Spinal teratoma with pulmonary differentiation: a report of rare case and review of literature

Sacrococcygeal Teratoma in a Seven-Day-Old Child with Pulmonary Differentiation

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.

Spinal intramedullary hamartoma with acute presentation in a 13-month old infant: case report

True hamartomas of the spinal cord are very rare, and although several have been reported in the literature, there are few detailed radiological and pathological descriptions of the condition. There is also considerable overlap with other entities, the most common being spinal cord teratomas. The authors report the case of a 13-month-old child with a supragluteal sacral dimple who presented with acute neurological deterioration. MRI of the spine revealed a big intramedullary lesion with heterogeneous signal intensity. A near-total resection was performed, and histopathological examination demonstrated findings consistent with a spinal cord hamartoma. The authors believe that careful preoperative evaluation and rigorous pathological examination are mandatory to establish diagnosis and direct further management of cases in which such a lesion is suspected.

Gastric teratoma: A series of 7 cases

BACKGROUND

Gastric teratoma is a rare entity comprising less than 1% of germ cell tumors of childhood. We present a series of seven gastric teratomas with a review of literature.

OBJECTIVE

To study the demographic profile, clinicopathological features and follow-up data of gastric teratomas.

METHODS

We did a retrospective analysis of 7 cases of gastric teratomas more than 15years and studied their demographic profiles, clinicopathological features and follow-up data.

RESULTS

We came across 7 cases of gastric teratomas out of which 5 were mature and 2 were immature. One case of immature teratoma came back with recurrence and another one had an unusual finding of presence of renal and pulmonary tissues, which has not been reported earlier.

CONCLUSION

Ours is the second largest case series of gastric teratomas in the pediatric age group and 2 out of 7 of our cases had immature elements. We also take this opportunity to report a case of gastric teratoma with the unusual histological finding of immature renal and pulmonary tissues, which has not been described previously.

Mature cystic retroperitoneal teratoma with well differentiated renal elements: relation to spinal dysraphism

Retroperitoneum is a relatively uncommon site for pediatric teratomas. Rarely, such tumors can have an intraspinal extension and few cases of retroperitoneal teratomas associated with spinal dysraphism have been reported. Teratomas consist of tissues arising from all three embryonic layers. However, mature renal tissues in the form of glomeruli and tubules are sparingly found in teratomas. A 15-day-old female presented with spina bifida occulta and on evaluation a cystic presacral mass was detected. Intraoperatively the cyst was found densely adherent to the hemivertebrae but not entering the spinal canal. Histopathological examination confirmed a mature cystic teratoma but also demonstrated presence of mature renal elements in the cyst wall. The teratomas lying in proximity to spine and associated with spinal dysraphism are likely to contain mature renal tissues or even nephroblastic elements. It supports the dysembryogenic model of origin of intradural teratomas from native progenitor cells rather than aberrantly migrated germ cells.

Split cord malformation types I and II: a personal series of 131 patients

PURPOSE

A personal series of 131 patients with split cord malformation (SCM) operated on is presented.

METHODS

Age, gender, symptoms and signs, radiological and operative findings, complications, associated anomalies, outcome, and pathological specimens were analyzed.

RESULTS

There were 88 girls (73 %) and 43 boys (27 %). The female predominance was slightly more remarkable in type I SCMs than in type II SCMs. The presenting symptoms can be summarized as skin lesions, spina bifida aperta, scoliosis or kyphoscoliosis, sphincter disturbance, foot deformities and weakness, and/or atrophy in the lower extremities. The ages of patients with neurological deficits and orthopedic deformities were significantly older than those without deficits (P = 0.030). The duration of symptoms was longer in the patients with neurological deficits and orthopedic deformities than that in those without deficits (P = 0.00095). In six patients, composite SCMs were present. Only one patient with a type II SCM did not have an associated spinal cord lesion. A type I SCM was more frequently encountered in patients with spina bifida (P < 0.0005). Transient postoperative complications were seen in 29 patients (22 %). There was no permanent complication. Retethered cord syndrome developed in five patients with a type I SCM.

CONCLUSIONS

The risk of neurological and orthopedic deficits increases with the age of the patient. The risk of permanent deficit after surgery is very low. The whole spine must be examined for additional lesions. All patients should be surgically treated when diagnosed, especially before the development of orthopedic and neurological manifestations, and all associated lesions should also be treated at the same session.

Spinal intradural teratomas: developmental programs gone awry?

Intradural spinal teratomas are rare tumors of the spinal cord that are infrequently encountered in children. Although the mechanistic basis for the formation of these tumors is unclear, several lines of evidence suggest that a dysembryogenic process in the embryo results in their formation. The authors present a case of spinal intradural teratoma in an 18-year-old, previously healthy man and review the literature linking the development of these tumors to defects in neurulation and embryogenesis.

Intradural lumbar mature teratoma with neuronal and glial tissue component in an adult. Case report

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.

Spinal teratomas: a clinico-pathological study of 27 patients

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.