Symptomatic mature teratoma of the lumbar spine: A case report

Background: Teratomas are a unique family of tumors derived from two or more of the three embryonic layers: endoderm, mesoderm, and ectoderm. Mature teratomas are comprised the most well-differentiated tissue types and may contain skin, hair, teeth, smooth muscle, respiratory tissues, etc. Infrequently, mature teratomas may be found within the central nervous system and, in exceedingly rare cases, may be occur within the spinal cord itself (i.e., intramedullary/intradural). Case Description: A 78-year-old female presented with a subacute progressive lower extremity paraparesis. The MR revealed a cystic 81 × 30 × 25 mm intradural/intramedullary spinal mass involving the distal conus with exophytic extension into the L1-L4 spinal canal. Following surgical intervention consisting of a L1-L4 laminectomy, the lesion was largely removed. Pathology of the mass confirmed a large mature teratoma containing a multilobulated cyst that intraoperatively compressed the conus and cauda equina. Immediately postoperatively, the patient significantly improved neurologically. However, on postoperative day 2, she acutely developed a change in mental status with the left gaze preference and hemiparesis. CT brain in the acute setting showed no evidence of causative pathology and subsequent MR brain was unremarkable. The patient’s neurologic deficits progressively improved leading to eventual discharge. Conclusion: Intrathecal intramedullary/extramedullary mature teratomas of the conus that results in subacute cauda equina syndromes are rare. The differential diagnosis for such lesions exophytic to the conus must include mature teratomas which, though rare, may be readily resected resulting in generally favorable outcomes.

Pilimiction, A Rare Presentation of Ovarian Teratoma: A Case Report

Background: Adnexal teratoma involving the urinary bladder is a very rare condition. Presentation is variable ranging from irritative LUTS (lower urinary tract symptoms) to pilimiction or trichiuria (passage of hair in the urine).Case presentation: We report a case of a 42-year-old woman who presented with pilimiction and lower abdominal pain. Contrast-enhanced computed tomography scan (CECT) and Cystoscopy were used for the diagnosis. Tumor markers were negative. Right side salpingo-oophorectomy and partial bladder wall excision were performed. Histopathology of the specimen showed features consistent with mature teratoma. The Patient-reported improvement of symptoms in the subsequent follow-up visits.Conclusion: Pilimiction is a pathognomonic sign of bladder teratomas. Therefore, it is wise to think of this pathology in patients who report the passage of hair through the urine (trichiuria or pilimiction), as in our case. Cystoscopy and cross-sectional imaging aided in the initial diagnosis. However, a definitive diagnosis was provided by histopathology.We performed right-side salpingo-oophorectomy and partial cystectomy. Transurethral resection is associated with a high recurrence rate and is not recommended for secondary bladder teratomas.

Mature ovarian teratoma-associated encephalitis

Introduction. Autoimmune encephalitis associated with ovarian teratoma is a serious and potentially fatal pathology. While this clinical entity is known to neurologists, the available literature rarely mentions the role of a gynecologist in diagnostic imagining and treatment. Although several months have passed from the appearance of the symptoms to surgical treatment, this case shows that even then a complete recovery is possible. Case presentation. The patient was a 28-year-old female, brought to the hospital because a sudden onset of unusual behavior - an acute psychosis with suicidal thoughts and auditory hallucinations. Soon after the admission she became delirious, uncooperative and agitated. Blood check, neurological assessment and cranial computed tomography yielded normal results. Therefore, a psychiatric disorder was suspected. Electroencephalogram revealed a diffuse encephalitic insufficiency. As cerebrospinal fluid was negative for infections, the autoimmune etiology of the disease was suspected. Abdominal computer tomography showed a complex right ovarian mass measuring 50 x 40 x 30 mm, confirmed by vaginal ultrasound. Laparoscopy with right adnexectomy was performed. The pathohistological finding showed a mature teratoma. In the meantime, the result of the cerebrospinal fluid test came positive for anti NMDAR antibodies. Six months after surgery, the patient was in a good mental and neurological status without symptoms. Conclusion. Gynecologists should be aware of the presence of ovarian tumors in encephalitis cases. A timely diagnosis of the underlying gynecological cause of a neurological condition, allows for prompt treatment and can remarkably improve clinical conditions and, thus, be lifesaving.

Life-Threatening Mediastinal Teratoma of Infant Requiring Emergency Surgical Removal

Background Teratoma is a tumor derived from fetal germ cells with aberrant differentiation. Case Description A 3-month-old infant with a mediastinal tumor was referred to our heart center. She presented with progressive dyspnea, cyanosis, and the need to be manually ventilated. The computed tomography scan displayed a huge tumor restricting the distal trachea including the bifurcation. An emergent operation was performed and the tumor was completely removed. Histological examination confirmed a mature teratoma. Conclusion In such life-threatening situation, the early detection and the immediate operation are very important for the management of rapidly-progressing mediastinal teratomas compressing the respiratory tract.

DIAGNOSTIC ROLE OF COMPRESSION SONOELASTOGRAPHY IN MULTIPARAMETRIC ULTRASOUND INVESTIGATION IN THE DETECTION OF BENIGN OVARIAN FORMATION

Properly diagnosed benign ovarian tumors are a condition for optimal treatment tactics. Qualitative assessment of signs detected by multiparametric ultrasound, including compression elastography, is highly effective in the differential diagnosis of benign ovarian tumors. Our study became especially relevant for women in the reproductive period, because the correct diagnosis influenced the choice of surgical treatment in order to preserve the ovarian reserve. A comprehensive radiological study of 51 women with benign ovarian tumors was performed. The age of patients averaged 37.3 ± 8.7 years. In the structure of benign ovarian tumors, the frequency of serous cystadenoma was 31.38%, serous superficial papillomas - 25.49%, mucinous cystadenoma - 17.65%, mature teratomas - 15.68%, fibroma - 9.8%. Ultrasound was performed on a HITACHI ALOCA ARIETTA 70 using a cavitary multifrequency sensor with a frequency of 7.5-10 mHz and a sector sensor with a frequency of 2-5 mHz. The article analyzes the detailed sonographic picture of these formations in B-mode, Doppler mode and compression sonoelastography mode. Color and energy Doppler mapping techniques, as well as pulsed Doppler mode, which gave a quantitative characterization of blood flow, were used to study blood vessels. Vessel localization was determined using color Doppler mapping, and detailed qualitative assessment of blood flow loci was determined using energy Doppler. For all types of benign ovarian formations, a qualitative feature was determined - elastotype on the Ueno scale and stiffness index - Strain Ratio (coefficient of deformation) - a quantitative indicator. It was found that serous and mucinous cystadenomas belong to 0 and I elastotype on the Ueno scale, the papillary component of serous superficial papillomas was mapped with I and II elastotype, fibroids mainly belonged to II and III elastotype, and mature teratomas - to IV end V elastotype. Quantitative deformation rate for all benign ovarian tumors ranged from 0,63 to 24,9. Thus, the cardiac index of stiffness in serous cystadenomas was 0.92 ± 0.46, and in mature teratomas - 16.7 ± 8.4. The increased density of the latter in comparison with other representatives of benign formations can be explained by the presence in their structure of such elements as fibroblasts, bundles of spindle-shaped cells and bundles of collagen fibers (fibroids), bone and cartilage (mature teratoma). In addition to all the above research methods, the mobile application IOTA ADNEX 2014 was used, which helped to calculate the risk of malignancy. This is a simple calculator, which loads the data of the ultrasound examination, the patient's age, the level of CA-125. Our results showed that ultrasound examination of ovarian tumors is an accurate and highly informative method for stratification of risks according to the O-RADS classification. For stratification and the ultrasound risk management system, the O-RADS system was guided by consensus guidance from the American College of Radiology, which reduces or eliminates ambiguity in the interpretation of data in ultrasound protocols and provides a more accurate definition of ovarian malignancy. The O-RADS working group includes 5 categories: O-RADS 0 - incomplete examination score, O-RADS 1 - normal unchanged premenopausal ovary, O-RADS 2 - almost always benign (risk of malignancy - <1%), O-RADS 3 - the presence of education with a low level of malignancy - from 1 to 10%, O-RADS 4 - medium risk of malignancy - from 10 to 50% and O-RADS 5 - education with a high level of malignancy -> 50%.

The Clinicopathological Features And Surgical Procedure of Adnexal Mass With Abdominal Pain In Pediatric And Adolescent Patients

Objective: To investigate the clinicopathological features and surgical procedures of adnexal masses with abdominal pain in pediatric and adolescent patients.Methods: A total of 212 pediatric and adolescent adnexal masses with abdominal pain who underwent surgery were retrospectively reviewed. The patients were divided into two groups, namely, the emergency surgery (EMS, n=96) group and the elective surgery (ELS, n=116) group, according to whether they had been surgically diagnosed with emergency conditions. EMS group refers to patients who had been surgically diagnosed with emergency conditions including adnexal masses torsion，corpus luteum rupture，and rupture of ectopic pregnancy. ELS group refers to patients with adnexal mass without emergency condition. The differences between the two groups were compared using the chi- squared test.Results: At the surgery evaluation, the median age was 14.5±3.6 years. A total of 175 patients (82.5%, 175/212) had menstruation, and 37 patients (17.5%, 37/212) had not yet begun menstruating. A total of 126 (59.4%, 126/212) patients presented with an abrupt onset of abdominal pain. Pelvic abdominal ultrasound was the first imaging modality used in all the patients (n = 212/212; 100%). Tumor markers were abnormally elevated in 26 patients.Compared with the ELS group, the proportion of patients with emergency onset of pain, pain duration less than 3 months, persistent and intense of pain were significantly higher than those in ELS group (P < 0.05). There were significantly more patients without menarche in the EMS group than in the ELS group (p<0.05). The average tumor size in the ELS group was larger than that in the EMS group (p<0.05). In the EMS group, 78 cases（ 81.3%,78/96）had adnexal mass torsion, 16 cases (16.7%，16/96) had mass rupture, and 2 cases (2.1%, 2/96）had ectopic pregnancy. Of the 78 patients with adnexal mass torsion, 49 cases (62.8%, 49/78）underwent ovary-preserving surgery, and 24 cases (30.8%，24/78）underwent adnexectomy. The most common pathologic types of adnexal torsion were mature teratoma cysts and simple cysts, accounting for 29% and 26%, respectively.Conclusions: Adnexal masses combined with abdominal pain in pediatric and adolescent patients, especially for patients presented as acute pain which characterized by emergency pain onset, persistent pain that cannot be relieved or recurrent pain，should be considered due to the possibility of adnexal mass combined with acute complications, and emergency surgery should be performed immediately. For patients with suspected malignant lesions, a comprehensive evaluation of the lesions should be conducted preoperatively to select the appropriate surgical method and strategy. After the discovery of an adnexal mass, evaluation should be performed quickly, and long-term management should be implemented.

Growing Teratoma Syndrome: Two case reports

We present two cases of nine and twenty-seven years old girls with recurrence of immature teratoma after an incomplete surgical staging. In both cases, there were huge abdominopelvic masses despite decrease in tumor markers with chemotherapy. Complete surgical resection of these masses was done, and histopathology showed only mature teratoma.

PEDT-3

Background: Germ cell tumors (GCTs) containing a teratoma component is a group of diseases consisting of various pathological conditions such as mature teratoma, immature teratoma, teratoma with malignant transformation, and mixed tumor with other GCTs. There is controversy about the efficacy and safety of radiation and chemotherapy for GCTs with teratoma component other than mature teratomas. Methods: Of 212 cases of GCTs treated at Tohoku University Hospital Neurosurgery from January 1990 to March 2021. In this study, 23 histologically verified GCTs containing teratoma components were included. Pathological findings, recurrence, survival, and late complications were examined. Results: The age of onset was 2 months-21 years (median 10.5 years). Histological diagnosis was mature teratoma alone in 5 cases, mixed GCTs with mature teratoma in 11 cases, immature teratoma in 5 cases, and mixed tumor with mature teratoma and germinoma in 2 cases. Patients except mature teratoma were treated by chemotherapy alone or radiochemotherapy. During follow-up for 7–362 months (median 135 months), 3 patients relapsed. One of these patients was diagnosed with mature teratoma at the time of treatment and did not receive post-treatment, but relapsed as germinoma 21 years later. A review of pathological specimens at the time of initial onset revealed immature teratomas in addition to mature teratomas. Recurrent lesions in 3 cases were controlled by additional treatment, and no deaths due to tumor progression were observed. On the other hand, of the 18 patients who underwent radiochemotherapy, 1 developed primary hypothyroidism and 2 developed thyroid cancer and leukemia. Conclusion: GCTs with teratoma component often contain malignant histological types and require caution when making a pathological diagnosis. In these cases, tumor control can be expected by radiation or chemotherapy, but there is a risk of developing endocrine disorders and secondary tumors, and further studies are needed to optimize treatment.