Trichoadenoma in a mature Cystic Teratoma: A Rare Finding

Skin adnexal tumors arising in dermoid cysts of the ovary are exceedingly rare. We report a trichoadenoma arising in a dermoid cyst in a 42-year-old female. The histopathology of trichoadenoma has also been described briefly. Mature teratomas, which are almost all cystic (dermoid cysts), account for approximately 25% of all ovarian tumors, and 30% of benign ovarian tumors. They usually develop in children or women of the reproductive age group. Histologically, they are composed of variable proportions of tissue originating from the ectoderm, mesoderm, and endoderm. Cystic cavities are lined by mature epidermis. Although skin appendages and neural tissue are extremely common, there are only few case reports of skin adnexal tumors arising in a mature teratoma. We report a case of ovarian teratoma with a trichoadenoma. To the best of the authors' knowledge, this is the first report describing this rare benign skin adnexal tumor, in a mature cystic teratoma of the ovary. Keywords: trichoadenoma, mature cystic teratoma.     

Ganglioneuroblastoma arising within a retroperitoneal mature cystic teratoma

We discuss an extremely rare case of ganglioneuroblastoma arising within a retroperitoneal mature cystic teratoma. Radiological examinations showed a cystic tumor sandwiched between the pancreas and left kidney. Surgery was scheduled because the tumor seemed to have originated from the pancreas. En-block resection of the tumor with distal pancreatectomy, splenectomy, and left adrenalectomy was performed. In terms of macroscopic appearance, the tumor mainly consisted of a unilocular cystic mass, but the presence of a smaller, solid mass was also noted within the tumor. Histopathologic examination confirmed that the cystic mass was consistent with a mature cystic teratoma of the retroperitoneum, and in addition, a ganglioneuroblastoma was evident in the solid component. Histopathologically, the ganglioneuroblastomatous area was intimately associated with dermoid tissue of the mature cystic teratoma, thus this case was diagnosed to be a mature cystic teratoma with malignant transformation. To best of our knowledge, this is the first reported case of ganglioneuroblastoma arising in a mature cystic teratoma.     

Adenosquamous carcinoma arising in a dermoid cyst (benign cystic teratoma) of the ovary--a case report

An 89-year-old woman with adenosquamous carcinoma arising in a dermoid cyst (benign cystic teratoma) of the ovary is reported. The malignant change of a dermoid cyst is rare. To our knowledge, this is the first report case of an adenosquamous carcinoma arising in a dermoid cyst of the ovary. Moreover, this case is the oldest patient on record. It is important that dermoid cyst be examined carefully.     

An ovarian mucinous adenocarcinoma arising from mature cystic teratoma associated with respiratory type tissue: a case report

Mature cystic teratoma (dermoid cyst) is the most common benign germ cell tumor of the ovary, accounting for approximately 30% of all ovarian tumors. Malignant transformation is rare; the most frequent transformation reported is to squamous-cell carcinoma in 80% of cases, whereas transformation to adenocarcinoma is described in about 7% of cases. We report a case of malignant transformation to mucinous adenocarcinoma arising from respiratory-like epithelium in a mature teratoma of the ovary.     

The microscopic surgical treatment for tumor of posterior cranial fossa in children

OBJECTIVE To analyze and discuss about the clinical characteristics, pathological types, surgical modalities and techniques, and postoperative complications in children with tumor of posterior cranial fossa.
METHODS Retrospective study was conducted on 102 cases of pediatric tumor of posterior cranial fossa, admitted and treated in our hospital during the period of January 1996 to January 2007. All patients underwent microscopic surgical treatment. Fiftyeight were male and 44 cases were female. The age ranged from 9 months to 14 years old, with an average of 6.1 ± 0.5 of age. Cranial CT or MRI examination was conducted before and after the surgery on all patients. RESULTS The primary manifestations for this group of patients were increased intracranial pressure and/or ataxia. Postoperative pathological diagnoses showed： 46 cases of medulloblastoma, 43 cases of astrocytoma, 11 cases of ependymoma （including 1 case of degenerative ependymoma）, 1 case of dermoid cyst, and 1 case of teratoma. In this group of the patients, radical surgery was used in 68 cases and subtotal surgical removal used in 31 cases, while surgical removal of large section was performed on 3 cases. There were no deaths from surgery reported. Ninety-one cases showed significant symptomatic improvement when compared with preoperative conditions, while 11 cases showed either no improvement or more severely affected afterward. For 6 cases, postoperative ventriculoperitoneal shunt was performed within 7 days to 2 months after the surgery. Sixty-three patients gained follow-up for 3 to 60 months in duration. Thirty-nine patients regained normal life and were able to learn well, while there were 7 patients who could not live normally on their own. During the follow-up period, there were 17 cases of recurrence and 7 cases of death. In 23 cases of medulloblastoma in children with age of 3 years old or above, 2 cases who underwent surgical removal of intracranial ependymoma received small dosage of postoperative X-ray radiotherapy on the the brain and spinal cord. Nine cases of medulloblastoma in children under age of 3 and 17 cases of astrocytoma diagnosed after the surgery received chemotherapy of Carmustine.
CONCLUSION Medulloblastomas and astrocytomas were the most common types of pediatric tumor of posterior cranial fossa, right followed by ependymoma, and dermoid cysts and teratomas were rare. Early correct diagnosis, proper selection of appropriate surgical modality and the surgical margin, proper treatment of postoperative complications, and the selecting right radiotherapy or chemotherapy were the key factors in influencing the prognostic outcome of children with tumor of posterior cranial fossa.     

Bifocal mixed germ-cell tumor with growing teratoma syndrome and metachronous mature metastases: case report

The authors report the case of a 16-year-old male who presented with a bifocal diencephalic tumor arising both in the neurohypophysis and the pineal region with hydrocephalus. The histological diagnosis obtained during endoscopic ventriculocisternostomy was germinoma. MRI revealed an increase of the neoplasm during chemotherapy with recurrent obstructive hydrocephalus. A new ventriculostomy was performed followed by total surgical resection. The final histopathological analysis demonstrated an immature teratoma. Subsequently, this patient developed metachronous cystic metastases in the cerebello-pontine angles, which were resected and identified as mature teratoma, then we observed a lesion of the brachium conjunctivum which stayed stable after 29 consecutive months. The patient is alive and feels well 6 years after the initial diagnosis and 5 years after the first metastasis. To our knowledge, this is the fifth case of the growing teratoma syndrome located in the brain but the first case with simultaneously bifocal location and infratentorial disseminated metastasis. Obviously surgical removal is the treatment of reference for teratomas. Metastases of teratoma can be mature and may be amenable to surgery with a favorable outcome. Primary intracranial germ-cell tumors (CGT) arise in the midline of the brain and are located in the diencephalon. The peak incidence occurs during the second decade of life. Germ cell tumor (CGT) includes germinomas and non-germinomatous tumors, mature and immature teratomas account for 19.6 % [1]. Curiously, teratomas are able to grow during the first weeks of chemotherapy while serum markers remain normal. This situation was originally described and designed as "the growing teratoma syndroma" (GTS) in primary testis tumors by Logothetis in 1982 [2]. Here we report the rare occurrence of a GTS in a teenager who presented metachronous cystic metastases located in posterior fossa which were histologically mature.     

The Microscopic Surgical Treatment for Tumor of Posterior Cranial Fossa in Children

OBIECTIVE To analyze and discuss about the clinical characteristics,pathological types,surgical modalities and techniques,and postoperative complications in children with tumor of posterior cranial fossa.METHODS Retrospective study was conducted on 102 cases of pediatric tumor of posterior cranial fossa,admitted and treated in our hospital during the period of January 1996 to January 2007.All patients underwent microscopic surgical treatment.Fiftyeight were male and 44 cases were female.The age ranged from 9months to 14 years old,with an average of 6.1±0.5 of age.Cranial CT or MRI examination was conducted before and after the surgery on all patients.RESULTS The primary manifestations for this group of patients were increased intracranial pressure and/or ataxia.Postoperative pathological diagnoses showed:46 cases of medulloblastoma,43cases of astrocytoma,11 cases of ependymoma(including 1 case of degenerative ependymoma),1 case of dermoid cvst,and 1 case of teratoma.In this group of the patients,radical surgery was used in 68 cases and subtotal surgical removal used in 31 cases,while surgical removal of large Section was performed on 3 cases.There were no deaths from surgery reported.Ninety-one cases showed significant symptomatic improvement when compared with preoperative conditions,while 11 cases showed either no improvement or more severely affected afterward.For 6 cases,postoperative ventriculoperitoneal shunt was performed within 7 days to 2 months after the surgery.Sixty-three patients gained follow-up for 3 to 60 months in duration.Thirty-nine patients regained normal life and were able to learn well,while there were 7 patients who could not live normally on their own.During the follow-up period,there were 17 cases of recurrence and 7 cases of death.In 23 cases of medulloblastoma in children with age of 3 Years old or above,2 cases who underwent surgical removal of intracranial ependymoma received small dosage of postoperative X-ray radiotherapy on the the brain and spinal cord.Nine cases of medulloblastoma in children under age of 3 and 17 cases of astrocytoma diagnosed after the surgery received chemotherapy of C:armustine.CONCLUSION Medulloblastomas and astrocytomas were the most common types of pediatric tumor of posterior cranial fossa,right followed by ependymoma,and dermoid cysts and teratomas were rare.Early correct diagnosis,proper selection of appropriate surgical modality and the surgical margin,proper treatment of postoperative complications,and the selecting right radiotherapy or chemotherapy were the key factors in influencing the prognostic outcome of children with turrtor of posterior cranial fossa.     

Serum alpha-fetoprotein as a marker for the effect of post-operative radiation therapy and/or chemotherapy in eight cases of ovarian endodermal sinus tumour.

The clinical pathological findings of eight cases of ovarian endodermal sinus tumour (yolk sac tumour) are presented. Histological exmination in all eight cases showed a typical endodermal sinus tumour pattern, and in six of the patients other tumour elements such as dysgerminoma, choriocarcinoma, malignant teratoma, endometriosis, and a dermoid cyst were also found. Six patients had increased serum alpha-fetoprotein concentration in the post-operative period, and two patients had a normal concentration 27 and 35 days after operation, respectively. In all cases except one, a close correlation between serum alpha-fetoprotein and progression or regression of tumour was found. Serum alphafetoprotein was thus found to be a reliable parameter in post-operative radiation and/or chemotherapy (VAMBLE). In one patient who died 10 months after operation with widespread endodermal sinus tumour growth, only a small terminal increase in serum alpha-fetoprotein concentration was found. Four of the eight women are still alive with normal alpha-fetoprotein concentration, and without clinical evidence of tumour disease.     

Glial Heterotopia in ENT—Two Case Reports and Review of Literature

The purpose of presenting these case reports is to highlight the occurrence of heterotopic glial tissue of the tongue and nose in children. So far, literature review has revealed few case reports of such lesions in neonates, but our patients presented with this unique lesion at the age of two and a half years and 3 years. This is a rare congenital anomaly in the tongue, which can mimic a lingual thyroid, teratoma, dermoid cyst etc. Surgical excision is mandatory when the lesion causes obstructive symptoms. The authors discuss the problems in diagnosis, pathology and management and review the literature.     

Testicular dermoid cyst in an 85-year-old man

We report a case of dermoid cyst of the right testis. An 85-year-old man was admitted to our hospital with an enlarged right testicle and a high prostate specific antigen (PSA) level. A hard testis of approximately 10 cm, with a smooth surface, was palpated. On digital rectal examination, a hard prostate of approximately 4 cm, with irregular surface, was palpated. We performed right inguinal orchiectomy and transrectal ultrasound-guided prostate needle biopsy. The wall of the testis was calcified, with a cyst that contained yellow-white sebaceous material and tufts of hair. Microscopically, the cyst wall showed calcification and ossification, and had hair roots. The diagnosis was dermoid cyst. We also found a well differentiated adenocarcinoma (Gleason 2–3) in the prostate. Dermoid cyst of the testis is very rare. To our knowledge, this case is in the oldest patient thus far reported. Received: September 9, 1999 / Accepted: January 20, 2000     

Congenital midline dermoid cyst with sinus of nose

An unusual case of congenital, extranasal, and extracranial dermoid cyst with a supratip sinus of the nose is reported.     

肾上腺成熟畸胎瘤的临床特征及治疗

目的探讨肾上腺成熟畸胎瘤的临床特征及治疗方法。方法回顾性分析6例经手术切除肿瘤、术后结合病理证实为肾上腺成熟畸胎瘤患者的临床、影像、病理学特点,评价手术治疗效果。结果6例患者中,肿块位于左侧肾上腺2例,右侧4例;患侧腰痛3例,体检发现肾上腺肿物3例。6例患者均无高血压史。CT平扫检查示肿物位于肾上腺区域,为椭圆形或哑铃状的囊、实性混合包块,其直径3～6cm,内有钙化灶,多表现为斑块状或弧形,包块内可见脂肪样密度灶。B型超声示肾上腺区囊实性肿物,边界清晰。CT增强后肿物边缘和内部软组织成分可见强化。病理示镜下可见钙化、软骨、脂肪、鳞状上皮及黏液柱状上皮等。6例患者均行肾上腺肿瘤切除,术中见肿瘤边界清楚,血供不丰富。术后随访1—8年未见肿瘤复发。结论成熟畸胎瘤发生于肾上腺罕见,以女性多见,多发于年轻人,临床症状不典型,对其术前诊断主要依靠影像学检查。肾上腺成熟畸胎瘤宜行手术切除,预后良好。     

椎管内先天性肿瘤的显微外科治疗

目的:探讨椎管内先天性肿瘤的特点及显微外科治疗体会。方法:回顾性分析山西医科大学第一医院2010年8 月至2015年8 月50例椎管内先天性肿瘤患者的临床资料,对不同类型肿瘤的特点、术中技巧等问题进行探讨。结果:椎管内先天性肿瘤患者发病年龄较轻,大部分位于腰骶部。50例患者中,肿瘤全切11例,近全切9 例,大部分切除29例,囊肿造瘘1 例。病检表皮样囊肿10例、皮样囊肿8 例、成熟畸胎瘤13例、脂肪瘤9 例（血管脂肪瘤2 例）、肠源性囊肿4 例、蛛网膜囊肿3 例、胶质室管膜囊肿1 例、错构瘤1 例、未获得病理诊断1 例。手术并发症包括脑（脊）膜炎1 例,切口感染1 例。其中39例获得随访,随访时间为3 个月～24个月,3 例复发。结论:采用显微外科手术治疗椎管内先天性肿瘤,肿瘤显露及切除满意,手术并发症少,患者恢复快。      

Autoimmune hemolytic anemia and dermoid cyst of the mesentery. A case report

An autoimmune hemolytic anemia has been detected in a patient suffering from a dermoid cyst of the mesentery. Early recognition of the teratoma is important, since only removal of the tumor is consistently curative. Investigations showing immunocompetent cells within the cyst's wall lend further support to the contention that the tumor tissue itself produces, for reasons yet unknown, antitumor autoantibodies that could cross-react with the patient's erythrocytes. The role of computerized tomography (CT) in the diagnosis of abdominal teratoma is emphasized, since CT has permitted visualization of the cystic structure of the tumor before the surgical removal of the mass.     

An Inflammatory Polyp of the Sigmoid Colon Observed in a Case with a Ruptured Ovarian Dermoid Cyst

We present here a rare case, an ovarian dermoid cyst with fistulaformation into the sigmoid colon, which forms an inflammatorypolyp of the sigmoid colon. A 58-year-old woman was admitted because of occasional analbleeding. Several examination disclosed the elevation of erythrocytesedimentation rate, a positive test of stool specimen for occultblood, a polyp of the sigmoid colon in barium enema. Laparotomyshowed that a dermoid cyst of the left ovary had ruptured intothe sigmoid. The etiology of the rupture was "idiopathic." Thefistulous communication between the cyst and the sigmoid colonwas thought to have developed the inflammatory polyp over aperiod of about two years.     

Sacrococcygeal teratoma in adults: case reports and a review of the literature.

BACKGROUND: The sacrococcygeal area is the most frequent site of teratoma in infants, but it is a rare location for teratoma in adults. METHODS: The authors report two patients in their sixth decade of life with the pathologic diagnosis of sacrococcygeal teratoma. The clinical presentations, the histologic findings, and the patients' clinical outcomes are described. A review of the literature on sacrococcygeal teratoma in adults is also presented. RESULTS: In the first patient, who had no evidence of recurrence after adequate resection, examination of the specimens showed mature teratoma. The second patient had mature teratoma with adenocarcinomatous component and possible leptomeningeal involvement. She died 2 months after the operation. CONCLUSIONS: Although rare in adults, sacrococcygeal teratoma should be considered in the differential diagnosis of patients with a pelvic mass presenting with obstructive symptoms. These two cases suggest that sacrococcygeal mature teratoma is surgically curable if teratoma is completely resected. The presence of leptomeningeal involvement and malignant transformation are associated with a less favorable outcome.     

Adult Extrarenal Wilms’ Tumor Mimicking Mixed Epithelial and Stromal Tumor in the Retroperitoneum: A Case Report with Immunohistochemical Study and Review of the Literature

We report an extremely rare case of adult extrarenal Wilms’ tumor (WT) in a 52-year-old woman who presented with fever and abdominal distension. Computed tomography revealed a well-defined mass lesion measuring 15.0 cm in the right retroperitoneum and that was in contact with the right kidney. The mass and kidney were surgically removed. Grossly, the mass was well-defined, measuring 16.3 × 11.0 × 9.8 cm, and appearing grayish-white in color. The border between the mass and the kidney was well-defined. Histologically, the tumor showed a triphasic pattern consisting of stromal, epithelial and blastemal components. The stromal component was predominant in the tumor and consisted both of spindle cells and smooth muscle cells. The epithelial component showed a mature glandular structure. Immunohistochemically, the stromal component was positive for vimentin, smooth muscle actin and desmin. The blastemal component was positive for vimentin, while the epithelial component was positive for cytokeratin (CK) 18, CK7 and vimentin. WT-1 was negative in the all three components, and the Ki-67 proliferation index was low. The postoperative histopathological diagnosis indicated extrarenal WT arising in the retroperitoneum. Although not treated by either chemotherapy or radiation therapy, she was free from disease recurrence for 30 months after surgery. To the best of our knowledge, this report is only the fourth case of adult extrarenal WT arising in the retroperitoneum. Furthermore, the present case showed predominant smooth muscle differentiation and a mature glandular structure, mimicking a mixed epithelial and stromal tumor.     

Malignant melanoma arising in a dermoid cyst of the ovary

Autopsy findings of primary malignant melanoma arising in an ovarian dermoid cyst in an 86-year-old woman are presented. The right ovary was replaced by a dermoid cyst, 14 x 9 x 9 cm in size, in which several nodular tumors with diameters less than 3.2 cm were localized. They comprised diffusely proliferating anaplastic cells with prominent nucleoli. Some of them contained melanin pigments in the cytoplasm. The tumor cells were positive for S-100 protein and ultrastructurally showed melanosomes. In addition, several benign pigmented lesions resembling dermal nevus, pigmented schwannoma, or cellular blue nevus were present in the dermoid cyst, one of which contained a malignant melanomatous component. Histologic transition between benign and malignant components and the presence of another small focus of atypical melanocytes in the benign lesion suggested that the malignant melanoma arose in close association with the previously existing benign pigmented lesions in the dermoid cyst.     

后颅窝病变疑难病例6例报告

背景与目的：后颅窝占位病变的术前诊断有时并不容易。本文报告我们日常临床丁作中遇到的后颅窝病变中诊断困难的病例并分析其特点。方法：统计哈尔滨医科大学第一临床学院神经外科2004年4月至2006年4月的后颅窝病变手术病例，选择6例诊断困难的病例，分析总结发病方式、临床症状和体征、辅助检查、手术所见和组织学检查。结果：6例病例中，其中3例术前诊断为前庭神经鞘瘤，术后证实为脑膜瘤。1例术前诊断为脑梗塞，术后证实为畸胎瘤。1例术前诊断为脑膜瘤，术后证实为畸胎瘤。1例术前诊断为脑膜瘤，术后证实为黑色素瘤。结论：（1）桥小脑角区脑膜瘤和前庭神经鞘瘤容易混淆。（2）先天性良性肿瘤畸胎瘤容易误诊为其他脑肿瘤或脑梗塞。（3）一些罕见的肿瘤容易误诊，如黑色素瘤。     

Retroperitoneal germ cell tumors in childhood. A clinical and pathologic study of 11 cases

During the last 54 years at the Children's Hospital 11 children (10 female, 1 male) had been treated for an extragonadal germ cell tumor arising in the retroperitoneum. There were eight teratomas (five mature, three immature), two endodermal sinus tumors and one tumor with a mixture of both components. Abdominal pain or discomfort was the usual presenting complaint, with the average age at diagnosis being 18 months. On physical examination, each child had a palpable abdominal mass usually localized in the upper quadrants. The finding of calcification, bone or teeth, on radiologic study was most helpful in establishing a preoperative diagnosis of teratoma. The preferred treatment for children with mature and immature teratomas is complete surgical resection; decisions regarding adjuvant therapy for patients with immature tumors must be evaluated on an individual basis. The prognosis remains guarded for children with unresectable primaries or those with endodermal sinus tumor. Of three tumor-related deaths, two were due to metastatic endodermal sinus tumor and one resulted from extensive local growth by immature teratoma. Successful management of children with endodermal sinus tumor requires surgery aimed at debulking or complete resection in combination with aggressive adjuvant chemotherapy.