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{{CMG}}__NOTOC__
__NOTOC__
{{Teratoma}}
{{Teratoma}}


{{CMG}}; {{AE}} {{G.D.}}
==Overview==
==Overview==
The histopathology of teratoma depends on the histological subtype.Teratoma is a germ cell tumor due to abnormal development of pluripotent cells and renmant of primitive node.


==Pathophysiology==
==Pathophysiology==
{{familytree/start |summary=Sample 1}}
{{familytree | | | | | | | | A01 |A01=[[Germ cell]]}}
{{familytree | | | | |,|-|-|-|^|-|-|-|-|.| | | }}
{{familytree | | | B01 | | | | | | | | B02 | | |B01=[[Pathogenesis]]|B02=[[Malignant transformation]]}}
{{familytree | | | |!| | | | | | | | | |!| }}
{{familytree | | | C01 | | | | | | | | |!| |C01=[[Mature teratoma]]}}
{{familytree | | | | | | | | | | | | | |!}}
{{familytree | | | | | | | | | |,|-|-|-|+|-|-|-|.| }}
{{familytree | | | | | | | |  | | E02 |  | |E02=[[Tumors]] with primitive [[embryonic]] [[ectoderm]], [[mesoderm]], and/or [[endoderm]] differentiation| }}
{{familytree | | | | | | | | | |!| | | |!| | |  | }}
{{familytree | | | | | | | | | | |||F02 | |F02=Immature [[teratoma]]}}
{{familytree/end}}
===Pathogenesis===
*Mature teratoma arises from a pathological transformation of primordial germ cell during the develompment.<ref name="VuralVural2015">{{cite journal|last1=Vural|first1=F.|last2=Vural|first2=B.|last3=Paksoy|first3=N.|title=Vaginal teratoma: A case report and review of the literature|journal=Journal of Obstetrics and Gynaecology|volume=35|issue=7|year=2015|pages=757–758|issn=0144-3615|doi=10.3109/01443615.2015.1004525}}</ref><ref name="El-MaarriRijlaarsdam2015">{{cite journal|last1=El-Maarri|first1=Osman|last2=Rijlaarsdam|first2=Martin A.|last3=Tax|first3=David M. J.|last4=Gillis|first4=Ad J. M.|last5=Dorssers|first5=Lambert C. J.|last6=Koestler|first6=Devin C.|last7=de Ridder|first7=Jeroen|last8=Looijenga|first8=Leendert H. J.|title=Genome Wide DNA Methylation Profiles Provide Clues to the Origin and Pathogenesis of Germ Cell Tumors|journal=PLOS ONE|volume=10|issue=4|year=2015|pages=e0122146|issn=1932-6203|doi=10.1371/journal.pone.0122146}}</ref>
*Mature teratoma comes from a single germ cell tumor after first phase of meiosis and failure of meiosis type II.<ref name="LinderMcCaw1975">{{cite journal|last1=Linder|first1=David|last2=McCaw|first2=Barbara Kaiser|last3=Hecht|first3=Frederick|title=Parthenogenic Origin of Benign Ovarian Teratomas|journal=New England Journal of Medicine|volume=292|issue=2|year=1975|pages=63–66|issn=0028-4793|doi=10.1056/NEJM197501092920202}}</ref><ref name="pmid2220805">{{cite journal| author=Surti U, Hoffner L, Chakravarti A, Ferrell RE| title=Genetics and biology of human ovarian teratomas. I. Cytogenetic analysis and mechanism of origin. | journal=Am J Hum Genet | year= 1990 | volume= 47 | issue= 4 | pages= 635-43 | pmid=2220805 | doi= | pmc=1683780 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2220805  }} </ref><ref name="pmid14614249">{{cite journal| author=Caspi B, Lerner-Geva L, Dahan M, Chetrit A, Modan B, Hagay Z et al.| title=A possible genetic factor in the pathogenesis of ovarian dermoid cysts. | journal=Gynecol Obstet Invest | year= 2003 | volume= 56 | issue= 4 | pages= 203-6 | pmid=14614249 | doi=10.1159/000074755 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14614249  }} </ref>
*Mature teratoma contains a well differentiated tumor with all three germ layers (ectoderm, mesoderm and endoderm).<ref name="El-MaarriRijlaarsdam2015">{{cite journal|last1=El-Maarri|first1=Osman|last2=Rijlaarsdam|first2=Martin A.|last3=Tax|first3=David M. J.|last4=Gillis|first4=Ad J. M.|last5=Dorssers|first5=Lambert C. J.|last6=Koestler|first6=Devin C.|last7=de Ridder|first7=Jeroen|last8=Looijenga|first8=Leendert H. J.|title=Genome Wide DNA Methylation Profiles Provide Clues to the Origin and Pathogenesis of Germ Cell Tumors|journal=PLOS ONE|volume=10|issue=4|year=2015|pages=e0122146|issn=1932-6203|doi=10.1371/journal.pone.0122146}}</ref>
*Mature teratoma may be located in the embryonic fusion midline or paraxial, mediastinum, ovary, retroperitoneum, and sacrococcygeal.<ref name="pmid8008317">{{cite journal| author=Comerci JT, Licciardi F, Bergh PA, Gregori C, Breen JL| title=Mature cystic teratoma: a clinicopathologic evaluation of 517 cases and review of the literature. | journal=Obstet Gynecol | year= 1994 | volume= 84 | issue= 1 | pages= 22-8 | pmid=8008317 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8008317  }} </ref>
*Immature teratoma may be due to the malignant tranformation of primitive germ cell layers and renmant of primive node.<ref name="pmid29798962">{{cite journal| author=Varma AV, Malpani G, Agrawal P, Malukani K, Dosi S| title=Clinicopathological spectrum of teratomas: An 8-year retrospective study from a tertiary care institute. | journal=Indian J Cancer | year= 2017 | volume= 54 | issue= 3 | pages= 576-579 | pmid=29798962 | doi=10.4103/ijc.IJC_294_17 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29798962  }} </ref><ref name="pmid21949666">{{cite journal| author=Keene DJ, Craigie RJ, Shabani A, Batra G, Hennayake S| title=Bipartite anterior extraperitoneal teratoma: evidence for the embryological origins of teratomas? | journal=Case Rep Med | year= 2011 | volume= 2011 | issue=  | pages= 208940 | pmid=21949666 | doi=10.1155/2011/208940 | pmc=3163403 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21949666  }} </ref>
==Genetics==
Genes involved in the pathogenesis of teratoma include:<ref name="pmid10850452">Kraggerud SM, Szymanska J, Abeler VM, Kaern J, Eknaes M, Heim S et al. (2000) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10850452 DNA copy number changes in malignant ovarian germ cell tumors.] ''Cancer Res'' 60 (11):3025-30. PMID: [https://pubmed.gov/10850452 10850452]</ref>
*Gain of part or all chromosomes
**1p
**16p
**19
**22q
==Immunohistochemistry==
*Neuronal element found in mature or immature teratoma are positive for:<ref name="pmid16306792">{{cite journal| author=Yoshikata R, Yamamoto T, Kobayashi M, Ota H| title=Immunohistochemical characteristics of mature ovarian cystic teratomas in patients with postoperative recurrence. | journal=Int J Gynecol Pathol | year= 2006 | volume= 25 | issue= 1 | pages= 95-100 | pmid=16306792 | doi=10.1097/01.pgp.0000172082.17805.6c | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16306792  }} </ref><ref name="TakayamaMatsumura2015">{{cite journal|last1=Takayama|first1=Yoshiyasu|last2=Matsumura|first2=Nozomi|last3=Nobusawa|first3=Sumihito|last4=Ikota|first4=Hayato|last5=Minegishi|first5=Takashi|last6=Yokoo|first6=Hideaki|title=Immunophenotypic features of immaturity of neural elements in ovarian teratoma|journal=Virchows Archiv|volume=468|issue=3|year=2015|pages=337–343|issn=0945-6317|doi=10.1007/s00428-015-1891-8}}</ref>
** [[Glial fibrillary acidic protein]] (GFAP)
** Neuron specific enolase (NSE)
** [[S-100 protein|S-100]]
*Carcinoid tumor found in the monodermal teratoma may be positive for:<ref name="OutwaterSiegelman2001">{{cite journal|last1=Outwater|first1=Eric K.|last2=Siegelman|first2=Evan S.|last3=Hunt|first3=Jennifer L.|title=Ovarian Teratomas: Tumor Types and Imaging Characteristics|journal=RadioGraphics|volume=21|issue=2|year=2001|pages=475–490|issn=0271-5333|doi=10.1148/radiographics.21.2.g01mr09475}}</ref>
** Serotonin and peptides hormones.
==Associated conditions==
Conditions associated with teratoma include:
*Anti-NMDA receptor encephalitis<ref name="pmid29245365">Liang Z, Yang S, Sun X, Li B, Li W, Liu Z et al. (2017) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=29245365 Teratoma-associated anti-NMDAR encephalitis: Two cases report and literature review.] ''Medicine (Baltimore)'' 96 (49):e9177. [http://dx.doi.org/10.1097/MD.0000000000009177 DOI:10.1097/MD.0000000000009177] PMID: [https://pubmed.gov/29245365 29245365]</ref><ref name="DalmauGleichman2008">{{cite journal|last1=Dalmau|first1=Josep|last2=Gleichman|first2=Amy J|last3=Hughes|first3=Ethan G|last4=Rossi|first4=Jeffrey E|last5=Peng|first5=Xiaoyu|last6=Lai|first6=Meizan|last7=Dessain|first7=Scott K|last8=Rosenfeld|first8=Myrna R|last9=Balice-Gordon|first9=Rita|last10=Lynch|first10=David R|title=Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies|journal=The Lancet Neurology|volume=7|issue=12|year=2008|pages=1091–1098|issn=14744422|doi=10.1016/S1474-4422(08)70224-2}}</ref><ref name="MalayevAlberts2015">{{cite journal|last1=Malayev|first1=Yuliya|last2=Alberts|first2=Jared|last3=Verardi|first3=Mary Ann|last4=Mattison|first4=Anissa R.|last5=Imlay|first5=Sherwin|title=Immature Teratoma Associated With Anti–N-Methyl-D-Aspartate Receptor Encephalitis|journal=The Journal of the American Osteopathic Association|volume=115|issue=9|year=2015|pages=573|issn=0098-6151|doi=10.7556/jaoa.2015.116}}</ref>
==Gross and microscopy pathology==
The gross and microscopy features of teratoma are described below:<ref name="Yayla AbideBostancı Ergen2018">{{cite journal|last1=Yayla Abide|first1=Çiğdem|last2=Bostancı Ergen|first2=Evrim|title=Retrospective analysis of mature cystic teratomas in a single center and review of the literature|journal=Journal of Turkish Society of Obstetric and Gynecology|volume=15|issue=2|year=2018|pages=95–98|issn=1307699X|doi=10.4274/tjod.86244}}</ref><ref name="OutwaterSiegelman2001">{{cite journal|last1=Outwater|first1=Eric K.|last2=Siegelman|first2=Evan S.|last3=Hunt|first3=Jennifer L.|title=Ovarian Teratomas: Tumor Types and Imaging Characteristics|journal=RadioGraphics|volume=21|issue=2|year=2001|pages=475–490|issn=0271-5333|doi=10.1148/radiographics.21.2.g01mr09475}}</ref><ref name="Ulbright2005">{{cite journal|last1=Ulbright|first1=Thomas M|title=Germ cell tumors of the gonads: a selective review emphasizing problems in differential diagnosis, newly appreciated, and controversial issues|journal=Modern Pathology|volume=18|issue=S2|year=2005|pages=S61–S79|issn=0893-3952|doi=10.1038/modpathol.3800310}}</ref><ref name="pmid29798962">{{cite journal| author=Varma AV, Malpani G, Agrawal P, Malukani K, Dosi S| title=Clinicopathological spectrum of teratomas: An 8-year retrospective study from a tertiary care institute. | journal=Indian J Cancer | year= 2017 | volume= 54 | issue= 3 | pages= 576-579 | pmid=29798962 | doi=10.4103/ijc.IJC_294_17 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29798962  }} </ref><ref name="pmid12432104">{{cite journal| author=Jung SE, Lee JM, Rha SE, Byun JY, Jung JI, Hahn ST| title=CT and MR imaging of ovarian tumors with emphasis on differential diagnosis. | journal=Radiographics | year= 2002 | volume= 22 | issue= 6 | pages= 1305-25 | pmid=12432104 | doi=10.1148/rg.226025033 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12432104  }} </ref><ref name="pmid26379326">{{cite journal| author=da Silva TK, Ribeiro GJ, Scortegagna FA, Zanetti G, Marchiori E| title=Teratoma: a set of teeth in the pelvis. | journal=Radiol Bras | year= 2015 | volume= 48 | issue= 4 | pages= 263-4 | pmid=26379326 | doi=10.1590/0100-3984.2015.0034 | pmc=4567366 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26379326  }} </ref><ref name="pmid30150913">{{cite journal| author=Rathore R, Sharma S, Agarwal S| title=Malignant transformation in mature cystic teratoma of the ovary: a retrospective study of eight cases and review of literature. | journal=Prz Menopauzalny | year= 2018 | volume= 17 | issue= 2 | pages= 63-68 | pmid=30150913 | doi=10.5114/pm.2018.77304 | pmc=6107092 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30150913  }} </ref><ref name="pmid5100397">{{cite journal| author=Caruso PA, Marsh MR, Minkowitz S, Karten G| title=An intense clinicopathologic study of 305 teratomas of the ovary. | journal=Cancer | year= 1971 | volume= 27 | issue= 2 | pages= 343-8 | pmid=5100397 | doi=10.1002/1097-0142(197102)27:2<343::aid-cncr2820270215>3.0.co;2-b | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5100397  }} </ref><ref name="pmid4722922">{{cite journal| author=Wisniewski M, Deppisch LM| title=Solid teratomas of the ovary. | journal=Cancer | year= 1973 | volume= 32 | issue= 2 | pages= 440-6 | pmid=4722922 | doi=10.1002/1097-0142(197308)32:2<440::aid-cncr2820320222>3.0.co;2-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4722922  }} </ref><ref name="pmid9264351">{{cite journal| author=Moran CA, Suster S| title=Primary germ cell tumors of the mediastinum: I. Analysis of 322 cases with special emphasis on teratomatous lesions and a proposal for histopathologic classification and clinical staging. | journal=Cancer | year= 1997 | volume= 80 | issue= 4 | pages= 681-90 | pmid=9264351 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9264351  }} </ref><ref name="pmid30256256">{{cite journal| author=Kao CS, Bangs CD, Aldrete G, Cherry AM, Ulbright TM| title=A Clinicopathologic and Molecular Analysis of 34 Mediastinal Germ Cell Tumors Suggesting Different Modes of Teratoma Development. | journal=Am J Surg Pathol | year= 2018 | volume= 42 | issue= 12 | pages= 1662-1673 | pmid=30256256 | doi=10.1097/PAS.0000000000001164 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30256256  }} </ref>


{{main|Germ cell tumor}}
{| class="wikitable"
|+
!Types
!Gross pathology
!Microscopic pathology
!Images
|-
!Mature teratoma
|
*Unilateral cystic mass in most cases, rarely solid
*Predominantly cystic with hair tufts, teeth, and cartilaginous material
*Unilocular in most cases
*Capsular compoment is well defined
*Soft, tan, measured about 3 to 21 cm in diameter
|
*Contains three embryonic layers (misoderm, endoderm, and ectoderm)
*Keratinized squamous cells epithelium
*Adnexal structures (sebaceous glands, hair follicles)
*Adipose tissues
*Lobules of mature cartilage
*Glands lined by the respiratry mucosa and digestive mucosa
*Skeletal muscles
*No cytology atypia
|
|-
![[Immature teratoma]]
|
*Solid mass with necrotic and hemorrhagic areas
*Cystic cavities may be filled with serous or mucinous fluid
*Capsular is not well defined
*Tends to be larger than mature cystic teratoma
|
*Neural tissues with neuroepithelial rosettes
*Choroid plexus
*Immature mesenchymal
*Presence of primtive elements
*Cytology atypia
*
|


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.
|-
![[Monodermal teratoma]]
|
*Unilateral mass
*Well differentiated neoplasm
*
|
*
*
*
*
*
|


===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>.


===Hypotheses of origin===
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]].
=== Dermoid cyst ===
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.
=== 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.




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


[[Category:Disease]]
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[[Category:Pediatric cancers]]
[[Category:Pediatric cancers]]
[[Category:Endocrinology]]
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[[Category:Oncology]]
[[Category:Medicine]]

Latest revision as of 09:58, 17 November 2019

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

Overview

The histopathology of teratoma depends on the histological subtype.Teratoma is a germ cell tumor due to abnormal development of pluripotent cells and renmant of primitive node.

Pathophysiology

 
 
 
 
 
 
 
Germ cell
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pathogenesis
 
 
 
 
 
 
 
Malignant transformation
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Mature teratoma
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
{{{ }}}
 
Tumors with primitive embryonic ectoderm, mesoderm, and/or endoderm differentiation{{{ }}}
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
{{{ }}}
 
 
 
 
 
 
 
 
 
 
 
Immature teratoma
 

Pathogenesis

  • Mature teratoma arises from a pathological transformation of primordial germ cell during the develompment.[1][2]
  • Mature teratoma comes from a single germ cell tumor after first phase of meiosis and failure of meiosis type II.[3][4][5]
  • Mature teratoma contains a well differentiated tumor with all three germ layers (ectoderm, mesoderm and endoderm).[2]
  • Mature teratoma may be located in the embryonic fusion midline or paraxial, mediastinum, ovary, retroperitoneum, and sacrococcygeal.[6]
  • Immature teratoma may be due to the malignant tranformation of primitive germ cell layers and renmant of primive node.[7][8]

Genetics

Genes involved in the pathogenesis of teratoma include:[9]

  • Gain of part or all chromosomes
    • 1p
    • 16p
    • 19
    • 22q

Immunohistochemistry

  • Neuronal element found in mature or immature teratoma are positive for:[10][11]
  • Carcinoid tumor found in the monodermal teratoma may be positive for:[12]
    • Serotonin and peptides hormones.

Associated conditions

Conditions associated with teratoma include:

Gross and microscopy pathology

The gross and microscopy features of teratoma are described below:[16][12][17][7][18][19][20][21][22][23][24]

Types Gross pathology Microscopic pathology Images
Mature teratoma
  • Unilateral cystic mass in most cases, rarely solid
  • Predominantly cystic with hair tufts, teeth, and cartilaginous material
  • Unilocular in most cases
  • Capsular compoment is well defined
  • Soft, tan, measured about 3 to 21 cm in diameter
  • Contains three embryonic layers (misoderm, endoderm, and ectoderm)
  • Keratinized squamous cells epithelium
  • Adnexal structures (sebaceous glands, hair follicles)
  • Adipose tissues
  • Lobules of mature cartilage
  • Glands lined by the respiratry mucosa and digestive mucosa
  • Skeletal muscles
  • No cytology atypia
Immature teratoma
  • Solid mass with necrotic and hemorrhagic areas
  • Cystic cavities may be filled with serous or mucinous fluid
  • Capsular is not well defined
  • Tends to be larger than mature cystic teratoma
  • Neural tissues with neuroepithelial rosettes
  • Choroid plexus
  • Immature mesenchymal
  • Presence of primtive elements
  • Cytology atypia
Monodermal teratoma
  • Unilateral mass
  • Well differentiated neoplasm




References

  1. Vural, F.; Vural, B.; Paksoy, N. (2015). "Vaginal teratoma: A case report and review of the literature". Journal of Obstetrics and Gynaecology. 35 (7): 757–758. doi:10.3109/01443615.2015.1004525. ISSN 0144-3615.
  2. 2.0 2.1 El-Maarri, Osman; Rijlaarsdam, Martin A.; Tax, David M. J.; Gillis, Ad J. M.; Dorssers, Lambert C. J.; Koestler, Devin C.; de Ridder, Jeroen; Looijenga, Leendert H. J. (2015). "Genome Wide DNA Methylation Profiles Provide Clues to the Origin and Pathogenesis of Germ Cell Tumors". PLOS ONE. 10 (4): e0122146. doi:10.1371/journal.pone.0122146. ISSN 1932-6203.
  3. Linder, David; McCaw, Barbara Kaiser; Hecht, Frederick (1975). "Parthenogenic Origin of Benign Ovarian Teratomas". New England Journal of Medicine. 292 (2): 63–66. doi:10.1056/NEJM197501092920202. ISSN 0028-4793.
  4. Surti U, Hoffner L, Chakravarti A, Ferrell RE (1990). "Genetics and biology of human ovarian teratomas. I. Cytogenetic analysis and mechanism of origin". Am J Hum Genet. 47 (4): 635–43. PMC 1683780. PMID 2220805.
  5. Caspi B, Lerner-Geva L, Dahan M, Chetrit A, Modan B, Hagay Z; et al. (2003). "A possible genetic factor in the pathogenesis of ovarian dermoid cysts". Gynecol Obstet Invest. 56 (4): 203–6. doi:10.1159/000074755. PMID 14614249.
  6. 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.
  7. 7.0 7.1 Varma AV, Malpani G, Agrawal P, Malukani K, Dosi S (2017). "Clinicopathological spectrum of teratomas: An 8-year retrospective study from a tertiary care institute". Indian J Cancer. 54 (3): 576–579. doi:10.4103/ijc.IJC_294_17. PMID 29798962.
  8. Keene DJ, Craigie RJ, Shabani A, Batra G, Hennayake S (2011). "Bipartite anterior extraperitoneal teratoma: evidence for the embryological origins of teratomas?". Case Rep Med. 2011: 208940. doi:10.1155/2011/208940. PMC 3163403. PMID 21949666.
  9. Kraggerud SM, Szymanska J, Abeler VM, Kaern J, Eknaes M, Heim S et al. (2000) DNA copy number changes in malignant ovarian germ cell tumors. Cancer Res 60 (11):3025-30. PMID: 10850452
  10. Yoshikata R, Yamamoto T, Kobayashi M, Ota H (2006). "Immunohistochemical characteristics of mature ovarian cystic teratomas in patients with postoperative recurrence". Int J Gynecol Pathol. 25 (1): 95–100. doi:10.1097/01.pgp.0000172082.17805.6c. PMID 16306792.
  11. Takayama, Yoshiyasu; Matsumura, Nozomi; Nobusawa, Sumihito; Ikota, Hayato; Minegishi, Takashi; Yokoo, Hideaki (2015). "Immunophenotypic features of immaturity of neural elements in ovarian teratoma". Virchows Archiv. 468 (3): 337–343. doi:10.1007/s00428-015-1891-8. ISSN 0945-6317.
  12. 12.0 12.1 Outwater, Eric K.; Siegelman, Evan S.; Hunt, Jennifer L. (2001). "Ovarian Teratomas: Tumor Types and Imaging Characteristics". RadioGraphics. 21 (2): 475–490. doi:10.1148/radiographics.21.2.g01mr09475. ISSN 0271-5333.
  13. Liang Z, Yang S, Sun X, Li B, Li W, Liu Z et al. (2017) Teratoma-associated anti-NMDAR encephalitis: Two cases report and literature review. Medicine (Baltimore) 96 (49):e9177. DOI:10.1097/MD.0000000000009177 PMID: 29245365
  14. Dalmau, Josep; Gleichman, Amy J; Hughes, Ethan G; Rossi, Jeffrey E; Peng, Xiaoyu; Lai, Meizan; Dessain, Scott K; Rosenfeld, Myrna R; Balice-Gordon, Rita; Lynch, David R (2008). "Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies". The Lancet Neurology. 7 (12): 1091–1098. doi:10.1016/S1474-4422(08)70224-2. ISSN 1474-4422.
  15. Malayev, Yuliya; Alberts, Jared; Verardi, Mary Ann; Mattison, Anissa R.; Imlay, Sherwin (2015). "Immature Teratoma Associated With Anti–N-Methyl-D-Aspartate Receptor Encephalitis". The Journal of the American Osteopathic Association. 115 (9): 573. doi:10.7556/jaoa.2015.116. ISSN 0098-6151.
  16. Yayla Abide, Çiğdem; Bostancı Ergen, Evrim (2018). "Retrospective analysis of mature cystic teratomas in a single center and review of the literature". Journal of Turkish Society of Obstetric and Gynecology. 15 (2): 95–98. doi:10.4274/tjod.86244. ISSN 1307-699X.
  17. Ulbright, Thomas M (2005). "Germ cell tumors of the gonads: a selective review emphasizing problems in differential diagnosis, newly appreciated, and controversial issues". Modern Pathology. 18 (S2): S61–S79. doi:10.1038/modpathol.3800310. ISSN 0893-3952.
  18. Jung SE, Lee JM, Rha SE, Byun JY, Jung JI, Hahn ST (2002). "CT and MR imaging of ovarian tumors with emphasis on differential diagnosis". Radiographics. 22 (6): 1305–25. doi:10.1148/rg.226025033. PMID 12432104.
  19. da Silva TK, Ribeiro GJ, Scortegagna FA, Zanetti G, Marchiori E (2015). "Teratoma: a set of teeth in the pelvis". Radiol Bras. 48 (4): 263–4. doi:10.1590/0100-3984.2015.0034. PMC 4567366. PMID 26379326.
  20. Rathore R, Sharma S, Agarwal S (2018). "Malignant transformation in mature cystic teratoma of the ovary: a retrospective study of eight cases and review of literature". Prz Menopauzalny. 17 (2): 63–68. doi:10.5114/pm.2018.77304. PMC 6107092. PMID 30150913.
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  22. Wisniewski M, Deppisch LM (1973). "Solid teratomas of the ovary". Cancer. 32 (2): 440–6. doi:10.1002/1097-0142(197308)32:2<440::aid-cncr2820320222>3.0.co;2-8. PMID 4722922.
  23. Moran CA, Suster S (1997). "Primary germ cell tumors of the mediastinum: I. Analysis of 322 cases with special emphasis on teratomatous lesions and a proposal for histopathologic classification and clinical staging". Cancer. 80 (4): 681–90. PMID 9264351.
  24. Kao CS, Bangs CD, Aldrete G, Cherry AM, Ulbright TM (2018). "A Clinicopathologic and Molecular Analysis of 34 Mediastinal Germ Cell Tumors Suggesting Different Modes of Teratoma Development". Am J Surg Pathol. 42 (12): 1662–1673. doi:10.1097/PAS.0000000000001164. PMID 30256256.

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