◽

Literature Search ◽

English Literature ◽

Mature Teratoma ◽

Germ Cell Tumors ◽

Rare Presentation ◽

Mediastinal Teratoma ◽

Intrathoracic Mass

Mediastinal mature teratomas are benign germ cell tumors which rarely involve the lung, but when they involve the lung they can cavitate. Aspergilloma developing in a mature teratoma is extremely rare, and according to our English literature search, there is only one previously reported case. We report a 21-year-old female who presented with cough and foul-smelling sputum. investigations revealed an intrathoracic mass, which intraoperatively and upon subsequent histological exam was found to be a mature mediastinal teratoma involving the lung and associated with an aspergilloma. Reporting our case will add to the understanding of this rare presentation of mediastinal mature teratomas. Keywords: mature teratoma; aspergilloma; surgical treatment

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Surgical treatment of retroperitoneal neuroblastoma in a 14-month-old child

Russian Journal of Pediatric Surgery ◽

10.18821/1560-9510-2021-25-1-61-67 ◽

2021 ◽

Vol 25 (1) ◽

pp. 61-67

Author(s):

M. N. Sukhov ◽

A. G. Narbutov ◽

I. P. Lyvina ◽

I. A. Bryzzheva ◽

M. V. Isaeva ◽

...

Keyword(s):

Surgical Treatment ◽

Nursery School ◽

Disease Recurrence ◽

Surgical Removal ◽

Anatomical Location ◽

Good State ◽

Staging Systems ◽

Tumor In Childhood ◽

The Right

Introduction. Neuroblastoma is the most common malignant embryonic extracranial solid tumor in childhood having a high mortality rate. While treating neuroblastoma, it is extremely important to follow international protocols with their staging systems and groups of risk. Surgical treatment is a compulsory approach, but in some cases it is extremely difficult, and it involves significant risks. However, in some cases, radical removal of the tumor can cure patients without chemotherapy.Material and methods. The article presents a clinical case of 14-month-old child with neuroblastoma of stage 3 and difficult anatomical location after 2 courses of polychemotherapy by NB-2004 protocol. The child had subradical resection of an extensive tumor in the retroperitoneal space and nephrectomy on the right. The authors also describe specific moments during surgery, problems which their faced during child’s treatment as well as follow-up examinations in the postoperative period.Results. Follow-up examinations did not reveal any signs of disease recurrence. Catamnesis lasted for 56 months. The child is in a good state; she is active, attends a nursery school.Conclusion. The discussed case demonstrates that a successful radical surgical removal of neuroblastoma of difficult anatomic location may have good outcomes without adjuvant postoperative therapy.

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Pediatric Extramedullary Epidural Spinal Teratomas: A Case Report and Review of the Literature

Case Reports in Orthopedics ◽

10.1155/2021/6702972 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

David G. Deckey ◽

Andrea Fernandez ◽

Nina J. Lara ◽

Steve Taylor ◽

Jamal McClendon ◽

...

Keyword(s):

Surgical Resection ◽

Motor Development ◽

Clinical Presentation ◽

Pediatric Population ◽

Mature Teratoma ◽

Cord Compression ◽

Histopathological Analysis ◽

Paravertebral Space ◽

Thoracic Spinal ◽

The Right

Background. Teratomas in the pediatric population are most commonly found in the sacrococcygeal region. Pediatric intraspinal teratomas, however, are an exceedingly rare central nervous system (CNS) neoplasm. The clinical presentation of these intraspinal neoplasms can vary significantly and thus can be difficult to identify in infants less than one year of age where verbal expression and motor development are still lacking. Case Description. A 7-month-old, previously healthy male presented with a thoracic scoliosis and an asymptomatic right midupper thoracic spinal prominence present since birth. MRI revealed an extensive heterogenous mass in the right epidural space from T5-T6 and the right paravertebral space, resulting in severe spinal stenosis. Outcome. Complete resection of the tumor, including a three-level neurotomy, was achieved by posterior decompression/laminectomy. The final tumor was consistent with a mature teratoma. The surgical resection was performed without any immediate complications. Conclusions. Extramedullary epidural teratomas are exceptionally rare tumors in the pediatric population. Clinical presentation can be ambiguous, particularly in an infant. MRI was useful in suggesting a teratoma as a potential diagnosis and for postoperative surveillance for recurrence. However, histopathological analysis remains the gold standard for definitive diagnosis. Surgical resection is the mainstay of treatment, especially in the setting of cord compression and progressive loss of motor function. Close follow-up is crucial to monitor for progressive spinal deformity or recurrence.

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Surgical treatment of Lhermitte–Duclos disease (dysplastic gangliocytoma of the cerebellum)

Russian journal of neurosurgery ◽

10.17650/1683-3295-2020-22-1-77-82 ◽

2020 ◽

Vol 22 (1) ◽

pp. 77-82

Author(s):

A. A. Bimurzin ◽

A. V. Kalinovsky

Keyword(s):

Surgical Treatment ◽

Clinical Case ◽

Right Hemisphere ◽

Surgical Removal ◽

Study Objective ◽

Dysplastic Gangliocytoma ◽

Satisfactory Condition ◽

Suboccipital Craniotomy ◽

Intact Brain ◽

The Right

The study objective is to describe a clinical case of a rare disorder of the cerebellum, Lhermitte–Duclos disease.Clinical case. The Federal Neurosurgical Center (Novosibirsk) admitted a male patient, 40 years old. Medical history showed that in 2017 he underwent ventriculoperitoneal shunt due to hypertensive hydrocephalus syndrome caused by space-occupying mass of the right hemisphere of the cerebellum. In June of 2017, the patient was consulted by a neurosurgeon. Later, an increase in the mass, partial atrophy of the optic disks were observed. Due to the patient’s complaints of headache, ataxia, vertigo, as well as insufficient effect of the shunt, microsurgical removal of the space-occupying mass in the cerebellum by right paramedian suboccipital craniotomy was performed. Gangliocytoma removal was performed under constant neurophysiological control which allowed to fully resect the gangliocytoma inside intact brain tissue. Histological and immunohistological examinations allowed to diagnose grade I dysplastic gangliocytoma of the cerebellum (Lhermitte–Duclos disease). In the postoperative period, brain symptoms regressed fully, vestibulocerebellar syndrome persisted. The patient was discharged in satisfactory condition. No negative dynamics were observed in 7 months of follow-up.Conclusion. Due to the rareness of Lhermitte–Duclos disease, currently there are no established approaches to treatment, however, in symptomatic course there are indications for surgical removal of the gangliocytoma. Radicality of resection should be correlated with the risk of neurological defects. In our case, surgical treatment allowed to improve the patient’s condition, prevent further progression of the gangliocytoma and obtain an accurate histological diagnosis.

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Sequential ACTH and catecholamine secretion in a phaeochromocytoma

Acta Endocrinologica ◽

10.1530/eje.0.1470201 ◽

2002 ◽

pp. 201-206 ◽

Cited By ~ 11

Author(s):

PS van Dam ◽

A van Gils ◽

MR Canninga-van Dijk ◽

EJ de Koning ◽

LJ Hofland ◽

...

Keyword(s):

Severe Hypertension ◽

Catecholamine Secretion ◽

Surgical Removal ◽

Ectopic Acth ◽

Hyperintense Signal ◽

Ectopic Acth Production ◽

Magnetic Resonance Imaging Mri ◽

The Right ◽

T2 Weighted Images

OBJECTIVE: We describe a patient with an ACTH-producing phaeochromocytoma who initially presented with hypercortisolism and normal catecholamine concentrations, followed by near-normalisation of ACTH secretion and massive catecholamine secretion. In vitro studies were carried out on the tumour to evaluate the interaction between the tumour cells and normal adrenal cortex. METHODS AND RESULTS: A 30-year-old man initially presented with severe hypercortisolism, biochemical evidence of ectopic ACTH production, a tumour in the right adrenal gland without a hyperintense signal on the T2-weighted images at magnetic resonance imaging (MRI) scanning, and normal urinary metanephrine concentrations. After 6 months, ACTH production had almost completely resolved, but the patient developed severe hypertension and excess catecholamines. At repeated MRI-scanning, the T2-weighted images showed a hyperintense signal, in agreement with the diagnosis of phaeochromocytoma. Although the initial T1-weighted images suggested bleeding in the adrenal tumour, no signs of bleeding were observed after surgical removal. The diagnosis of ACTH-producing phaeochromocytoma was histologically and immunohistochemically confirmed. Cultured cell suspensions of the tumour secreted ACTH, which stimulated cortisol production in the ipsilateral adrenocortical cells. CONCLUSION: This case demonstrates that the biological activity of an ACTH-producing phaeochromocytoma can vary significantly in time, which may be the consequence of different stages of tumour differentiation.

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Extraorgan retroperitoneal mature teratoma in a 12-year-old child

Russian Journal of Pediatric Hematology and Oncology ◽

10.21682/2311-1267-2019-6-2-68-71 ◽

2019 ◽

Vol 6 (2) ◽

pp. 68-71

Author(s):

S. V. Kaplunov ◽

I. V. Ivashchenko ◽

G. L. Snigur

Keyword(s):

Computed Tomography ◽

Surgical Treatment ◽

Preoperative Diagnosis ◽

Mature Teratoma ◽

Germ Cell Tumors ◽

Malignant Potential ◽

Retroperitoneal Space ◽

Correct Preoperative Diagnosis ◽

Derivatives Of ◽

Histological Verification

Teratomas are germ cell tumors consisting of derivatives of 3 germ layers and havingvarious malignant potential – from benign mature forms to immature embryonic and forms with somatic type of malignancy.This article describes the clinical caseof rare localization of mature teratoma – retroperitoneal space, aswell asan example of multidisciplinary interaction of clinicians, radiation diagnosticians and pathomorphologists in correct preoperative diagnosis using computed tomography, successful surgical treatment and histological verification of extraorgan teratoma of the retroperitoneal space.

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Mature Intracranial Teratoma

Acta Facultatis Medicae Naissensis ◽

10.2478/v10283-012-0043-1 ◽

2013 ◽

Vol 30 (2) ◽

pp. 97-102

Author(s):

Irena Dimov ◽

Desanka Tasić ◽

Ivana Stojanović ◽

Simonida Stojanović ◽

Nebojša Stojanović ◽

...

Keyword(s):

Germ Cell ◽

Striated Muscle ◽

Mature Teratoma ◽

Germ Cell Tumors ◽

Intracranial Teratoma ◽

Resected Tumor ◽

Cell Layers ◽

Minor Part ◽

Glandular Structures ◽

A Minor

SUMMARY Teratomas constitute a group of nongerminomatous germ cell tumors that are composed of an admixture of different tissue types representative of ectoderm, endoderm and mesoderm. Intracranial teratomas are rare, comprising approximately 0.5% of all intracranial tumors. They preferentially involve the midline structures, and occur primarily in children. We presented an unusual case of mature intracranial teratoma with extracranial extension in a 24-year-old man who complained of headache, nausea and vomiting. The intracranial expansive lesion was localized in the left frontotemporobasal region extending into the ipsilateral orbit. The patient underwent total resection of the tumor. No adjuvant treatment was given. On gross examination, the resected tumor was lobulated, containing heterogeneous solid and cystic components. Histologic investigation revealed the presence of various fully differentiated tissues representative of the three germ cell layers, including adipose tissue, cartilage, bone, striated muscle bundles, brain tissue, respiratory epithelium and glandular structures. The diagnosis of mature teratoma was established. Follow-up at four years did not show any evidence of recurrence. The presented case is an unusual example of mature teratoma with regards to the age of the patient and, especially, to the location of the tumor, both intraand extracranially. It is critical to recognize this rare entity by extensive sampling to rule out the presence of immature elements which may constitute only a minor part of the tumor.

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