Sacrococcycygeal teratoma in adult: report of a case

Background Sacrococcygeal teratomas are neoplasias, which are most frequently found in infants, with the sacrococcígea area being the most frequently found extragonadal location. Aim of the Study To describe a sacrococcygeal teratoma in a 51-year-old adult patient and discuss the diagnosis and management. Methods The case of a 51-year-old woman who had a sacrococcygeal teratoma. Computed tomography showed a mass containing calcification. Early signs were when she experienced acute lower back pain upon leaning over or sitting. Results The tumor appeared first as a sacral swelling. The patient also claimed disturbances in her bowel functioning. Computed tomography (CT) showed the tumor and its relationship inside the pelvic cavity. Surgical ablation was performed on the entire tumor and the coccyx was preserved. Conclusion The surgical block was sent to pathological exam, which showed it to be a mature sacrococcygeal teratoma. A good clinical evolution took place after resection. Titular member of the Colégio Brasileiro de Cirurgi?es (TCBC). Titular member of the Colégio Brasileiro de Cirurgia Digestiva (TCBCD). Member ISURCS.     

Presacral cystic teratoma: a clinical case

A singular case of retrorectal tumor is presented. This tumor was diagnosed by rectal examination and confirmed by computed tomography. The patient was submitted to surgical treatment consisting of a combined abdominal and perineococcygeal approach in two consecutive events. The result was a complete removal. The histopathological examination showed a mature cystic teratoma. A literature review about these rare tumors is reported herein. Received: 1 January 1999 / Accepted in revised form: 22 September 1999     

Hyperechoic mass of the right ventricle in adults: A rare presentation of an intracardiac teratoma

Cardiac teratomas are very rare primary tumors; most are intrapericardial, while a few are intracardiac. Furthermore, most reported intracardiac teratomas are in the pediatric population, with few cases of secondary metastases from testicular teratomas reportedly manifesting in adults. Here, we report a rare case of a mature cystic teratoma in the right ventricle complicated by a bicuspid aortic valve (BAV) in an adult. Echocardiography and enhanced computed tomography (CT) were performed, and the mass was surgically excised. A pathological examination confirmed the diagnosis of a mature cystic teratoma. Meanwhile, mechanical valve replacement of the aortic valve was performed. No tumor recurrence or symptoms occurred in the 2-year follow-up. This is the first report of an adult primary intracardiac teratoma with solid hyperechoic findings on echocardiography and a BAV.     

Childhood cystic teratoma of the pancreas: Clinical presentation,evaluation and management

Pancreatic cystic teratoma in children is extremely rare. Here we present a female infant with a mature cystic teratoma of the pancreatic body. The patient was admitted for a palpable abdominal mass and anorexia. Computed tomography (CT) indicated a huge cystic mass in the abdominal cavity. Exploratory laparotomy was performed, and the tumor was excised completely. Pathology confirmed the tumor was a mature cystic teratoma of pancreatic origin. Two months after the initial surgery, a pseudocyst was detected and then cystojejunostomy was performed. Fourteen months after the second surgery, tumor relapse occurred and distal pancreatectomy was performed. The patient remained well without tumor recurrence during the next 24 months of follow-up. Our experience suggests that clinical manifestations of children with pancreatic cystic teratomas might be nonspecific and preoperative diagnosis is difficult. Radical tumor resection and maximized preservation of healthy pancreatic tissue should always be balanced in surgical treatment.     

Pulmonary metastasectomy following chemotherapy in patients with testicular tumors: experience in 52 patients

BACKGROUND: Surgical resection is an important form of treatment for residual post-chemotherapy pulmonary masses in patients with non-seminomatous germ cell tumors. We analyzed the outcome and prognostic factors after surgery. METHODS: Between 1996 and 2001, 52 patients underwent pulmonary resection of thoracic masses following cisplatin-based chemotherapy. These patients' records were subsequently reviewed. RESULTS: The overall 5-year survival rate was 75.8 %. A significantly longer survival was observed using multivariate analysis in patients with normal serum AFP and/or hCG tumor marker levels and after complete surgical resection. In patients with viable malignant tumor cells in the resected specimen and in patients with only necrosis/fibrosis or teratoma, the 5-year survival rates were 49.6 % and 82.8 %, respectively. This difference was only statistically significant in univariate analysis. CONCLUSIONS: We conclude that pulmonary resection in metastatic non-seminomatous germ cell tumors is a safe and effective treatment modality. Incomplete resection and elevated tumor marker levels, AFP and/or hCG, were identified as prognosis-related criteria for a poor outcome in multivariate analysis.     

Calcified amorphous tumor in left atrium presenting with cerebral infarction

Calcified amorphous tumor (CAT) of the heart is an extremely rare cardiac mass. We describe a case of cardiac CAT in a 70-year-old Korean female who presented with acute onset dysarthria and right side weakness. Echocardiography and chest computed tomography revealed a left atrial mass that originated from the interatrial septum. The patient underwent surgical resection and pathologic examination demonstrated CAT. Postoperative course was uneventful and she was followed without recurrence.     

Intrapericardial Teratoma in a Newborn: A Case Report

A bstract lntrapericardial teratomas are unusual tumors that often cause respiratory distress and might be lethal in the newborn. The purpose of this article is to present the clinical and pathological findings in a 12-day-old male successfully treated for a big intrapericardial teratoma. Given that the diameter of this tumor is generally related to the age at the time of diagnosis, the rarity of our case is the presence of a huge intrapericardial teratoma in a newborn. The surgical resection was lifesaving.     

Massive immature mediastinal teratoma extending into the left pleural cavity

We report a case of a massive mediastinal teratoma in an 18-year-old woman who presented with a short history of exertional dyspnoea. The tumor arose from the left lobe of the thymus and extended into the left pleural cavity, completely compressing the left lung and extensively shifting the mediastinum to the right. Measuring 23 cm x 17 cm x 9 cm and weighing 2005 g it is one of the largest anterior mediastinal teratomas reported. It was successfully treated by surgical resection, with a final pathological diagnosis of a grades 1-2 immature teratoma.     

Calcified amorphous tumor of the heart in a hemodialysis patient

We report a case of calcified amorphous tumor (CAT) of the heart in a 60‐year‐old Japanese man on hemodialysis. Because the masses in the mitral annulus developed during two‐year echocardiographic follow‐up, he underwent surgical resection with mitral valve replacement. Histological examination showed that the tumor contained multiple calcified nodules, which confirmed the diagnosis of CAT. This case report reinforces the need to deeply and periodically investigate for cardiac involvement of CAT in all patients on hemodialysis.     

Intrapericardial teratoma in an adult

The intrapericardial teratoma is a very rare congenital tumor of the heart which today is mostly diagnosed in early childhood using modern imaging devices. The course of a 46-year-old male who suffered from a pericardial effusion for the first time at the age of 13 is reported. During the subsequent three decades, the patient recurrently complained of chest pains. The final diagnosis was determined following surgical removal of the tumor and upon histological evaluation. The case reported here is unique because of clinical signs and symptoms of an intrapericardial teratoma documented in adolescence and adulthood over a period of 34 years.     

Large mediastinal teratoma originating from the aortic adventitia

Many mediastinal tumors do not cause local symptoms, so they are discovered incidentally upon thoracic imaging. We present the case of a patient who had a large, mature, cystic, mediastinal teratoma. The primary tumor arose from the ascending aortic adventitia and was in a highly unusual location-the medial mediastinum. The teratoma, which was diagnosed in our patient on thoracic computed tomography for follow-up evaluation of empyema, was resected completely. To our knowledge, such a teratoma, arising from the adventitia of the ascending aorta in the medial mediastinum, has not previously been reported in the English medical literature. We review diagnostic methods and therapeutic approaches to such mediastinal tumors. We conclude that surgical resection is the method of choice for treating these tumors, because it enables radical therapy and tissue diagnosis after extirpation.     

Intrapericardial Teratoma Presenting in Fetal Life: Intrauterine Diagnosis and Neonatal Management

Intrapericardial teratoma is a rare and often fatal germ‐cell tumor of neonates. It is usually histologically benign but may cause death in utero by hydrops fetalis or by pericardial tamponade in the early days of life. The etiology of these tumors is uncertain, but resection appears to be curative. However, these tumours present a challenge in terms of prenatal management. The prevention or adequate management of hydrops fetalis is essential for the gestation to proceed to term, at which point it can be managed successfully with surgical resection. We present a case of intrapericardial teratoma, diagnosed in utero on ultrasound screening and managed both prenatally by laser decompression in utero and surgically in the first days of life.     

A Rare Case of Primary Solid Intrarectal Dermoid

Primary rectal teratomas are rare and only few cases have been reported in the literature worldwide. These usually occur in females. These are usually cystic but very rarely solid variants may occur. We present a case of a solid intra-rectal dermoid arising primarily in rectum from postero-lateral wall. Excision biopsy was done per rectally. Histology revealed the presence of squamous epithelium, fat cells, hair follicles, cartilaginous material and columnar lining of glandular structures suggestive of mature teratoma. It is usually benign but may become malignant, therefore complete resection is advised.     

Recurrent Giant Hemangioma Causing Severe Respiratory Distress

Hemangioma is a common benign tumor of the liver that is usually asymptomatic. If >4 cm (giant hemangioma), it could present symptoms related to bleeding, thrombosis, comsumptive coagulopathy, or adjacent abdominal organ compression. If symptomatic surgical treatment should be considered, liver resection as well as enucleation are considered. Recurrences after surgical resection are rare. We herein present a case of woman admitted to the emergency room for acute severe respiratory distress. She had undergone 2 surgical resections of liver hemangiomas. The respiratory syndrome, as showed by chest x-ray, computed tomography scan, and nuclear magnetic resonance imaging, was related to a recurrent giant multiple hemangioma, creating a prominent compression of right lung with left mediastinal shift and left heart dislocation. It resulted in pulmonary parenchymal compression associated with reduced chest wall compliance and increased pulmonary pressure. The patient was not eligible for surgical treatment because of the disease extension and her clinical conditions. She died 6 months later from respiratory insufficiency and hypercapnic coma.     

Rapid growing huge teratoma: complete surgical resection

We report successful total resection of a huge mediastinal teratoma. An 11-year-old male underwent chest computed tomography that revealed a 14-cm mediastinal mass occupying the right thoracic cavity. The mass was successfully removed without any postoperative postoperative complication.     

Huge right ventricular mass revealing a testicular nonseminomatous germ cell tumor

Background

Cardiac intracavitary metastases from a testicular cancer are very unusual, and intra-cardiac metastasis is exceptionally the first expression of a noncardiac primary neoplasm. We report a case of a young patient for whom a cardiac symptom led to the diagnosis of a metastatic testicular cancer.

What could hemoptysis hide in an otherwise healthy child?

We describe a previously healthy 12-year-old boy who attended our Department after a sudden episode of hemoptysis and recurrent consolidation. CT-scan revealed a mediastinal tumor. The biopsy specimens taken from the mass showed a mature teratoma. Hemoptysis is an unusual presenting symptom in an otherwise healthy child with a well capsulated, unruptured mature mediastinal teratoma. In this report, hemoptysis prompted us to undertake the diagnostic work-up that eventually disclosed the tumor.     

Primary sarcoma of the pulmonary trunk: successful surgical intervention and prolonged survival

We present a rare case of pulmonary trunk sarcoma in a young male in which the diagnosis was made antemortem. Total surgical removal of the tumor, including replacement of the pulmonary valve, was undertaken. This patient is the longest reported survivor of pulmonary trunk sarcoma and remains free of any signs or symptoms of recurrence. No adjuvant chemotherapy was required.     

Aggressive surgical resection for hepatocellular carcinoma with tumor thrombus extending to inferior vena cava and synchronous pulmonary metastasis

We describe a 66-year-old man having hepatocellular carcinoma with tumor thrombus extending into the inferior vena cava and synchronous pulmonary metastasis. He was referred to Chiba University Hospital on May, 2000, complaining of emaciation. Radiological findings showed a huge hepatocellular carcinoma in the entire right lobe and tumor thrombus extended into the intrapericardial inferior vena cava. He also had a solitary pulmonary metastasis in the left pulmonary lobe (stage IVB). Right hemihepatomy was performed under total hepatic vascular exclusion without cardiopulmonary bypass, and tumor thrombus was completely removed. Thoracoscopic wedge resection of pulmonary metastasis was also performed. The patient had an uneventful postoperative course. Histopathological examination revealed that the tumor was moderately differentiated hepatocellular carcinoma The patient is still alive after 26 months with pulmonary recurrence, but without hepatic recurrence. To our knowledge, there has been no reported case of resection for both hepatocellular carcinoma invading the inferior vena cava and synchronous pulmonary metastasis. In conclusion, aggressive surgical resection for advanced hepatocellular carcinoma concomitant with pulmonary resection may bring about better prognosis in highly selected patients.     

Carcinoid heart disease from ovarian primary presenting with acute pericarditis and biventricular failure

A case is described of a 54 year old woman who had acute pericarditis with large exudative effusion accompanied by severe right and left ventricular failure. The patient was finally diagnosed with carcinoid heart disease from an ovarian carcinoid teratoma. She was treated with octreotide--a somatostatin analogue--followed by radical surgical resection of the neoplasm. At one year follow up only mild carcinoid tricuspid regurgitation remained. Only 16 cases of carcinoid heart disease from an ovarian primary have been described in literature. Moreover clinically manifest acute, nonmetastatic pericarditis and left heart failure are not considered as possible presentations of carcinoid heart disease, whatever the origin. In a recent series a small pericardial effusion was considered an infrequent and unexpected echocardiographic finding in carcinoid heart patients. One case of "carcinoid pericarditis" has previously been described as a consequence of pericardial metastasis. Left sided heart involvement is usually caused by bronchial carcinoids or patency of foramen ovale; both were excluded in the case presented.