Teratoma natural history: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
No edit summary
 
(12 intermediate revisions by 5 users not shown)
Line 1: Line 1:
{{CMG}}__NOTOC__
__NOTOC__
{{Teratoma}}
{{Teratoma}}
{{CMG}}; {{AE}} {{G.D.}}


==Overview==
==Overview==
The prognosis of teratoma depends on the type of tumor and malignant transformation. Mature teratoma is begnin and has an excellent prognosis compared to immature teratoma which has a favorable prognosis.The 6 year survival rate of patients with mature teratoma is approximately 96%. The overall 5 years survival rate of patient with immature teratoma is 90% and 75% for stage II-IV.Common complications are malignant transformation, rupture, torsion, and hemolytic anemia.
==Natural History, Complications, and Prognosis==


==Natural history==
===Natural History===
 
*The symptoms of teratoma depends on the locations of the tumors.
{{main|Germ cell tumor}}
 
Teratomas belong to a class of tumors known as [[nonseminoma]]tous [[germ cell tumor]] (NSGCT).  All tumors of this class are the result of abnormal development of [[pluripotent]] cells: [[germ cell]]s and [[embryo|embryonal cells]]. Teratomas of embryonal origin are [[congenital disorder|congenital]]; teratomas of germ cell origin may or may not be congenital (this is not known). The kind of pluripotent cell appears to be unimportant, apart from constraining the location of the teratoma in the body.
 
===Location and incidence===
[[Image:teratoma_back.jpg|thumb|left|Mature cystic teratoma of ovary (benign) Courtesy of Ed Uthman, MD]]
 
Teratomas derived from germ cells occur in the [[testes]] in males and [[ovary|ovaries]] in females. Teratomas derived from embryonal cells usually occur on the body midline: in the brain, elsewhere inside the [[skull]], in the nose, in the tongue, under the tongue, and in the [[neck]] (cervical teratoma), [[mediastinum]], [[retroperitoneum]], and attached to the [[coccyx]].  However, teratomas may also occur elsewhere: very rarely in solid organs (most notably the heart and liver) and hollow organs (such as the stomach and bladder), and more commonly on the [[cranial sutures|skull sutures]]. Embryonal teratomas most commonly occur in the sacrococcygeal region: [[sacrococcygeal teratoma]] is the single most common tumor found in [[Infant|newborn babies]].
 
Of teratomas on the skull sutures, approximately 50% are found in or adjacent to the [[orbit (anatomy)|orbit]]<ref>[http://www.emedicine.com/oph/topic620.htm Emedicine article on orbital dermoid cyst]</ref>.  '''Limbal dermoid''' is a '''choristoma''', not a teratoma.


Teratoma qualifies as a [[rare disease]], but is not extremely rare.  Sacrococcygeal teratoma alone is diagnosed at birth in 1 out of 40,000 babies.  Given the current [[world population]] [[birth rate]], this equals 5 per day or 1800 per year.  Add to that number sacrococcygeal teratomas diagnosed later in life, and teratomas in other locations, and the [[Incidence (epidemiology)|incidence]] approaches 10,000 new diagnoses of teratoma per year.


===Hypotheses of origin===
===Complications===
*Common complications of teratoma specially ovarian teratoma include:<ref name="pmid18635624">{{cite journal| author=Park SB, Kim JK, Kim KR, Cho KS| title=Imaging findings of complications and unusual manifestations of ovarian teratomas. | journal=Radiographics | year= 2008 | volume= 28 | issue= 4 | pages= 969-83 | pmid=18635624 | doi=10.1148/rg.284075069 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18635624  }} </ref><ref name="pmid8008317">Comerci JT, Licciardi F, Bergh PA, Gregori C, Breen JL (1994) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8008317 Mature cystic teratoma: a clinicopathologic evaluation of 517 cases and review of the literature.] ''Obstet Gynecol'' 84 (1):22-8. PMID: [https://pubmed.gov/8008317 8008317]</ref><ref name="pmid2841767">{{cite journal| author=Singh P, Yordan EL, Wilbanks GD, Miller AW, Wee A| title=Malignancy associated with benign cystic teratomas (dermoid cysts) of the ovary. | journal=Singapore Med J | year= 1988 | volume= 29 | issue= 1 | pages= 30-4 | pmid=2841767 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2841767  }} </ref>
**Torsion
**Rupture
**Malignant transformation
**Infections
**Autoimmune hemolytic anemia


Concerning the origin of teratomas, there exist numerous hypotheses.<ref name="Gonzalez-Crussi1982">Gonzalez-Crussi, F. (1982) Extragonadal Teratomas.  Atlas of Tumor Pathology, Second Series, Fascicle 18.  Armed Forces Institute of Pathology, Washington D.C.</ref>  These hypotheses are not to be confused with the unrelated hypothesis that [[fetus in fetu]] (see below) is not a teratoma at all but rather a [[parasitic twin]].
===Prognosis===
 
*Mature teratoma has an excellent prognosis.<ref name="pmid25631333">{{cite journal| author=Terenziani M, D'Angelo P, Inserra A, Boldrini R, Bisogno G, Babbo GL et al.| title=Mature and immature teratoma: A report from the second Italian pediatric study. | journal=Pediatr Blood Cancer | year= 2015 | volume= 62 | issue= 7 | pages= 1202-8 | pmid=25631333 | doi=10.1002/pbc.25423 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25631333  }} </ref>
=== Dermoid cyst ===
*The 6 year survival rate of patients with mature teratoma is approximately 96%.<ref name="pmid9607423">{{cite journal| author=Göbel U, Calaminus G, Engert J, Kaatsch P, Gadner H, Bökkerink JP et al.| title=Teratomas in infancy and childhood. | journal=Med Pediatr Oncol | year= 1998 | volume= 31 | issue= 1 | pages= 8-15 | pmid=9607423 | doi=10.1002/(sici)1096-911x(199807)31:1<8::aid-mpo2>3.0.co;2-h | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9607423  }} </ref>
A [[dermoid cyst]] is a mature teratoma containing hair (sometimes very abundant) and other structures characteristic of normal skin and other tissues derived from the ectoderm. The term is most often applied to teratoma on the skull sutures and in the ovaries of females.
*Immature teratoma has favorable prognosis for stage I and poor for advance stages.<ref name="pmid18541896">Mann JR, Gray ES, Thornton C, Raafat F, Robinson K, Collins GS et al. (2008) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18541896 Mature and immature extracranial teratomas in children: the UK Children's Cancer Study Group Experience.] ''J Clin Oncol'' 26 (21):3590-7. [http://dx.doi.org/10.1200/JCO.2008.16.0622 DOI:10.1200/JCO.2008.16.0622] PMID: [https://pubmed.gov/18541896 18541896]</ref>
 
*Immature teratoma has 90%-95% of 5 years of survival rate for stage I and 75 % for stage II-IV.<ref name="pmid18541896">Mann JR, Gray ES, Thornton C, Raafat F, Robinson K, Collins GS et al. (2008) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18541896 Mature and immature extracranial teratomas in children: the UK Children's Cancer Study Group Experience.] ''J Clin Oncol'' 26 (21):3590-7. [http://dx.doi.org/10.1200/JCO.2008.16.0622 DOI:10.1200/JCO.2008.16.0622] PMID: [https://pubmed.gov/18541896 18541896]</ref>
=== Fetus in fetu and fetiform teratoma===
'''Fetus in fetu''' and '''fetiform teratoma''' are rare forms of mature teratoma that include one or more components resembling a malformed fetus.  Both forms may contain or appear to contain complete organ systems, even major body parts such as torso or limbs.  Fetus in fetu differs from fetiform teratoma in having an apparent [[vertebral column|spine]] and bilateral symmetry.<ref name="Gonzalez-Crussi1982"/>
 
Most authorities agree that fetiform teratomas are highly developed mature teratomas;  the natural history of fetus in fetu, however, is controversial.<ref name="Gonzalez-Crussi1982"/>  There also may be a cultural difference, with fetiform teratoma being reported more often in ovarian teratomas (by gynecologists) and fetus in fetu being reported more often in retroperitoneal teratomas (by general surgeons).  [[Fetus in fetu]] has often been interpreted as a [[fetus]] growing within its [[twin]].  As such, this interpretation assumes a special complication of [[twin]]ning, one of several grouped under the term [[parasitic twin]]. In this regard, it is noteworthy that in many cases the fetus in fetu is reported to occupy a fluid-filled cyst within a mature teratoma.<ref>Saito K, Katsumata Y, Hirabuki T, Kato K, Yamanaka M.  Fetus-in-fetu: Parasite or Neoplasm? A Study of Two Cases. Fetal Diagn Ther. 2007 Jun 5;22(5):383-388</ref><ref>Kajbafzadeh AM, Baharnoori M.  Fetus in fetu.  Can J Urol. 2006 Oct;13(5):3277-8.</ref><ref>Chua JH, Chui CH, Sai Prasad TR, Jabcobsen AS, Meenakshi A, Hwang WS. Fetus-in-fetu in the pelvis: report of a case and literature review. Ann Acad Med Singapore. 2005 Nov;34(10):646-9. [http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=16382253 PubMed abstract and free full text PDF]</ref> Cysts within mature teratoma have also been reported to contain a rudimentary beating heart.<ref>{{cite journal
|author=Kazez A, Ozercan IH, Erol FS, Faik Ozveren M, Parmaksiz E
|title=Sacrococcygeal heart: a very rare differentiation in teratoma.
|journal=European journal of pediatric surgery (Zeitschrift für Kinderchirurgie)
|volume=12
|issue=4
|pages=278-80
|year=2002
|pmid=12369008
|doi=10.1055/s-2002-34483
|issn=
}}{{PMID|12369008}}</ref>
 
Regardless of whether fetus in fetu and fetiform teratoma are one entity or two, they are distinct from and not to be confused with [[ectopic pregnancy]].
 
=== Struma ovarii ===
A '''struma ovarii''' (literally: [[goitre]] of the ovary) is a rare form of mature teratoma that contains mostly [[thyroid]] tissue. Despite its name, struma ovarii is not restricted to the ovary. Only 5% of struma ovarii are malignant.
 
==Complications==
 
Teratomas are not dangerous for the fetus unless there is either a [[mass effect (medicine)|mass effect]] or a large amount of blood flow through the tumor (known as ''vascular steal''). The mass effect frequently consists of obstruction of normal passage of fluids from surrounding organs. The vascular steal can place a strain on the growing heart of the fetus, even resulting in heart failure, and thus must be monitored by fetal [[echocardiography]].
 
After surgery, there is a risk of regrowth in place, or in nearby organs.<ref>[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=14532748 ''A recurred case of a mature ovarian teratoma presenting as a rectal mass'' (in Korean, abstract in English)]</ref>
 
==Prognosis==
The prognosis of teratoma depends on the following:
 
:*Whether or not the tumor can be removed by surgery.
:*The size and location of the tumor
:*The patient’s general health


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
{{WH}}
{{WS}}


[[Category:Disease]]
[[Category:Disease]]
Line 71: Line 40:
[[Category:Pathology]]
[[Category:Pathology]]
[[Category:Surgery]]
[[Category:Surgery]]
[[Category:Oncology]]
[[Category:Types of cancer]]
[[Category:Types of cancer]]
[[Category:Rare diseases]]
[[Category:Rare diseases]]
[[Category:Pediatric cancers]]
[[Category:Pediatric cancers]]
[[Category:Endocrinology]]
[[Category:Endocrinology]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]

Latest revision as of 20:35, 25 November 2019

Teratoma Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Teratoma from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Staging

Laboratory Findings

Chest X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Teratoma natural history On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Teratoma natural history

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Teratoma natural history

CDC on Teratoma natural history

Teratoma natural history in the news

Blogs on Teratoma natural history

Directions to Hospitals Treating Teratoma

Risk calculators and risk factors for Teratoma natural history

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Gertrude Djouka, M.D.[2]

Overview

The prognosis of teratoma depends on the type of tumor and malignant transformation. Mature teratoma is begnin and has an excellent prognosis compared to immature teratoma which has a favorable prognosis.The 6 year survival rate of patients with mature teratoma is approximately 96%. The overall 5 years survival rate of patient with immature teratoma is 90% and 75% for stage II-IV.Common complications are malignant transformation, rupture, torsion, and hemolytic anemia.

Natural History, Complications, and Prognosis

Natural History

  • The symptoms of teratoma depends on the locations of the tumors.


Complications

  • Common complications of teratoma specially ovarian teratoma include:[1][2][3]
    • Torsion
    • Rupture
    • Malignant transformation
    • Infections
    • Autoimmune hemolytic anemia

Prognosis

  • Mature teratoma has an excellent prognosis.[4]
  • The 6 year survival rate of patients with mature teratoma is approximately 96%.[5]
  • Immature teratoma has favorable prognosis for stage I and poor for advance stages.[6]
  • Immature teratoma has 90%-95% of 5 years of survival rate for stage I and 75 % for stage II-IV.[6]

References

  1. ↑ Park SB, Kim JK, Kim KR, Cho KS (2008). "Imaging findings of complications and unusual manifestations of ovarian teratomas". Radiographics. 28 (4): 969–83. doi:10.1148/rg.284075069. PMID 18635624.
  2. ↑ Comerci JT, Licciardi F, Bergh PA, Gregori C, Breen JL (1994) Mature cystic teratoma: a clinicopathologic evaluation of 517 cases and review of the literature. Obstet Gynecol 84 (1):22-8. PMID: 8008317
  3. ↑ Singh P, Yordan EL, Wilbanks GD, Miller AW, Wee A (1988). "Malignancy associated with benign cystic teratomas (dermoid cysts) of the ovary". Singapore Med J. 29 (1): 30–4. PMID 2841767.
  4. ↑ Terenziani M, D'Angelo P, Inserra A, Boldrini R, Bisogno G, Babbo GL; et al. (2015). "Mature and immature teratoma: A report from the second Italian pediatric study". Pediatr Blood Cancer. 62 (7): 1202–8. doi:10.1002/pbc.25423. PMID 25631333.
  5. ↑ Göbel U, Calaminus G, Engert J, Kaatsch P, Gadner H, Bökkerink JP; et al. (1998). "Teratomas in infancy and childhood". Med Pediatr Oncol. 31 (1): 8–15. doi:10.1002/(sici)1096-911x(199807)31:1<8::aid-mpo2>3.0.co;2-h. PMID 9607423.
  6. ↑ 6.0 6.1 Mann JR, Gray ES, Thornton C, Raafat F, Robinson K, Collins GS et al. (2008) Mature and immature extracranial teratomas in children: the UK Children's Cancer Study Group Experience. J Clin Oncol 26 (21):3590-7. DOI:10.1200/JCO.2008.16.0622 PMID: 18541896

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Teratoma_natural_history&oldid=1590271"