CT features of mature teratoma in the mediastinum of two young adults—a report of two cases

Abstract Background Germ cell tumors prefer gonadal regions, but they can be expected in extragonadal sites such as the anterior mediastinum, which is the commonly involved region after gonads. Amongst germ cell tumors, teratomas are the rarer subtypes which develop in the anterior mediastinum. Case presentation The authors present two adult patients, a male and a female, both complaining of chronic chest pain and cough. Chest CT scans were performed revealing characteristic CT features of mature teratomas in the anterior mediastinum which were extending to the superior mediastinum in both patients. Conclusion Germ cell tumors are involving the mediastinum; however, amongst all germ cell tumors, teratoma is the least common type arising in the mediastinum, and a chest CT scan considered the imaging investigation of choice. Surgery is the best option and patients may have a very good prognosis.

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A randomized trial of etoposide + cisplatin versus vinblastine + bleomycin + cisplatin + cyclophosphamide + dactinomycin in patients with good-prognosis germ cell tumors.

Journal of Clinical Oncology ◽

10.1200/jco.1988.6.8.1231 ◽

1988 ◽

Vol 6 (8) ◽

pp. 1231-1238 ◽

Cited By ~ 176

Author(s):

G J Bosl ◽

N L Geller ◽

D Bajorin ◽

S P Leitner ◽

A Yagoda ◽

...

Keyword(s):

Germ Cell ◽

Randomized Trial ◽

Mature Teratoma ◽

Germ Cell Tumors ◽

Good Prognosis ◽

Event Free Survival ◽

Free Survival ◽

Acute And Chronic Effects ◽

Related Mortality

Standard chemotherapy for disseminated germ cell tumors (GCT) cures most patients but causes considerable acute toxicity, including treatment-related death due to septicemia during neutropenia and pulmonary fibrosis. In addition, chronic and delayed toxicities, particularly Raynaud's phenomenon, have been reported in 6% to 37% of treated patients. In an attempt to minimize the acute and chronic effects of treatment which are related primarily to vinblastine and bleomycin, a randomized trial comparing the efficacy and toxicity of vinblastine + bleomycin + cisplatin + cyclophosphamide + dactinomycin (VAB-6) and etoposide + cisplatin (EP) was conducted on 164 eligible patients with good-prognosis GCT. Seventy-nine of 82 (96%) patients receiving VAB-6 and 76/82 (93%) receiving EP achieved a complete remission (CR) with or without adjunctive surgery. Similar proportions of patients in both arms were found at surgery to have necrosis/fibrosis or mature teratoma. With a median follow-up of 24.4 months in the VAB-6 arm and 25.9 months in the EP arm, the total, relapse-free, and event-free survival distributions were similar in the two arms. Patients receiving EP experienced less emesis (P = .05), higher nadir WBC (P = .06) and platelet counts (P = .01), less magnesium wasting (P = .0001), less mucositis (P = .09), and no pulmonary toxicity. No treatment-related mortality was observed. EP is an efficacious and less toxic regimen and is recommended for good-prognosis patients with disseminated GCT.

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Mediastinal mature teratoma in an adolescent: a rare case presentation

International Surgery Journal ◽

10.18203/2349-2902.isj20195150 ◽

2019 ◽

Vol 6 (11) ◽

pp. 4177

Author(s):

Divyang Dave ◽

Nipun Bansal ◽

Hardik Astik ◽

Varun Joshi ◽

Ojas Patel

Keyword(s):

Germ Cell ◽

Rare Case ◽

Mature Teratoma ◽

Germ Cell Tumour ◽

Anterior Mediastinum ◽

Government Medical College ◽

Common Site ◽

Case Presentation ◽

Medical College ◽

Low Incidence

Teratomas are the most common germ cell tumours composed of two or more germ layers. Mediastinum is the most common site of extragonadal germ cell tumour. Teratomas are relatively rare of all tumours in mediastinum. Here, we report a rare case of an adolescent who presented with chest pain and breathlessness. CT scan showed a large, well-defined lesion with internal fat density, calcifications, cystic and solid components arising from anterior mediastinum. He was successfully operated and treated at New Civil Hospital Surat attached to Government Medical College Surat. The purpose of this case report is to bring in light to the mediastinal mature teratomas in adolescents as they have very low incidence rate.

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A Rare Case of Primary Anterior Mediastinal Yolk Sac Tumor in an Elderly Adult Male

Case Reports in Oncological Medicine ◽

10.1155/2016/8961486 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Sammy G. Nakhla ◽

Srinath Sundararajan

Keyword(s):

Germ Cell ◽

Rare Case ◽

Germ Cell Tumors ◽

Anterior Mediastinum ◽

Yolk Sac ◽

Yolk Sac Tumor ◽

Elderly Adult ◽

Children And Young Adults ◽

Extragonadal Germ Cell Tumors ◽

Mediastinal Germ Cell Tumors

Mediastinal germ cell tumors are extragonadal germ cell tumors (EGGCTs) commonly seen in children and young adults. They are more common in men. Clinically they are classified as teratomas, seminomas, and nonseminomatous germ cell tumors. Primary mediastinal yolk sac neoplasm is an extremely rare tumor. We present here a very rare case of primary yolk sac tumor of the anterior mediastinum in a 73-year-old male. Mediastinal germ cell tumors have a worse prognosis than gonadal germ cell tumors. Chemotherapy followed by adjuvant surgery improves overall response in EGGCTs. However, comorbidities can render treatment with chemotherapy and surgery challenging in elderly patients.

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MPC-08 CLINICOPATHOLOGICAL ANALYSIS OF 12P GAIN IN INTRACRANIAL GERM CELL TUMORS

Neuro-Oncology Advances ◽

10.1093/noajnl/vdz039.105 ◽

2019 ◽

Vol 1 (Supplement_2) ◽

pp. ii23-ii23

Author(s):

Kaishi Satomi ◽

Hirokazu Takami ◽

Shintaro Fukushima ◽

Yoichi Nakazato ◽

Shota Tanaka ◽

...

Keyword(s):

Germ Cell ◽

Germ Cell Tumor ◽

Copy Number ◽

Mature Teratoma ◽

Methylation Status ◽

Germ Cell Tumors ◽

Copy Number Variations ◽

Cell Tumor ◽

Testicular Germ Cell ◽

Intracranial Germ Cell Tumor

Abstract BACKGROUND Gain of short arm of chromosome 12 (12p) is commonly observed in testicular germ cell tumors (tGCTs). 12p gain is also frequently seen in intracranial GCTs (iGCTs). However, little is known about the clinical significance of 12p gain in iGCTs. MATERIALS AND METHODS We have collected over 200 fresh frozen tissue samples of iGCTs through the Intracranial Germ Cell Tumor Genome Analysis Consortium in Japan. Firstly, we analyzed DNA methylation status in 83 iGCTs, 3 seminomas and 6 normal control samples using Infinium Human Methylation 450K BeadChip array (Illumina, CA). Idat files were processed using R (Version 3.5.3) and minfi package (1.30.0) to generate copy number variations. Compared with average genome-wide copy number level, 12p gain was determined. Then, 58 iGCTs with clinicopathological information were analyzed for progression-free survival (PFS) and overall survival (OS). Those tumors that consist of only either germinoma and/or mature teratoma components were classified as Favorable Histology (FH) and all the others that contains malignant histological components were classified as Unfavorable Histology (UFH). RESULT 12p gain was observed in 100% (3/3) of seminoma, 13.6% (3/22) of germinoma, 16.7% (1/6) of mature teratoma, 25% (1/4) of immature teratoma, 55% (11/20) of mixed germ cell tumor, 100% (4/4) of yolk sac tumor, 100% (1/1) of embryonal carcinoma, and 100% (1/1) of choriocarcinoma. In total, 44.6% (37/83) of iGCT showed 12p gain. Regarding histological classification, the 12p gain rate in UFH (72%, 18/25) was significantly higher than that in FH (12.1%, 4/33, P<0.01). Both PFS and OS were significantly worse in iGCTs with 12p gain (PFS: P=0.027, OS: P=0.0012). DISCUSSION 12p gain can be a molecular marker to predict prognosis and histological malignancy in iGCTs.

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Necrotizing Sarcoid Granulomatosis with Pneumothorax

Case Reports in Medicine ◽

10.1155/2019/4648720 ◽

2019 ◽

Vol 2019 ◽

pp. 1-4

Author(s):

Mihan Pourabdollah ◽

Seyed Reza Saghebi ◽

Mitra Abdolahi ◽

Mitra Sadat Rezaei

Keyword(s):

Lower Lobe ◽

Good Prognosis ◽

Lung Lesion ◽

Chest Ct ◽

Variable Amount ◽

Granulomatous Vasculitis ◽

Strauss Syndrome ◽

Granulomatous Diseases ◽

Churg Strauss ◽

Chest Ct Scan

Necrotizing sarcoid granulomatosis (NSG) is a rare granulomatous pneumonitis which is composed of a background of sarcoidosis-like granulomas, granulomatous vasculitis, and variable amount of necrosis. We reported a case of a 38-year-old nonsmoking woman presented with left-sided chest pain and dyspnea for three days. Chest CT scan exhibited collapse consolidation of the left lower lobe with the presence of two separated small-sized cystic lesions within the collapsed segment. Lung lesion resection was performed, and histological examination confirmed the diagnosis by excluding other causes of granulomatous diseases. The prognosis of NSG is favorable, and medical treatment is usually not necessary, as well as in our case. NSG is a rare disease with nonspecific symptoms and good prognosis which is frequently confused with Wegener’s granulomatosis, sarcoidosis, and Churg–Strauss syndrome. This entity should also be considered as differential diagnosis of necrotizing granulomatous diseases.

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Applying Radiomics to Predict Pathology of Postchemotherapy Retroperitoneal Nodal Masses in Germ Cell Tumors

JCO Clinical Cancer Informatics ◽

10.1200/cci.18.00004 ◽

2018 ◽

pp. 1-12 ◽

Cited By ~ 3

Author(s):

Jeremy Lewin ◽

Paul Dufort ◽

Jaydeep Halankar ◽

Martin O’Malley ◽

Michael A.S. Jewett ◽

...

Keyword(s):

Germ Cell ◽

Mature Teratoma ◽

Germ Cell Tumors ◽

Area Under The Curve ◽

Prediction Algorithm ◽

Support Vector ◽

Clinical Predictors ◽

Testicular Germ Cell ◽

Clinical Variables ◽

Computed Tomography Images

Purpose After chemotherapy, approximately 50% of patients with metastatic testicular germ cell tumors (GCTs) who undergo retroperitoneal lymph node dissections (RPNLDs) for residual masses have fibrosis. Radiomics uses image processing techniques to extract quantitative textures/features from regions of interest (ROIs) to train a classifier that predicts outcomes. We hypothesized that radiomics would identify patients with a high likelihood of fibrosis who may avoid RPLND. Patients and Methods Patients with GCT who had an RPLND for nodal masses > 1 cm after first-line platinum chemotherapy were included. Preoperative contrast-enhanced axial computed tomography images of retroperitoneal ROIs were manually contoured. Radiomics features (n = 153) were used to train a radial basis function support vector machine classifier to discriminate between viable GCT/mature teratoma versus fibrosis. A nested 10-fold cross-validation protocol was used to determine classifier accuracy. Clinical variables/restricted size criteria were used to optimize the classifier. Results Seventy-seven patients with 102 ROIs were analyzed (GCT, 21; teratoma, 41; fibrosis, 40). The discriminative accuracy of radiomics to identify GCT/teratoma versus fibrosis was 72 ± 2.2% (area under the curve [AUC], 0.74 ± 0.028); sensitivity was 56.2 ± 15.0%, and specificity was 81.9 ± 9.0% ( P = .001). No major predictive differences were identified when data were restricted by varying maximal axial diameters (AUC range, 0.58 ± 0.05 to 0.74 ± 0.03). The prediction algorithm using clinical variables alone identified an AUC of 0.76. When these variables were added to the radiomics signature, the best performing classifier was identified when axial masses were limited to diameter < 2 cm (accuracy, 88.2 ± 4.4; AUC, 0.80 ± 0.05; P = .02). Conclusion A predictive radiomics algorithm had a discriminative accuracy of 72% that improved to 88% when combined with clinical predictors. Additional independent validation is required to assess whether radiomics allows patients with a high predicted likelihood of fibrosis to avoid RPLND.

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Impact of Teratoma on the Cumulative Incidence of Disease-Related Death in Patients With Advanced Germ Cell Tumors

Journal of Clinical Oncology ◽

10.1200/jco.18.01608 ◽

2019 ◽

Vol 37 (26) ◽

pp. 2329-2337 ◽

Cited By ~ 4

Author(s):

Samuel A. Funt ◽

Sujata Patil ◽

Darren R. Feldman ◽

Robert J. Motzer ◽

Dean F. Bajorin ◽

...

Keyword(s):

Germ Cell ◽

Cumulative Incidence ◽

Mature Teratoma ◽

Germ Cell Tumors ◽

Adverse Outcomes ◽

Term Survival ◽

Risk Status ◽

Primary Tumors ◽

Platinum Based Chemotherapy

PURPOSE In men with metastatic germ cell tumors (GCTs), risk-directed treatment is determined, in part, by a distinction between seminoma and nonseminomatous GCT (NSGCT). The importance of NSGCT cell type is uncertain. We evaluated the long-term impact of teratoma on survival in patients with NSGCT. METHODS Prechemotherapy, primary tumors from patients who received platinum-based chemotherapy were studied, and the histology was confirmed by a genitourinary pathologist. The cumulative incidence of disease-related death (CIDD) was the primary end point, and a competing-risk analysis was performed. RESULTS Tumors were available from 232 patients, including 193 with NSGCT. An element of teratoma was present in 82 NSGCT primary tumors (42%). With a median follow-up of 17 years (range, 0.3 to 35 years), 58 patients with NSGCT died, 47 as a result of GCT and 11 as a result of other causes. Most GCT deaths occurred within the first 5 years and were associated with pretreatment risk status ( P < .001). Death as a result of other causes rose steadily after 15 years and was not associated with risk status ( P = .66). A higher CIDD was observed in patients who had NSGCT with teratoma than those with NSGCT without teratoma and seminoma (5-year CIDD rate, 27.4%, 17.4%, and 10.3%, respectively; P = .03). A higher CIDD was observed in patients who had NSGCT with mature teratoma compared with those with either NSGCT with immature teratoma or NSGCT without teratoma (5-year CIDD rate, 38.1%, 19.9%, and 17.4%, respectively; P = .01). CONCLUSION The presence of teratoma, particularly mature teratoma, in an NSGCT primary tumor is associated with a higher CIDD, consistent with the hypothesis that differentiation is associated with adverse outcomes. Death as a result of non-GCT causes is not associated with risk status and must be separated from GCT death when evaluating long-term survival.

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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 identified after postchemotherapy surgery in patients with disseminated nonseminomatous testicular germ cell tumors

Cancer ◽

10.1002/(sici)1097-0142(19980401)82:7<1343::aid-cncr18>3.0.co;2-6 ◽

1998 ◽

Vol 82 (7) ◽

pp. 1343-1351 ◽

Cited By ~ 71

Author(s):

Dirk J.�A. Sonneveld ◽

Dirk Th. Sleijfer ◽

Heimen Schraffordt Koops ◽

Mariel E. Keemers-Gels ◽

Willemina M. Molenaar ◽

...

Keyword(s):

Germ Cell ◽

Mature Teratoma ◽

Germ Cell Tumors ◽

Testicular Germ Cell Tumors ◽

Testicular Germ Cell

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Management of Malignant Pineal Germ Cell Tumors with Residual Mature Teratoma

Neurosurgery ◽

10.1097/00006123-200103000-00011 ◽

2001 ◽

Vol 48 (3) ◽

pp. 518-523 ◽

Cited By ~ 65

Author(s):

Jonathan A. Friedman ◽

James J. Lynch ◽

Jan C. Buckner ◽

Bernd W. Scheithauer ◽

Corey Raffel

Keyword(s):

Magnetic Resonance Imaging ◽

Radiation Therapy ◽

Magnetic Resonance ◽

Germ Cell ◽

Neoadjuvant Therapy ◽

Mature Teratoma ◽

Germ Cell Tumors ◽

Response To Therapy ◽

External Beam Radiation ◽

Resonance Imaging

Abstract OBJECTIVE The treatment of intracranial mixed germ cell tumors presents a unique challenge, since eradication of malignant tumor by radiation and/or chemotherapy may spare the benign tumor component. We reviewed our surgical experience with residual malignant pineal germ cell tumors after neoadjuvant therapy. METHODS Between 1987 and 1997, 16 patients with malignant intracranial germ cell tumors were treated at the Mayo Clinic with a protocol of neoadjuvant chemotherapy and radiation therapy. After the diagnosis was confirmed by histopathological examination, all patients were treated with four cycles of etoposide and cisplatin as well as external beam radiation therapy (range, 3030–5940 cGy). Six patients had an incomplete response to therapy, as demonstrated by observation of residual tumor on magnetic resonance imaging scans. Initial pathology in these six patients was germinoma in four and combinations of yolk sac tumor, embryonal carcinoma, malignant teratoma, and germinoma in two. Two patients had synchronous pineal and suprasellar tumors, with leptomeningeal dissemination. Tumor markers were elevated in four of the six patients at presentation. RESULTS All patients with residual pineal tumors underwent surgical resection via an infratentorial, supracerebellar approach. Pathological examination revealed mature teratoma in five patients and amorphous debris in one patient. No patient had recurrent malignancy. Significant neurological morbidity occurred in one patient, with no mortality. At a mean follow-up of 23 months, no recurrence on magnetic resonance imaging has been documented. CONCLUSION Residual pineal tumor occurring after treatment of malignant intracranial germ cell tumor with neoadjuvant therapy is likely to be mature teratoma. Operative resection of these benign recurrences is safe and effective.

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