Multilocated mature teratoma: a case report and review of the literature

Summary Mature teratomas are rare inclusion tumors, which have benign behaviors. Different locations of the tumor were reported in the literature. However, multiple tumor locations are extremely rare. An eight year old patient presented with an intraventricularly mature teratoma. During the six year follow up-period, two separately located masses were observed in the chest area and in the right iliac region, and both tumors were histologically diagnosed as mature teratomas. In this study, this unique case of mature teratoma presented with multiple locations in three separate body compartments. Furthermore, intraventricular dissemination with sellar and parasellar extension was observed in the third ventricle.     

Mediastinal mature teratoma with rupture into pleural cavity due to blunt trauma

We report a rare case of mediastinal mature teratoma with rupture due to blunt trauma. A 15-year-old boy had received a strong head-butt in the left upper chest wall and was admitted with the sudden onset of left-sided severe chest pain and dyspnea. Chest computed tomography (CT) scan on admission revealed a heterogeneous mass lesion in the anterior mediastinum. The contrast-enhanced CT scans obtained 2 days after admission showed not only mediastinal mass lesion but also left pleural effusion. On the radiologic finding at 5 months later, the lesion became larger and was thought to be a typical mediastinal mature teratoma. The patient underwent extirpation of the tumor. Microscopically, the tumor was typically composed of adult-type tissues and was confirmed to be mature teratoma.     

Embryonal rhabdomyosarcoma arising in a mature teratoma of the testis: a case report

We report a case of embryonal rhabdomyosarcoma present in the primary excision of an intratesticular purely mature teratoma. Testicular mature and immature teratomas are usually associated with other germ cell tumors. Nongerminal malignancies that tend to occur in gonadal and extragonadal teratomas are often epithelial. Sarcomas of all types are less frequent but embryonal rhabdomyosarcomas are encountered predominantly. This sarcomatous element can be present in the primary excision or it can appear after chemotherapy in the metastases. Usually, prognosis is dependent on the degree of aggressiveness of the sarcomatous component. A review of the literature reveals that it is unusual for an embryonal rhabdomyosarcoma to develop on purely mature teratoma. We report a case in the testicle. During followup metastases arise rapidly from the purely embryonal rhabdomyosarcomatous component. The accurate diagnosis of this unusual sarcomatous component is of paramount importance because of the implications for therapy.     

Acquired pulmonary stenosis caused by mediastinal mature teratoma: a case report

A 13-year-old girl was admitted with a sudden onset of chest oppression. Mediastinal teratoma was suspected on chest X-ray and CT scan. A grade 2/6 systolic murmur was heard at the upper left sternal area and cardiac catheterization showed mild pulmonary stenosis. After resection of the tumor, the murmur disappeared and histopathological diagnosis was mature teratoma. This is a rare case report of pulmonary stenosis caused by mediastinal mature teratoma.     

Primary carcinoid tumor in a retroperitoneal mature teratoma: report of a case

Primary retroperitoneal teratoma in an adult is rare, as is the occurrence of a malignant tumor within a mature teratoma, known as “malignant transformation”. A 24-year-old woman was admitted to our hospital for investigation of an abdominal mass. Computed tomography and magnetic resonance imaging revealed a multilocular mass in the right upper abdomen. The tumor consisted of fat, soft tissue, and bone, with a slightly enhanced solid component. The tumor was diagnosed preoperatively as a retroperitoneal mature teratoma with an immature component, and excised. Histologically, it was composed mainly of mature fat, soft tissue, and bone, accompanied by a solid component of prostate-like tissue. In addition, a latent carcinoid tumor was recognized in the middle of the tumor. The tumor was finally diagnosed as a primary carcinoid tumor within the retroperitoneal mature teratoma. The patient has been followed-up for 24 months since her operation without any evidence of recurrence. We report this case to highlight the possibility of malignant transformation in adult retroperitoneal teratoma, even when the preoperative diagnosis is benign mature teratoma.     

Mediastinal mature teratoma perforating into the lung with elevated serum carbohydrate antigen 19-9 (CA19-9) levels; report of a case

A 17-year-old woman was suddenly seized with anterior chest pain and admitted to our hospital. Chest X-ray, computed tomography (CT) scan and magnetic resonance imaging (MRI) showed a mass shadow in the left middle lung field associated with the left pleural effusion and high serum carbohydrate antigen 19-9 (CA 19-9) levels (58.5 U/ml). We performed a total resection of the tumor with adherent parts of the left lung. The tumor was 6.5 x 3. 8 x 2.9 cm in size, and was made up of soft tissues, fluid and cystic components. The histological diagnosis was a mature cystic teratoma with perforation into the lung, which contained pancreatic tissues, hepatic cells, bronchial epithelium, serous glands and so on. The levels of fluid amylase and CA 19-9 were high. We report mediastinal mature teratoma perforating into the lung and discuss the mechanism of perforation.     

Mediastinal mature teratoma in a Jehovah's Witness: Discrepancy between imaging and intraoperative findings

IntroductionPrimary mediastinal germ cell tumors are exceedingly rare but may present with a wide spectrum of elements. The occasional mediastinal teratoma that presents completely comprised of mature elements is a benign tumor but the appearance on imaging studies may be more suggestive of an invasive tumor. The treatment is complete resection but the assessment of resectability based on computed tomographic imaging can be misleading.Presentation of caseWe present a case of a 26 year old female, Jehovah's Witness who presented with a symptomatic mediastinal mass that on CT scan appeared to be unresectable due to presumed invasion of adjacent structures including the left pulmonary artery. Surgical exploration revealed an encapsulated, completely resectable mass which was excised without difficulty. Her early postoperative course was uneventful and at 18 months follow up is doing well without evidence of recurrence.DiscussionThe treatment of mature teratoma is complete surgical excision but the imaging studies may at times be misleading. We believe this case presents a unique clinical situation, since mediastinal mature teratomas are very rare and in addition, the preoperative decision to excise a mass becomes more complex in a case of a Jehovah's Witness. This case illustrates that the CT findings may be misleading when assessing a mediastinal mass.ConclusionResectability of a mediastinal mass can only be assessed at the time of operation and rarely should operation be denied solely on the basis of findings on imaging. Thus in these primary mediastinal tumors there should be a low threshold for proceeding with operation.     

Primary retroperitoneal mature cystic teratoma in an adult: A case report

BackgroundMature cystic teratoma is one of the most common tumors of the ovaries; however, primary retroperitoneal lesions are rare entities in adults.Case summaryWe report a case of a 33 year-old woman noticing a mass in her epigastric and left upper abdominal region without any specific signs and symptoms. Radiological evaluation revealed a retroperitoneal mass with extension from the posterior aspect of the pancreas to the pelvic cavity, composed of calcifications and cystic elements.ConclusionThe tumor was resected through a midline laparotomy and the pathology report confirmed the diagnosis of a mature cystic teratoma with no evidence of malignancy or immature components.     

Mediastinal mature teratoma with elevated serum SCC levels —A report of 2 cases—

This is a report of two cases of mature mediastinal teratoma associated with elevated serum SCC levels. The first patient was a 17-year-old female admitted to our hospital for severe left chest pain. Chest x-ray film and CT scan showed a mediastinal tumor. The preoperative serum SCC level was elevated. Resection was performed and the pathological diagnosis was mature teratoma. The second patient was a 32-year-old male admitted to our hospital for severe anterior chest pain. A chest CT scan showed a mediastinal tumor. The preoperative serum SCC level was high. Surgery was performed and the pathological diagnosis was mature teratoma. The cause of the high serum SCC levels was unclear, but we suspect that the pulmonary atelectasis may have caused it.     

Intramedullary mature cystic teratoma of the conus medullaris. A case report

Intramedullary teratoma is extremely rare and to our knowledge has been reported in only nine cases in the literature. We report a case of mature cystic teratoma of the conus medullaris. The case was diagnosed by magnetic resonance imaging and operated with microneurosurgical techniques.     

Adult sacrococcygeal teratoma: a case report

We report a case of adult sacrococcygeal teratoma resected by an abdominosacral approach. A cystic mass 13 cm in diameter in the pelvic cavity and left hydronephrosis were detected incidentally by abdominal computed tomographic (CT) scan in a 55-year-old man. The pelvic tumor extending from the presacral area to the coccyx was resected via a combined abdominal and transsacral approach. The resected specimen weighed 700 g and the pathological diagnosis was mature teratoma. While the sacrococcygeal area is the most frequent site of teratoma in infants, it is a rare site in adults. This is to our knowledge, the 30th case report of adult sacrococcygeal teratoma in Japan. At one month after the operation the patient had no bowel dysfunction and no dysbasia, but he had mild bladder dysfunction requiring self-catheterization twice a day at twelve months. The patient had no evidence of disease at twenty months after the operation.     

Testicular pure teratoma: a case report

A 46-year-old man visited our hospital, complaining of fever and painful swelling of the right scrotum contents. The symptoms and signs suggested epididymitis, but testicular tumor could not be excluded. Therefore, high inguinal orchiectomy was performed. Macroscopic findings were compatible with the testicular teratoma, containing hair, and epididymitis. Histological findings revealed that the tumor was composed of mature epidermis with skin appendages, cartilage, hair, bone and adipose tissue, and that many leucocytes infiltrated in the epididymis, resulting in the diagnosis of pure mature teratoma with epididymitis. For 6 months after the operation, no evidence of recurrence has been observed. Despite its histologically benign appearance, primary pure teratoma of the testis has a metastatic and recurrent potential. Therefore, primary pure teratoma should be man aged in the same way as other nonseminomatous germ cell tumors.     

Testicular mature teratoma with onset during childhood and removed 40 years later: a case report

A 56-year-old man presented with a painless mass in the left scrotum. The mass was first noticed when he was a junior high school student,and it had been left for about 40 years. The intrascrotal tumor of 7 cm in diameter was elastic soft and smooth. The serum levels of α -fetoprotein, β -human chorionic gonadotropin and lactate dehydrogenase were within each individual normal range. He was diagnosed as having a left testicular tumor (cT1N0M0) and underwent left high orchiectomy. Histopathological diagnosis was mature teratoma without any malignant germ cell components. No evidence of recurrence has been observed for 4 years after the operation.     

Malignant transformation of intracranial mature teratoma to yolk sac tumor after late relapse. Case report

The recurrence of intracranial mature teratomas as germ cell tumors of different histological types is rarely reported. The authors describe the first case of the malignant transformation of an intracranial mature teratoma into a yolk sac tumor in a 16-year-old boy who presented with a 1-month history of anorexia and somnolence. Seven years prior to this presentation, the boy had undergone surgery for extirpation of a mature pineal teratoma. Computed tomography images obtained at his second presentation revealed a homogeneously enhanced mass within the third ventricle. The tumor was resected and the results of a histological examination were consistent with a yolk sac tumor. After resection, the patient underwent radiation therapy followed by chemotherapy with cisplatin and etoposide but died of tumor progression 15 months after his second hospitalization.     

Perforating mediastinal mature teratoma associated with acute cardiac tamponade; report of a case

We report a case of the mediastinal teratoma associated with acute cardiac tamponade followed by emergency operation. This tumor causes a variety of complications, but reports of acute cardiac tamponade have been rare. 20-year-old male admitted into our hospital with complaint of the chest pain, who was diagnosed with mediastinal tumor. She was admitted due to sudden fever up, and 5 days after admission, the complaint of severe epigastralgia and abdominal swelling were occurred. A chest X-ray film and chest computed tomography (CT) revealed cardiac tamponade. We carried out emergency surgical pericardial drainage and extirpation of the tumor. The tumor was composed of cystic part involving of dark green fluid macroscopically. The amylase level in this fluid was 42 U/l. We observed a small hole on the pericardial sac beside the base of ascending aorta. The amylase level in pericardial effusion was 19 U/l. Histopathological diagnosis was mature teratoma perforating into pericardiac sac, which included skin, bronchus and pancreatic tissue. We concluded that the progress of the tumor and the mechanical inflammation were major cause of perforation of the tumor into the pericardial sac, and autodigestion by enzyme from pancreas was minor cause of perforation.