Prenatal sonographic features of fetal mediastinal teratoma

Mediastinal teratoma can cause severe hydrops fetalis, which worsens the effects of the mass compression on the vital mediastinal organs. A careful sonographic examination is mandatory to demonstrate the characteristic features suggestive of this congenital tumor. We describe these features at 20 weeks gestation. The most prominent finding was the heterogeneous echogenicity of a large cystic-solid mass with hyperechoic dots, seen as a part of the anterior mediastinum immediately posterior to the sternum. Additional diagnostic features included posterior displacement of the heart, low cardiac output, and hypoplasia of the normally structured heart and lungs due to the direct mass compression. These sonographic findings were confirmed at autopsy which confirmed a nonmetastatic immature teratoma. Sonography may enable accurate diagnosis of mediastinal teratoma considering the anterior location and heterogeneous appearance of the mass, posterior displacement of the heart, normal lung morphology, and compression effects on these organs.     

Mature mediastinal teratoma: sonographic imaging patterns and pathologic correlation.

OBJECTIVE: To characterize the sonographic patterns of teratomas located within the mediastinum and to correlate them with pathologic findings, because there have been few reports concerning the application of sonography in the diagnosis of mediastinal teratoma. METHODS: Over a 9-year period, we carried out an image analysis of the sonographic findings of 28 mediastinal teratomas whose diagnoses were proved surgically. RESULTS: Sonography showed that 18 patients had a complex mass of heterogeneous echogenicity, including regional bright echoes (n = 12), acoustic shadows (n = 8), hyperechoic lines and dots (n = 7), soft tissue septa (n = 9), dermoid plugs (n = 6), and hypoechoic areas (n = 11). This type of mediastinal teratoma revealed, in pathologic findings, varying combinations of fat, sebaceous and mucinous materials, hair, mineralized elements, and multiple compartments. Eight patients had a homogeneous hyperechoic mass, and the 2 remaining patients had floating spherules within a cystic mass. Pathologically, the homogeneous mass mainly contained hair and sebaceous material. The floating spherules were also composed of sebaceous tissue and were above the fluid of the cyst. CONCLUSIONS: On the basis of the evaluation of the sonographic and pathologic findings, we described 3 major patterns of mediastinal teratoma: a complex mass of heterogeneous echogenicity, homogeneous high echogenicity within a solid mass, and floating spherules within a cystic mass. Thus, sonography can improve the diagnosis of mediastinal teratoma. However, additional prospective studies are needed to test the sensitivity and specificity of these sonographic patterns in the diagnosis of mediastinal teratoma.     

改良剑突下入路胸腔镜前纵隔畸胎瘤切除术的临床应用分析

目的:探讨改良剑突下入路胸腔镜前纵隔畸胎瘤切除术的临床疗效和安全性。方法:回顾性分析经病理确诊的前纵隔畸胎瘤患者17例,均行改良剑突下入路胸腔镜前纵隔畸胎瘤切除术,观察患者的临床疗效及手术安全性。结果:17例患者均在胸腔镜下顺利完成手术,其中,2例患者合并行心包部分切除术,1例患者合并行右肺楔形切除术。肿瘤标本切除完整,切除肿瘤标本平均直径为(8.4±1.7) cm;手术平均时间为(67.8±17.3) min,术中平均出血量为(48.8±31.6) mL,术后平均引流量为(73.5±11.1) mL,术后平均住院时间为(3.8±1.0) d。所有患者无手术并发症,均顺利出院。结论:改良剑突下入路胸腔镜前纵隔畸胎瘤切除术安全、可靠,患者疗效满意,值得临床推广。     

Uniportal video-assisted thoracoscopic surgery for complex mediastinal mature teratoma: A case report

BACKGROUNDMediastinal mature teratoma is the most common histological type of primary extragonadal germ cell tumor. In this report, we describe a rare case of giant mature teratoma located primarily in the anterior mediastinum and causing partial atelectasis of the upper and middle lobes of the right lung, as well as extrinsic compression of the right atrium.CASE SUMMARYA 31-year-old male with a giant mediastinal mature teratoma presented with progressive exertional dyspnea and chest pain for 1 mo. Computed tomography of the chest indicated the diagnosis of anterior mediastinal teratoma. The patient underwent right uniportal anterior approach video-assisted thoracoscopic surgery (VATS). En bloc resection of the giant teratoma, wedge resection of the upper and middle lobes of the right lung, resection of the thymus and partial excision of the pericardium were successfully performed. The pathological diagnosis revealed a mature cystic teratoma with foreign-body reaction that was closely related to the right lung, atrium dextrum, superior vena cava and ascending aorta. An atrophic thymic tissue was also discovered at the external teratoma surface. The patient was discharged on postoperative day 7.CONCLUSIONThis is the first report of the use of uniportal VATS for complete resection of a teratoma in combination with wedge resection of the right upper and middle lung lobes and partial resection of the pericardium.     

Rectal mature teratoma: A case report

BACKGROUNDRectal mature teratoma is rare and has been reported as a case report in this study. Herein, clinical presentation, magnetic resonance imaging findings, and immunohistochemistry showed a pelvic rectal mature teratoma. The case report and the surgical treatment procedure have been discussed below.CASE SUMMARYA 29-year-old Chinese female showed up with over a 1-mo history of perianal mass that emerged after defecation. Physical examination indicated that the mass was 4 cm × 3 cm × 3 cm. The intraoperative procedure involved ligation of the sigmoid colon 10 cm above the upper edge of the tumor, followed by ligation of the rectum 3.5 cm above the upper edge of the tumor, and subsequent complete removal of the mass. The histopathology confirmed the mature teratoma.CONCLUSIONThe tumor can be completely removed using surgery to prevent its recurrence.     

Fetal mediastinal teratoma: Misinterpretation as congenital cystic lesions of the lung on prenatal ultrasound

Congenital mediastinal teratoma can lead to development of hydrops fetalis and may be misinterpreted on ultrasound. In this case report, ultrasound revealed severe fetoplacental hydrops, moderate posthemorrhagic hydrocephalus, and multiple pulmonary cysts suggesting cystic adenomatoid malformation and displacement of the heart to the left side. Autopsy of the hydropic 24-weeks male fetus showed a large cystic-solid mediastinal mass that was consistent with nonmetastatic immature teratoma. It also demonstrated thymic, cardiac and pulmonary hypoplasia, and confirmed the germinal matrix-intraventricular hemorrhage. Accurate prenatal diagnosis of mediastinal teratoma may be achieved by a careful Doppler ultrasound assessment that also allows evaluating the fetal outcome.     

内含脑膜瘤/脑膜增殖成分的儿童睾丸畸胎瘤1例

内含脑膜瘤/脑膜增殖成分的睾丸畸胎瘤非常罕见。组织学上除分化成熟的成分外,还包含与周围神经节及神经胶质相邻的脑膜瘤/脑膜增殖区域。免疫组织化学显示瘤细胞SSTR2A和PR强阳性、EMA弱阳性。临床确诊需结合组织学观察和免疫组织化学检测。     

A case report of mediastinal cavernous hemangioma

When faced with a hypervascular mediastinal tumor, mediastinal hemangioma should be taken into consideration. Although it is uncommon, considering this important diagnosis may avoid a possible extensive surgery that is not necessary.     

胎儿颅内畸胎瘤生长至口腔外1例

胎儿颅内肿瘤十分罕见,占胎儿肿瘤的10%,孕晚期为主,常导致胎死宫内或新生儿死亡。以往报道的绝大多数胎儿颅内肿瘤为良性,生长在骶尾部、颅内、口腔、胃等部位,鲜见畸胎瘤从颅内生长至口腔外的。在孕4个月及孕晚期增加检查,以减少异常妊娠的漏诊,同时应多观察胎儿的颅内结构,在整个生长过程中是否有异常变化。     

Mature ovarian teratoma with gliomatosis peritonei: A rare case report

Gliomatosis peritonei (GP) is rarely observed along with mature ovarian teratoma. However, it is important to recognize the benign nature of GP when associated with mature ovarian teratoma. Treatment for primary tumor and long‐term follow‐up is vital.     

经胸超声心动图可用于无症状纵隔肿瘤的诊断

目的评价经胸超声心动图对纵隔肿瘤的诊断价值。方法回顾性分析2018年1月1日~2019年12月31日经胸超声心动图检查首次发现纵隔肿瘤的体检者临床资料,总结纵隔肿瘤在经胸超声心动图中的超声特点,并分别与放射影像（X线和CT扫描）及组织病理对比。结果共获得20例经胸超声心动图诊断纵隔肿瘤的无症状患者,检出纵隔肿瘤分为囊肿9例、胸腺肿瘤5例、淋巴结肿大3例、畸胎瘤2例、淋巴瘤1例。相较X线诊断而言,超声检查纵隔肿瘤有着较为明显的优势。此外,超声对纵隔肿瘤的检查价值也不亚于CT检查（Kappa=0.792,P＜0.001）。以病理检查结果为金标准,经胸超声心动图诊断纵隔肿瘤的误诊率为15%,对肿物良恶性质诊断的敏感性为75%,特异性为92%。结论经胸超声心动图检查可以用于纵隔肿瘤的诊断,不仅能对纵隔占位病变的内部结构进行观察,还可以对其良恶性质进行判定。     

Prenatal sonographic diagnosis of mature renal teratoma: A case report

Renal teratoma is an extremely rare condition found in adolescents and young adults. Here, we report a case in which renal teratoma was diagnosed by fetal ultrasound examination. To our knowledge, this is the first report to describe the imaging manifestation of renal teratoma in prenatal diagnosis.© 2012 Wiley Periodicals, Inc. J Clin Ultrasound, 2013     

Successful all robotic-assisted excision of highly malignant mediastinal neuroblastoma in a toddler: A case report

An otherwise well 28-month-old girl presented with fever/left thigh pain. Computed tomography identified a 7 cm right posterior mediastinal tumor extending to the paravertebral and intercostal spaces with multiple bone and bone marrow metastases on bone scintigraphy. Thoracoscopic biopsy diagnosed MYCN non-amplified neuroblastoma. Chemotherapy shrank the tumor to 5 cm by 35 months of age. Robotic-assisted resection was chosen because the patient was large enough and public health insurance coverage was available. At surgery, the tumor was well-demarcated by chemotherapy and dissection posteriorly from the ribs/intercostal spaces and medially from the paravertebral space and azygos vein was facilitated by superior visualization/instrument articulation. The capsule of the resected specimen was intact on histopathology, confirming complete tumor resection. Despite minimum distance specifications between arms, trocars, and target sites with robotic assistance, excision was safe without instrument collisions. Robotic assistance should be actively considered for pediatric malignant mediastinal tumor provided the thorax is of adequate size.     

Extra‐gonadal mature teratoma: A case report of retroperitoneal location with a literature review

Extra‐gonadal mature teratoma is a benign tumor occurring rarely in adults. The retroperitoneal localization constitutes less than 4%. Treatment consists of surgical resection. Histological examination is essential for definitive diagnosis. We reported an unusual case of mature retroperitoneal teratoma discovered in a young man with abdominal pain.     

纵隔畸胎瘤：CT与病理对照分析

目的：研究纵隔畸胎瘤的CT表现及其病理基础。方法：回顾分析56例经手术病理证实的纵隔畸胎瘤的CT表现,并与手术病理表现对照。结果：囊性畸胎瘤31例,良性实质性畸胎瘤20例,恶性畸胎瘤5例,CT表现与手术病理表现基本一致。结论：纵隔畸胎瘤的CT表现能反映其手术病理特征,具有一定的特异性,对术前诊断与鉴别诊断有很高的临床价值。     

Malignant transformation of mature cystic teratoma into undifferentiated carcinoma: A case report

Malignant transformation of mature cystic teratoma (MCTO) is a rare entity. Even rarer is the transformation of MCTO into undifferentiated carcinoma. We report a case of an 80‐year‐old woman with undifferentiated carcinoma and squamous cell carcinoma component originating from mature cystic teratoma of the ovary.     

Duodenal mature teratoma causing partial intestinal obstruction: A first case report in an adult

BACKGROUND A teratoma is a germ cell tumor that is composed of tissue derived from two or three germ layers.Duodenal teratomas are extremely rare and have been exclusively reported in neonates and children.This is the third case of a teratoma primarily arising in the duodenum and the first case that occurred in an adult.CASE SUMMARY A 31-year-old male presented with clinical partial gut obstruction(epigastric pain,nausea,and vomiting).The physical examination showed a palpable illdefined mass on the left side of the abdomen.The computed tomography scan revealed a multiseptated cystic tumor at the retroperitoneal area.First,he underwent gastrojejunostomy to relieve the symptoms and was referred to a tertiary-care hospital.The second operation revealed a 10-cm solid-cystic mass originating from the third part of the duodenum and adhering to the abdominal aorta and pancreas.Segmental duodenectomy was performed.The pathological diagnosis was a mature cystic teratoma.The patient was asymptomatic at 5 mo after the operation.CONCLUSION Duodenal teratomas are extremely rare but should be included in the differential diagnosis in patients who present with intestinal obstruction.Radiological imaging is helpful to reach the preoperative diagnosis.Multidisciplinary team planning is essential to avoid injury to the adjacent organ in duodenal operation.     

Four-year-old anti-N-methyl-D-aspartate receptor encephalitis patient with ovarian teratoma: A case report

BACKGROUNDA population-based comparative study in United States shows that the prevalence and incidence of autoimmune encephalitis are comparable to those of infectious encephalitis and its detection is increasing over time. Some patients are complicated with ovarian teratoma. The younger the patient is, the less likely a tumor will be present.CASE SUMMARYThis case report describes the successful treatment of anti-N-methyl-D-aspartate-receptor (NMDAR) encephalitis by early laparoscopic ovarian cystectomy and immunotherapy in a 4-year-old female child. And to the best of our knowledge, this detailed case report describes the youngest patient to date with anti-NMDAR encephalitis who underwent laparoscopic ovarian cystectomy.CONCLUSIONAlthough the younger the patient is, the less likely a tumor will be detected, we still emphasize that all patients with suspected or confirmed anti-NMDAR encephalitis should be screened for ovarian tumors if possible. Prompt initiation of immunotherapy and tumor removal are crucial for good outcomes.