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Peeters SM, Uhr L, Chivukula S, McBride D, Everson R, Duong D, Yang I, Cornford M, Mlikotic A, Yong W, Kim W. Cervicomedullary junction mature teratoma with pulmonary differentiation and diastematomyelia in an adult - A rare case. Surg Neurol Int 2023; 14:334. [PMID: 37810313 PMCID: PMC10559391 DOI: 10.25259/sni_633_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/15/2023] [Indexed: 10/10/2023] Open
Abstract
Background Intradural extramedullary teratomas in the cervical or cervicomedullary region are rare in adults. Case Description We report a symptomatic, mature teratoma at the cervicomedullary junction in a 52-year-old Hispanic female who also has a type I diastematomyelia in the thoracolumbar spine. The patient underwent surgical resection of the lesion with the resolution of presenting symptoms. Histopathology of the lesion revealed a mature cystic teratoma with pulmonary differentiation. Conclusion We discuss the case along with a review of pertinent literature and considerations with regard to the diagnosis, etiology, prognosis, and management of this unusual pathology.
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Affiliation(s)
- Sophie M. Peeters
- Department of Neurosurgery, University of California Los Angeles (UCLA), Los Angeles, California, United States
| | - Lauren Uhr
- Department of Neurosurgery, University of California Los Angeles (UCLA), Los Angeles, California, United States
| | - Srinivas Chivukula
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Duncan McBride
- Department of Neurosurgery, University of California Los Angeles (UCLA), Los Angeles, California, United States
| | - Richard Everson
- Department of Neurosurgery, University of California Los Angeles (UCLA), Los Angeles, California, United States
| | - Duc Duong
- Department of Neurosurgery, Harbor UCLA Medical Center, Torrance, United States
| | - Isaac Yang
- Department of Neurosurgery, University of California Los Angeles (UCLA), Los Angeles, California, United States
| | - Marcia Cornford
- Department of Pathology, Harbor UCLA Medical Center, Torrance, United States
| | - Anton Mlikotic
- Department of Radiology, Harbor UCLA Medical Center, Torrance, United States
| | - William Yong
- Department of Pathology, UCLA, Los Angeles, California, United States
| | - Won Kim
- Department of Neurosurgery, University of California Los Angeles (UCLA), Los Angeles, California, United States
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Gupta B, Yadav S, Khurana N, Raj P. Sacrococcygeal Teratoma in a Seven-Day-Old Child with Pulmonary Differentiation. J Clin Diagn Res 2017; 11:SD01-SD02. [PMID: 28969230 DOI: 10.7860/jcdr/2017/27273.10357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 05/13/2017] [Indexed: 11/24/2022]
Abstract
Sacrococcygeal Teratoma (SCT) showing pulmonary differentiation has been rarely reported in the literature. Till date, only eight cases have been reported, out of which six belong to teratomas arising from female genital tract. Spinal teratomas showing pulmonary differentiation are rarer and only two cases have been reported so far in the literature both of which had associated congenital spinal anomaly. We present a rare case of seven day old infant with sacrococcygeal teratoma showing mature lung differentiation as one of its components. The infant was otherwise asymptomatic and had no associated spinal anomaly. This case has been presented for its rarity. Extensive review of the literature along with the possible pathogenesis is also included for better understanding.
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Affiliation(s)
- Barkha Gupta
- Senior Resident, Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Surekha Yadav
- Senior Resident, Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Nita Khurana
- Professor, Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Prince Raj
- Assistant Professor, Department of Paediatric Surgery, Lok Nayak Hospital, New Delhi, India
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Case report: A rare presentation of spinal teratoma in neonates: Two cases from Ethiopia. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2017. [DOI: 10.1016/j.epsc.2017.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Gu W, Shang H, Jin X, Xie J, Zhao W. Intradural lumbar mature teratoma with neuronal and glial tissue component in an adult. Case report. Neurol Med Chir (Tokyo) 2011; 50:1112-5. [PMID: 21206190 DOI: 10.2176/nmc.50.1112] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 23-year-old Chinese male patient presented with an extremely rare case of spinal teratoma with neuronal and glial tissue components manifesting as lower back pain and radiating pain to the leg. Subtotal excision of the tumor was conducted. Histological examination revealed a mature teratoma with neuronal and glial tissue components. Initial presentation of spinal teratoma in adulthood is rare. Teratomas show a wide array of organoid tissue differentiation, but neuronal tissue component is uncommon.
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Affiliation(s)
- Weiting Gu
- Department of Neurosurgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R.C
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Park SC, Kim KJ, Wang KC, Choe G, Kim HJ. Spinal epidural teratoma: review of spinal teratoma with consideration on the pathogenesis: case report. Neurosurgery 2010; 67:E1818-25. [PMID: 21107150 DOI: 10.1227/neu.0b013e3181f846ca] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND AND IMPORTANCE Of the 170 cases of teratomas in the spinal canal reported in the English literature, only 13 were spinal epidural teratomas (SETs). We present a case of SET, review the characteristics of SETs in comparison with spinal intradural teratomas (SITs), and investigate the pathogenesis of spinal teratoma. CLINICAL PRESENTATION A 17-month-old boy visited our clinic with paraparesis. A multicystic mass was noted in the left epidural space from T8 to T10 and the left paraspinal area. Complete resection of the tumor, including the paraspinal portion, was accomplished by laminoplastic laminotomy. The tumor was well encapsulated and filled with heterogeneous contents. The tumor was suspected to originate from the left T9 root. CONCLUSION On histopathological examination, the tumor was found to be a mature teratoma. The clinical characteristics of SETs and SITs show similarities in age, male preponderance, location, associated anomalies, and pathology. SETs and SITs are probably 2 different types of a single disease entity. Pluripotent somatic cell from the Hensen's node and caudal cell mass is the probable origin of spinal teratoma. However, originating from misplaced primordial germ cell could not be excluded.
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Affiliation(s)
- Seong-cheol Park
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Sharma MC, Jain D, Sarkar C, Suri V, Garg A, Singh M, Mahapatra AK, Sharma BS. Spinal teratomas: a clinico-pathological study of 27 patients. Acta Neurochir (Wien) 2009; 151:245-52; discussion 252. [PMID: 19247572 DOI: 10.1007/s00701-009-0212-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2008] [Accepted: 08/01/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Spinal cord teratomas are uncommon tumours. The diagnosis is rarely suspected before surgery and final diagnosis is invariably made at histopathological examination. METHODS We retrospectively analysed our neuropathology records for the last 20 years and all patients diagnosed as spinal teratomas were retrieved. The clinical and radiological features were noted. Slides were reviewed and the diagnosis was confirmed. FINDINGS During a period of 20 years, we found 27 examples of spinal teratomas. There was a wide age range and 37.3% presented in adulthood. Male predominance was observed both in children as well as adults. The dorso-lumbar location was common in children as well as in adults but an intramedullary location, in association with a myelomeningocele and split cord malformation, was more common in children. Twenty one patients had associated features of spinal dysraphism. Of the six who were not associated with this, five were adult patients. Radiologically mixed solid and cystic morphology, fat signal and areas of calcification were seen in one third of patients. All tumours except one showed benign (mature) components. Interestingly, two lesions contained mature renal tissue: one exhibited pulmonary differentiation and one had Wilm's tumour as a component of the teratoma. In five patients the initial sections showed epidermis with skin adenexal structures and a diagnosis of dermoid cyst was suspected but serial sectioning revealed other teratomatous components. All patients were treated with surgical excision. CONCLUSION Although there are no specific features on imaging, mixed solid and cystic morphology, fat signal and areas of calcification are helpful in the pre-operative diagnosis. Most of these lesions are diagnosed on histopathological examination after surgery and therefore thorough sampling and serial sectioning are mandatory to identify all components of the teratoma in order to avoid misdiagnosis.
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Jain D, Sharma MC, Sarkar C, Rishi A, Suri V, Garg A, Mahapatra AK. Spinal teratoma with pulmonary differentiation: a report of rare case and review of literature. Fetal Pediatr Pathol 2007; 26:185-91. [PMID: 18075833 DOI: 10.1080/15513810701696924] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The occurrence of intradural spinal teratomas in association with spinal dysraphism is uncommon and even rarer is pulmonary differentiation in a teratoma. We report a case of spinal dysraphism, duplication of lumbosacral spine, split cord malformation (SCM I), and meningomyelocele in an 8-month-old child. Excision of meningomyelocele and detethering of cord was done. Pathologic examination revealed a mature teratoma with pulmonary differentiation. To the best of our knowledge this is the second case of spinal teratoma with pulmonary differentiation.
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Affiliation(s)
- Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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Chen YH, Chang CH, Chen KC, Diau GY, Loh IW, Chu CC. Malignant Transformation of a Well-organized Sacrococcygeal Fetiform Teratoma in a Newborn Male. J Formos Med Assoc 2007; 106:400-2. [PMID: 17561476 DOI: 10.1016/s0929-6646(09)60326-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We report herein a case of a male newborn with a sacrococcygeal fetiform teratoma (FT). The baby presented with a large coccygeal teratoma. The preoperative diagnosis of FT was made by plain radiography, ultrasonography and magnetic resonance imaging. The baby was successfully treated by complete excision and pelvic floor reconstruction. Postoperative follow-up was uneventful until the teratoma recurred 11 months later as a malignancy. After undergoing a second operative procedure accompanied by chemotherapy, he has been doing well for 18 months.
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Affiliation(s)
- Yi-Hsin Chen
- Division of Pediatric Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Güvenç BH, Etus V, Muezzinoglu B. Lumbar teratoma presenting intradural and extramedullary extension in a neonate. Spine J 2006; 6:90-3. [PMID: 16413454 DOI: 10.1016/j.spinee.2005.08.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2005] [Revised: 08/13/2005] [Accepted: 08/25/2005] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The association of teratomas and spinal malformations such as spina bifida, partial sacral agenesis, hemivertebrae, and diastematomyelia has been described in the literature. Reported cases, however, are mainly presacral or sacrococcygeal with an extremely rare presentation of intradural extension. PURPOSE A case of lumbar teratoma with an intradural extension and extramedullary component and the clinical outcome following surgical treatment are reported. STUDY DESIGN/SETTING To our knowledge, among the reported teratoma cases with an intradural extension and extramedullary component, our case has a distinguishing feature regarding the involvement of the lumbar spine. It is also the first case, showing no neurological deficit during the postoperative period. METHODS A full-term, female infant presented with a 30 x 30 x 10 mm lumbar mass covered with normal skin. The mass contained an irregular, bone-like, hard and mobile material accompanying cystic components. Magnetic resonance imaging revealed a total closure defect of the first and second lumbar laminae and a subcutaneous mass with intradural extension. The lesion was found to penetrate the dural sac through an extended exposure from T12 to L3. There was no firm attachment of the intradural, extramedullary component of the lesion. Total removal of the tumor was achieved. RESULTS The patient was discharged on day 7 without any neurological deficit or sign of hydrocephalus. The pathological examination showed a benign teratoma containing mature cartilage, muscle, adipose tissue, and glandular tissue. Follow-up at 2 years showed no recurrence or neurological deficit and a normal sphincter tone. Urodynamic evaluation was within normal limits. CONCLUSION Accompanying a spinal dysraphic state, the mature teratoma in our case may support the idea of a tumor actually arising from a dysraphism and growing outward to produce the mass.
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Affiliation(s)
- B Haluk Güvenç
- Department of Pediatric Surgery, Kocaeli University Medical Faculty, Umuttepe Yerleşkesi, Uctepe, 41380 Kocaeli, Turkey.
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Matsubayashi J, Ishida T, Ozawa T, Aoki T, Koyanagi Y, Mukai K. Subphrenic bronchopulmonary foregut malformation with pulmonary-sequestration-like features. Pathol Int 2003; 53:313-6. [PMID: 12713567 DOI: 10.1046/j.1440-1827.2003.01475.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
A retroperitoneal bronchopulmonary foregut malformation in a 62-year-old man is reported. The lesion was composed of mature lung tissue with randomly distributed bronchial structures and ciliated epithelium-lined cysts, some of which were lined with gastric mucosa. The histological features of this lesion were of both pulmonary sequestration and a bronchogenic, or foregut, cyst, and thus were a unique example of bronchopulmonary foregut malformation with pulmonary differentiation. This case is important in understanding the pathogenesis of foregut anomalies (i.e. bronchopulmonary foregut malformations), which range from pulmonary sequestrations to bronchogenic cysts and foregut duplication cysts.
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Affiliation(s)
- Jun Matsubayashi
- First Department of Pathology, Tokyo Medical University, Tokyo, Japan
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Abstract
Only a few series of patients with cervical myelomenigocele (cMMC) and cervical meningocele (cMC) have been published. Interventions as well as the neurologic, orthopaedic, urologic and intellectual outcomes were analysed in this retrospective description of five patients with cMMC and cMC diagnosed in the period 1984-1999. Four patients suffered from cMMC, one from cMC. The average duration of follow-up was 9.5 years. None of the patients had periconceptual prevention with folic acid. Three had a Chiari II malformation and two a hydrocephalus. Tethering of the cervical cord was demonstrated in three patients at follow-up. All children achieved an independent ambulatory function and urinary continence. Incomplete sensorimotor hemiparesis was present in two children, and a mild unilateral arm paresis in one. Two of five patients had age appropriate cognitive functions. Three patients with mild mental retardation or behavioural problems had to be placed in special classes. The outcome of patients with cMMC is favourable regarding to the neurologic, orthopaedic and urologic problems compared with lower neural tube defects. However, the burden of repeated examinations and therapies is considerable and induces high costs, therefore prevention with periconceptual folic acid is a crucial issue also in cMMC. Spinal cord dysfunction has to be considered in growing children due to persistent tethering or re-tethering, therefore regular neurologic and urodynamic investigations are of particular importance.
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Affiliation(s)
- Andreas D Meyer-Heim
- Division of Paediatric Neurology, University Children's Hospital, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland
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