DNA content and expression of tumour markers in germ cells adjacent to germ cell tumours in childhood: Probably A different origin for infantile and adolescent germ cell tumours

The origin of testicular germ cell tumours occurring during childhood is poorly understood. In adults, the classical seminomas and non-seminomas originate from carcinoma in situ of the testis, which can usually also be detected in seminiferous tubules adjacent to the tumours. In order to contribute with information regarding a possible association between carcinoma in situ and the childhood group of germ cell tumours, we investigated seminiferous tubules adjacent to 13 infantile yolk sac tumours, five infantile teratomas, and six adolescent germ cell tumours of various types, using morphological evaluation, immunohistochemical staining with markers for carcinoma in situ cells, and densitometric DNA measurement of the germ cells. We detected clear differences between the germ cell populations adjacent to adolescent and infantile germ cell tumours. The former were associated with both normal germ cells and carcinoma in situ cells. The presence of carcinoma in situ cells strongly suggested that the adolescent tumours arose from carcinoma in situ cells, like germ cell tumours occurring in adult men. Although we were in doubt in two cases, the infantile germ cell tumours were in general not associated with carcinoma in situ cells. The aetiology of infantile yolk sac tumours and teratomas may therefore be fundamentally different from that of adolescent and adult germ cell tumours. The origin of yolk sac tumours and teratomas remains to be elucidated.     

Diffusion-weighted echo-planar MR imaging and ADC mapping in the differential diagnosis of ovarian cystic masses: usefulness of detecting keratinoid substances in mature cystic teratomas

PURPOSE: To elucidate whether apparent diffusion coefficient (ADC) values calculated from echo-planar diffusion-weighted MR imaging (EPDWI) are useful in the differential diagnosis of ovarian cystic masses. MATERIALS AND METHODS: EPDWI was performed in 131 patients with ovarian cystic masses (54 mature cystic teratomas, 35 endometrial cysts, four other benign cysts, 14 benign neoplasms, and 24 malignant neoplasms). The areas of the highest signal intensity on EPDWI (b = 1000 seconds/mm(2)) and the lowest ADC values within the cystic component were evaluated. RESULTS: On qualitative and quantitative analyses, mature cystic teratomas tended to show higher signal intensity and had areas of lower ADC values than endometrial cysts and other benign and malignant neoplasms (P < .005). In vitro scanning of the cystic contents of mature cystic teratomas confirmed that high signal on DWI or low ADC value was attributable to the keratinoid substance within the tumors. The difference in ADC between malignant and benign lesions were significant when mature cystic teratomas and endometrial cysts were included, but was not significant when they were excluded. CONCLUSION: The ADC value may add useful information to the differential diagnosis of ovarian cystic masses in limited populations, such as those with mature cystic teratomas with a small amount of fat.     

Pelvic neoplasms in children

The pelvis of the infant and child has different anatomic relationships than the adolescent or adult pelvis, and the knowledge of congenital anomalies of the rectum and bladder can assist in treating the primary neoplasms of the pelvis. The most common neoplasms are rhabdomyosarcomas of the bladder, prostate, and vagina; sacrococcygeal teratoma; and the germ cell tumors, including teratomas, endodermal sinus tumors, and the choriocarcinomas. Rapidly improving chemotherapy for all of these lesions has resulted in a changed role for the surgeon. Less radical resection of these tumors is being performed whereas it is necessary to have more precise histologic and genetic identification of the tumor and the specific anatomic location and extent of the tumor in the pelvis. Survival for all types of childhood pelvic neoplasms has improved dramatically under the influence of the combined children's cancer study groups, which have been functioning for the last 20 years. Because of the complexities of diagnosis and treatment of these pelvic neoplasms in childhood and because the survival rates have dramatically improved with the most current therapy, these children should be cared for in a children's center that is part of the major children's cancer study groups.     

Ultrasonography of mediastinal teratoma

We have studied real-time sonograms of 11 surgically proven benign mediastinal teratomas. Eight cystic teratomas were sonographically visualized as various kinds of masses: four complex, two solid, and two cystic. The echo patterns of cystic teratomas were determined by the serous or nonserous nature of the cysts. In the presence of serous fluid, the tumor was visualized as a cystic mass. If, on the other hand, the cyst of the tumor was nonserous or was sebaceous, it appeared as a solid or complex tumor. The remaining three solid teratomas, which had some small cysts, appeared as complex tumors.     

Cervical Spine Dysraphism with Teratoma Exhibiting Pulmonary Differentiation: Case Report and Review of the Literature

Spinal dysraphism and teratomas are well-recognized spinal cord lesions, but both entities are rare in the cervical spinal cord. Rarely, teratomas have been described within dysraphic lesions in the thoracic and lumbosacral regions. To date, teratomas contained within cervical spine dysraphic lesions have not been described. Although mature cystic teratomas are renowned for the array of organoid tissue differentiation they display, mature lung differentiation is a rarity. While pulmonary differentiation has been described in six female genital tract teratomas, it has not been reported in spinal teratomas. The clinicopathologic features of a complex cervical lesion, comprising a combination of cervical spine dysraphism with a mature cystic teratoma that exhibited pulmonary differentiation, is presented, and the literature on teratomas exhibiting pulmonary differentiation is reviewed. Received February 21, 1997; accepted December 8, 1997.     

Management of nasopharyngeal teratomas associated with cleft palate

Nasopharyngeal teratomas are rare tumours, responsible for a high birth mortality rate from acute respiratory distress. Palatine localization can lead to an embryopathogenic mechanical obstacle responsible for a cleft palate. The aim of this study was to update current knowledge concerning the management of this rare pathological association.We conducted a multicentre, retrospective study by case analysis. The inclusion criteria were patients of any age under care for a nasopharyngeal teratoma associated with a velopalatine cleft. The diagnosis of the teratoma was confirmed by histological analysis.Seven cases were included in the study: three cases from the University Hospital of Lille, one from the University Hospital of Caen, one from of the University Hospital of Toulouse, and two from of the University Hospital of Amiens. Approximately 30% of patients experienced acute respiratory distress at birth, necessitating oro- or nasotracheal intubation. The surgical excision was performed in the first 5 months of life for all patients and in a single operative time for 70%. There was no recurrence.Therapeutic management of nasopharyngeal teratomas associated with cleft palate at birth is multidisciplinary and is based on surgical excision. In the absence of other associated pathologies, the prognosis is favourable.     

Oesophageal Hiatus Hernia:Follow-up Studies after Surgical Correction

The purpose of these studies was to examine the experience of the surgical correction of oesophageal hiatus hernia at the University Hospital (Landspitalinn), Reykjavik. It contains a detailed review of 45 patients operated on during a 15-year period with variable techniques and two main approaches, the transthoracic and the transabdominal. The operative techniques are analysed and operated co-existing diseases are listed. The primary mortality was 2.2%. There is a detailed follow-up of 38 patients. They were all interviewed for clinical results and all underwent barium-meal radiological examinations. The clinical successes of the operations numbered 36 out of 38 patients, or 94.8%. The radiological recurrence as estimated by recurrence of the hernia, reflux, or both, was 28.9%. The recurrence hernias were on the average smaller than the original hernias. Better results are shown by transthoracic as compared with transabdominal approach. Comparisons are made with other reported series.     

性腺外畸胎瘤172例临床病理分析

目的 探讨性腺外畸胎瘤临床病理特征。方法 参照WHO（1999）卵巢肿瘤组织学分型标准对172例手术切除的性腺外畸胎瘤的临床和病理特征进行回顾性研究。结果 172例性腺外畸胎瘤患者男性85例（49．4％），女性87例（50．6％），男女之比约为1：1；35岁以下患者131例（76．2％）；肿瘤主要发生在身体中线部位，频率依次为纵隔、椎管内、颅内、骶尾部、腹膜后、肠系膜及下腹部等。172例畸胎瘤中18例（10．5％）为恶性，其患者男女之比为1．6：1；发生频率依次为颅内、纵隔、骶尾部、椎管内、肝、腹膜后、下腹部。18例恶性畸胎瘤中7例为完全由胚胎性组织构成的未成熟性畸胎瘤，另11例为成熟性或未成熟性畸胎瘤合并其他类型生殖细胞肿瘤或伴有腺癌等恶性成分。结论 性腺外畸胎瘤有以下特点：①多发生在身体中线两旁；②好发于小儿、青年，男性患者恶性率高于女性；③恶性率较高，尤以颅内畸胎瘤恶性多见；④未成熟性畸胎瘤多合并其他生殖细胞瘤成分；⑤可能有不同于性腺畸胎瘤的发生机制。