Intramedullary cervical teratoma in an adult

Background and contextMature teratomas are extremely rare spinal tumors, and in the cervical spine presentation in an adult it is even more infrequent. To the best of our knowledge, only five previous intramedullary teratomas in an adult cervical spine have been reported.PurposeHere, we present another case of a cervical intramedullary mature teratoma in an adult and review the literature.Study design and settingCase report and review of the literature.Patient sampleThirty-four-year old man with initial symptoms of numbness of his left fingers, and later brachialgia of the whole arm. The diagnosis from initial manifestation of symptoms was relatively long (11 years).MethodCase review and Medline/Internet search using key word adult, teratoma, cervical spine, and intramedullary.ResultCase report presented. Only five cases of intramedullary cervical teratoma were found in the world literature.ConclusionCervical intramedullary teratomas in adults are rare entities. The indolent nature of the condition often leads to late presentation. Surgery can result in good outcome and complete cure. This is, to our knowledge, only the sixth case of cervical teratoma in an adult.     

Benign cervical teratoma in an adult: Report of a case

Cervical teratomas are rarely encountered in adults. We report herein the case of a 21-year-old woman who was admitted to our hospital for surgical treatment of a neck tumor, 7.5×4.5×2.7 cm in size, located in the left lower pole of the thyroid. Ultrasonography (US) and computed tomography (CT) revealed a multicystic tumor. The levels of carcinoembryonic antigen (CEA), carbohydrate antigen 19–9 (CA 19-9), and squamous cell carcinoma-related antigen (SCC) in the cystic fluid were extremely elevated in contrast to the normal levels found in the serum. The tumor was completely excised and histological examination revealed it to be composed of elements derived from the three germ layers, confirming a diagnosis of benign cystic teratoma.     

Malignant cervical teratoma in an adult presenting with impending airway obstruction

Extragonadal teratomas and germ cell tumours are uncommon. Most teratomas of the head and neck present in the paediatric age group. Occurrence of such tumours in an adult is extremely rare and, to date, less than 40 cases have been reported in the literature. We report a case of a young man presenting with impending airway obstruction secondary to a malignant teratoma of the neck.     

Rupture of a benign mediastinal teratoma into the right pleural cavity

A 27-year-old woman with a ruptured mediastinal cystic teratoma had high levels of amylase and carcinoembryonic antigen in cystic fluid. The activity of the amylase is thought to be the most likely cause of the rupture. High levels of carcinoembryonic antigen in pleural fluid are not necessarily indicative of a malignant lesion but may suggest the presence of a ruptured teratoma in patients with mediastinal tumors.     

An adult case of precursor B cell lymphoblastic lymphoma extending from right neck to upper cervical spinal region

We report the rare adult case of upper cervical spinal tumor diagnosed precursor B cell lymphoblastic lymphoma. A 48- year-old male had suffered from right neck pain and swelling for two months. He had no neurological symptoms. The serum level of IL-2 receptor was high (1,820 U/ml). The radiological examinations including MRI showed the tumor extending from right neck to the epidural space from medulla to the C4 level. The pathological diagnosis of biopsy specimens was malignant lymphoma. Since the early pre-B lymphoblast antigens were positive by the flow cytometry, the diagnosis was precursor B cell lymphoblastic lymphoma. This type of lymphoma is highly aggressive. The intensive chemotherapy regimen such as hyper-CVAD was superior to the lymphoma-like regimens. In the case showed the progressive neurological symptoms such as myelopathy and urinary incontinence, the immediate surgical decompression of the spinal cord may be necessary. Measurement of IL-2 receptor and biopsy with flow cytometry were necessary to work out the treatment strategy of the spinal malignant lymphoma. In this case, the complete response (CR) of the tumor was achieved with hyper-CVAD regimen and radiation therapy.     

Microsurgery of cervical intramedullary ependymomas extending into the medulla oblongata

Intramedullary spinal cord ependymomas are well-demarcated tumors, which can be totally resected without significant morbidity. However, it is challenging to remove intramedullary ependymomas extending into the medulla oblongata, because the medulla oblongata has such important roles as regulation of respiration, circulation, and digestion. We describe here three cases of intramedullary ependymomas extending into the medulla oblongata. The tumors were localized in the dorsal part of the caudal medulla oblongata and were surrounded by the nuclei and tracts related to the dorsal columns. The tumors were safely exposed by dividing the medulla oblongata along the posterior median sulcus and resected from the surrounding normal tissues. Although patients demonstrated transient dorsal column dysfunction postoperatively, the symptom finally recovered.     

Management of fetal mediastinal teratoma

Background/Purpose

Mediastinal teratomas are rare congenital germ cell tumors that prenatally can compress mediastinal structures and cause hydrops. Two possible presentations of massive fetal mediastinal teratoma include hydrops leading to fetal demise, or fetal esophageal and airway compression causing late-gestation polyhydramnios and preterm labor. The authors present 2 cases of fetal mediastinal teratoma that illustrate successful strategies for either of these presentations.

Methods

A 37-year-old woman carrying a fetus with a mediastinal mass and secondary hydrops at 23 weeks of gestation underwent in utero resection of the mass. Delivery was by cesarean delivery at 25 weeks because of preterm labor. A 24-year-old mother carrying a fetus with a mediastinal mass and severe polyhydramnios at 36 weeks of gestation underwent an ex utero intrapartum therapy procedure for establishment of an airway and tumor resection on uteroplacental support.

Results

These strategies resulted in physiologic improvement in the first case and controlled resection and resuscitation in the second. The first patient had significant sequelae of prematurity including bronchopulmonary dysplasia but is currently well at 9 months of age. The second patient is well at 1 year of age.

Conclusions

Massive fetal mediastinal teratoma can result in fetal or neonatal mortality by a variety of mechanisms. Optimal prenatal and perinatal management is required to salvage fetuses compromised by this lesion.     

The history of mediastinal teratoma

The first discovery in 1823 of what has become known as mediastinal teratoma is discussed. The uniqueness of this tumor with its various spontaneous complications is described along with its early and often inept surgical therapies. This article highlights the development of the surgical treatment of mediastinal teratoma that has matured synchronously with the understanding of the physiology of the chest and the evolution of modern surgery.     

Skull base reconstruction in cases of intracranial teratoma extending into the extracranial structures.

Recently experienced were two cases of postnatally diagnosed intracranial teratoma, one a mature teratoma and the other an immature teratoma, both extending into the extracranial structures. In each case, tumor resection was performed in which a barrier was created between the intracranial and extracranial spaces with a temporalis muscle flap. The technical aspect of skull base reconstruction is described, and previously reported cases of intracranial teratoma involving the skull base are reviewed.     

Benign sacrococcygeal teratoma in an adult

Sacrococcygeal teratomas are rare congenital tumors generally discovered at birth. Exceptionally these tumors are observed in adults. Radical resection must be performed to avoid potentially malignant recurrence even if the primary lesion was benign. We report a case of a benign sacroccygeal teratoma diagnosed in a 25-year-old male and discuss clinical features, pathological considerations and treatment.