Intracranial Mature Teratoma in an Adult Patient: A Case Report

Mature cystic teratoma of the right cerebellopontine angle: a rare case report

BACKGROUND AND IMPORTANCE

Intracranial mature cystic teratomas are benign neoplasms that commonly occur at the midline. Mature cystic teratomas at the cerebellopontine (CP) angle are very rare. They are unique germ cell tumours curable by safe total surgical resection and have good prognosis. This case report documents the clinical, radiological, histological features and operative findings of mature cystic teratoma at CP angle.

CLINICAL PRESENTATION

We present a rare case of a mature cystic teratoma at the CP angle in a 24-year-old woman who presented with brainstem compression and cranial nerve deficits. Brain MRI showed atypical findings like hyperintense areas in both T1 and T2 weighted images, calcification and diffusion restriction in part of the lesion. She underwent near total resection of the tumour via right retrosigmoid approach. Intraoperatively, the lesion was intra-arachnoidal unlike schwannomas and the cyst contained sebum-like material, fibrous areas with calcification which are unusual features of common CP angle tumours. Histopathological examination showed well differentiated mature tissues from all three germinal layers and confirmed the diagnosis of a mature cystic teratoma arising from the right CP angle. Patient had good outcome with neurologic recovery.

CONCLUSIONS

Mature cystic teratoma is a rare clinical entity and should be considered in patients with CP angle tumours when there are atypical findings in brain MRI imaging. Cysts with sebum-like material, fibrous areas with calcification and poor tumour-arachnoid plane intraoperatively strongly suggest the possibility of mature cystic teratoma.

Mature Teratoma with Somatic-Type Malignancy: An Entity of Unacquaintance-A Case Report

Primary intracranial teratomas are nongerminomatous germ cell tumors. They are infrequent lesions along the craniospinal axis, with their malignant transformation extremely uncommon. A 50-year-old-male patient presented with one episode of generalized tonic-clonic seizure (GTCS), without any neurological deficit. Radiological imaging revealed a large lesion in the pineal region. He underwent gross total excision of the lesion. Histopathological examination was representative of teratoma with adenocarcinomatous malignant transformation. He underwent adjuvant radiation therapy and had an excellent clinical outcome. The present case highlights the rarity of malignant transformation of the primary intracranial mature teratoma.

Fat in the brain: Facts and features

The presence of fat within a lesion in the brain is not only easy to identify on both CT/MRI but also can help narrow the differential. The purpose of this paper is to illustrate the spectrum of common and rare fat-containing lesions in the brain that are encountered in clinical practice. This paper intends to discuss 15 such lesions which are confirmed by MRI findings and histopathological correlation. We divided the spectrum of fat-containing lesions into lesions with adipose cells, lesions with cholesterol-rich content and tumours with lipomatous differentiation/transformation. Knowledge of these common and rare fat-containing lesions is essential for making the right diagnosis or narrowing the differential diagnosis.

Mature teratoma of the cisterna magna in an adult patient

Background:

Teratomas are a rare subgroup of CNS germ cell tumors and are histologically classified into mature teratomas, immature teratomas, and teratomas with malignant transformation. CNS teratomas are infrequently found in the posterior fossa and pure mature teratomas of posterior fossa are rare especially in adults. We present a case of a young adult female with a mature teratoma in the cisterna magna.

Case Description:

A 26-year-old female presented to the neurosurgery clinic with headache, nausea and vomiting for the past 1 year. She was found to have dysdiadochokinesia on neurological examination. Brain magnetic resonance imaging scan showed a-well defined lesion, hyperintense on T1 and hypointense on T2-weighted sequences located within the cisterna magna. She underwent a suboccipital craniotomy with resection of lesion. Histopathology confirmed the diagnosis of mature cystic teratoma.

Conclusion:

Mature teratomas located in the posterior fossa among adults are rare in the literature. We report the second case of mature teratoma in the cisterna magna of an adult patient.

Central nervous system mature teratoma producing carbohydrate antigen 19-9: illustrative case

BACKGROUND

Central nervous system (CNS) mature teratoma is a rare disease with symptoms that can vary according to tumor location. Most lesions are benign; rarely, malignancy can develop in any of the somatic components. Elevated levels of tumor markers such as α-fetoprotein and β-human chorionic gonadotropin are not usually found in patients with CNS mature teratoma, and no reports have described an association with carbohydrate antigen 19-9 (CA19-9).

OBSERVATIONS

A 64-year-old woman with headache was found to have a mass lesion in the anterior cranial fossa. Magnetic resonance imaging of the brain suggested a mature teratoma. Serum and cerebrospinal fluid (CSF) tests showed significant CA19-9 elevations (2,770 U/mL and 4,387 U/mL, respectively). Other examinations, including whole-body 18F-fluorodeoxyglucose positron emission tomography, did not detect the origin of elevated CA19-9, suggesting that the high CA19-9 levels were caused by intracranial tumor. The patient underwent tumor removal. The histopathological diagnosis was mature teratoma with positive CA19-9 staining. CA19-9 levels in serum and CSF decreased significantly after tumor removal.

LESSONS

The histopathological findings and postoperative decreased CA19-9 levels established the diagnosis of CA19-9-producing CNS mature teratoma. CNS mature teratoma can cause elevations in CA19-9 in cases with absence of neoplasms in the trunk.

Mature cystic teratoma of the temporal lobe: A rare tumor with an unusual location

Intracranial mature cystic teratoma is rare. The temporal lobe is a very unusual location and can pose a considerable diagnostic challenge. Proper histological diagnosis and long‐term follow‐up are imperative.

Optic Nerve Choristoma Mimicking a Neurenteric Cyst

Optic nerve choristomas are rare entities in which a developmental focus of histologically normal tissue is abnormally located within or along a segment of the optic nerve. Although benign, choristomas may demonstrate slow growth, ultimately resulting in visual field deficits due to compression of the adjacent nerve in the few cases reported in the anterior fossa. Choristomas may have cystic components, though this has not been described in such lesions along the optic nerve. Here, a predominantly cystic optic nerve choristoma is described, with radiologic features mimicking those of an anterior cranial fossa neurenteric cyst. The case highlights the radiology-pathology correlates of choristomas and reviews the surgical approach and management of patients with such lesions.

Intramedullary cervical spinal cord teratoma

BACKGROUND

Intramedullary cervical spinal cord teratomas (ICTs) are extremely rare, and diagnosis and treatment are challenging. We conducted a systematic review of the literature on the diagnosis and treatment of ICT.

METHOD

The presentation, imaging manifestations, diagnosis, management, surgery findings, prognosis and histology were reviewed following Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines. English-language studies and case reports published from inception to 2018 were retrieved. Data on presentation, imaging characteristics, diagnosis, management, surgery findings, outcomes, and histopathology were extracted.

RESULTS

Ten articles involving 10 patients were selected. The lesions were located in the upper cervical vertebrae in 4 cases, whereas in the lower cervical vertebrae in the remaining 6 cases. In 5 cases, the lesions were located on the dorsal side of the spinal cord, and in the center of the spinal cord in the remaining 5 cases. Quadriparesis (60%), paraplegia (30%), monoplegia (10%), and neck pain (50%) were the main presentations. The lesion appeared as a intramedullary heterogeneous signal during an MRI scan, and the lesion signal would be partially enhanced after the contrast medium was applied. All patients underwent surgical intervention through a posterior approach. Neurological function improved postoperatively in all patients. Two patients with pathology confirmed to be immature teratomas experienced recurrence.

CONCLUSION

ICTs are extremely rare entities that are mainly located in the center or dorsal part of the spinal cord which mainly manifest as quadriplegia and neck pain. MRI is a useful modality that provides diagnostic clues. Surgery from a posterior approach is the primary treatment, and the effect of adjuvant therapy remains uncertain. The prognosis is mainly related to the pathological nature of the tumor and not the method of resection.