Teratome des Ovars

Clinical characteristics and long-term management of prepubertal testicular teratomas: a retrospective, multicenter study

Prepubertal testicular teratomas are rare tumors with limited practical guidance for their management. This study aimed to analyze a large multicenter database to establish the optimal management of testicular teratomas. We retrospectively collected data on testicular teratomas in children younger than 12 years who underwent surgery without postoperative chemotherapy in three large professional children's institutions in China between 2007 and 2021. The biological behavior and long-term outcomes of testicular teratomas were analyzed. In total, 487 children (with 393 mature teratomas and 94 immature teratomas) were included. Among mature teratomas, 375 cases were testis-sparing, 18 were orchiectomies, 346 were operated through the scrotal approach, and 47 underwent the inguinal approach. The median follow-up period was 70 months, and no recurrence or testicular atrophy was observed. Among the children with immature teratomas, 54 underwent testis-sparing surgery, 40 underwent orchiectomy, 43 were operated through the scrotal approach, and 51 were operated through the inguinal approach. Two cases of immature teratomas with cryptorchidism had local recurrence or metastasis within 1 year of the operation. The median follow-up duration was 76 months. No other patients had recurrence, metastasis, or testicular atrophy.  Conclusion: Testicular-sparing surgery is the first treatment choice for prepubertal testicular teratomas, with the scrotal approach being a safe and well-tolerated strategy for these diseases. Additionally, patients with immature teratomas and cryptorchidism may have tumor recurrence or metastasis after surgery. Therefore, these patients should be closely followed up in the first year after surgery. What is Known: • There is a fundamental difference between testicular tumours in childhood and those in adulthood - not only in terms of the difference and incidence but also in terms of histology. • For surgical techniques, the inguinal approach is recommended for the treatment of testicular teratomas in children. What is New: • The scrotal approach being a safe and well-tolerated strategy for testicular teratomas in children. • Patients with immature teratomas and cryptorchidism may have tumor recurrence or metastasis after surgery. These patients should be closely followed up in the first year after surgery.

Well-developed Cerebellum in an Ovarian Mature Teratoma From a Pregnant Female

Teratomas are the most common neoplasm of the ovary, comprising over half of all diagnosed tumors in patients under 50. Most lesions are classified as benign mature teratomas and are histologically defined by the presence of mature tissues from one or more of the embryological germ layers: ectoderm, mesoderm, and endoderm. Neuroectodermal derivatives, including glia, neurons, ependymal cells, and meninges are present in a third to half of mature teratomas. Although teratomatous tissue elements are typically arranged in a haphazard fashion, well-developed and organized embryonic organ structures have been rarely reported and often with limited histologic, clinical, or gross characterization. In this report, we describe the case of an ovarian mature cystic teratoma identified in a pregnant female which exhibited remarkably well-developed posterior fossa structures including lobated and foliated cerebellum with appropriate anatomic organization and associated brainstem, ventricular, and meningeal structures.

Primary adrenal mature teratoma: A rare case report and review of literature

Introduction

Teratoma is a germ cell tumor, deriving from totipotent cells. Teratomas usually occur in gonads and are rarely extra-gonadal. The adrenal location is exceptional. Only few cases of primary adrenal teratomas have been reported in literature, mainly in young patients.

Case report

We report the case of a 56-year-old female patient who presented with pyrosis, dyspepsia and abdominal pain that was evolving for 5 months. The abdominal computed tomography revealed a voluminous mass of the right adrenal gland and the hormonal evaluation was normal. The patient underwent an open transperitoneal adrenalectomy and the histopathological examination of the specimen confirmed the diagnosis of mature teratoma.

Discussion

Adrenal teratomas are commonly asymptomatic and their diagnosis depends mostly on radiologic findings. Malignant transformation is very rare. Surgical excision is the mainstay of treatment with a good prognosis.

Conclusion

Open surgery should always be considered in large and adhering teratoma tumors of the adrenal gland. Some pathologic features and tumorigenesis of adrenal teratomas are not entirely elucidated, thus the importance of larger studies in order to comprehend this pathological entity.

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The adrenal location of primary adrenal teratomas is exceptional.

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The preoperative diagnosis is challenging, based mainly on imaging findings.

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Open surgery should always be considered in large and adhering teratoma tumors of the adrenal gland.

Primary adrenal teratoma: Clinical characteristics and retroperitoneal laparoscopic resection in five adults

Primary adrenal teratoma is extremely rare. To investigate the clinical characteristics and further enrich the limited knowledge on its diagnosis and treatment, the present study retrospectively analyzed the detailed clinical data of five patients with primary adrenal teratomas treated in the Peking Union Medical College Hospital (Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China) between March 2009 and February 2014. The five patients were female, aged from 16 to 51 years (mean, 36.0±16.3 years), with solitary lesions that were incidentally found on routine physical examinations. The tumor size ranged from 2.4 to 9.0 cm (mean, 6.0±2.7 cm). Ultrasonography revealed a mixed echo in four patients, and computed tomography showed mixed density masses with fat components and calcification in three patients. Adrenal-related endocrine tests were normal in all five patients, and no abnormalities were found in the three patients who underwent somatostatin receptor scintigraphy examination. All patients were treated with retroperitoneal laparoscopic surgery, with no complications, and the resected tumors were identified as mature cystic teratomas pathologically. To date, the patients have been followed up for 4-60 months post-operatively, with no recurrence. In conclusion, this rare adrenal teratoma is an occult entity to which reproductive females are susceptible. The tumor exhibits no typical clinical manifestations or adrenal-related laboratory abnormalities, and the pre-operative diagnosis mainly relies on imaging characteristics of a heterogeneous lesion containing fat components with scattered and marginal calcifications. The preferred treatment is retroperitoneal laparoscopic surgery, and the prognosis is good.

Immature ovarian teratoma with unusual gliomatosis

This study aimed to investigate an unusual case of immature ovarian teratoma with onset of mature glial cells implanted on the contralateral ovary, a challenge in the diagnosis of the second ovarian tumor. We report the case of a 31- yr-old woman, who developed at the age of 16 an immature teratoma in the right ovary that was surgically removed. Six years later mature glial implants were present on the left ovary and six months later at the level of peritoneum that relapsed after other six months. The patient suffered three surgical resections after the initial one. Paraffin sections and immunohistochemical examinations using antibodies against glial and neuronal antigens were performed. In the teratoma, the neuroectodermal tissue expressed Glial fibrillary acidic protein (GFAP), S100 protein, Epithelial membrane antigen (EMA) and Cytokeratin 34 beta E12 (Ck34beta E12), wheares the implants expressed only GFAP and S100 protein. The immature teratoma is the rarest type of ovarian teratomas. Gliomatosis peritonei is an exceptional finding, expecially with onset on the contralaterally ovary. The implant of the mature glial cells has a high risk of relapse, as seen in our case, thus close follow-up of the patient is necessary.