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Lam PPH, Lum RTW, Chan JWY, Lau RWH, Ng CSH, Li JJX. Neuroendocrine Lesions Arising From Mediastinal Teratoma-A Case Report and Literature Review. Int J Surg Pathol 2024:10668969241261552. [PMID: 39034154 DOI: 10.1177/10668969241261552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
Background. Neuroendocrine lesions arising from mediastinal teratomas are rare tumors with only small number of patients reported in literature. The behavior of these lesions appears to be different from traditional neuroendocrine neoplasms. A comprehensive review will be valuable for histologic assessment and treatment planning for similar cases. Case presentation. We present an example of a 57-year-old man who presented with cough. Subsequent work-up revealed an anterior mediastinal mass of 2.1 cm on computed tomography. The patient underwent robot-assisted thoracoscopic thymectomy. Histological examination revealed a mature cystic teratoma with a neuroendocrine component consisting of clusters of tumor cells with round to oval nuclei and a "salt-and-pepper" chromatin pattern. The tumor cells were immunoreactive to cytokeratin, synaptophysin, chromogranin, and INSM1, with a Ki-67 proliferative index of 4%. A histological diagnosis was mature teratoma with well-differentiated low-grade neuroendocrine tumor (carcinoid) was made. The patient was well and without disease after complete surgical excision at 10 months. Literature review. Literature reviewed yielded 13 examples of neuroendocrine lesions arising from mediastinal teratomas. No disease-related mortality was reported, even in lesions with high-grade neuroendocrine, carcinomatous, or immature teratomatous components. Conclusions. Surgical removal is the mainstay of treatment of these lesions, and the presence of a neuroendocrine component does not appear to negatively affect prognosis.
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Affiliation(s)
- Pensi P H Lam
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Ray T W Lum
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Joyce W Y Chan
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Rainbow W H Lau
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Calvin S H Ng
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Joshua J X Li
- Department of Pathology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong
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Sato D, Izu A, Sakakibara M, Hayashi S, Kawachi R, Shimamura M, Masuda S, Sakurai H. A neuroendocrine tumor within an anterior mediastinal mature teratoma: a case report. J Cardiothorac Surg 2022; 17:333. [PMID: 36550490 PMCID: PMC9783718 DOI: 10.1186/s13019-022-02091-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Mature teratomas are benign germ cell tumors. On rare occasions, they have been associated with somatic malignancies and are termed rare germ cell tumors with a somatic-type malignancy (GCTSM). Mature teratomas commonly comprise adenocarcinomas; only seven previous cases of mature teratomas with neuroendocrine tumors have been reported to date. Here, we report a patient with a neuroendocrine tumor whithin a mature teratoma. CASE PRESENTATION A 26-year-old man visited our department complaining of chest tightness. Contrast-enhanced computed tomography (CT) scans showed a strongly enhanced lesion within a 10-cm encapsulated cystic lesion in the anterior mediastinum. Positron emission tomography (PET) scans showed no areas of significant 18F-fluorodeoxyglucose (18F-FDG) accumulation. He underwent complete tumor resection via the transsternal approach. Histopathological examination of the specimen indicated a neuroendocrine tumor contained within a mature teratoma. CONCLUSIONS In this case, a neuroendocrine tumor was contained within a mature teratoma. Our patient had no specific symptoms and his serum markers were within the normal range. Although PET is beneficial for diagnosing other GCTSM, it is not useful in detecting a neuroendocrine tumor. Therefore, the preoperative diagnosis of neuroendocrine tumors contained within mature teratomas remains challenging. However, GCTSM should be suspected in patients exhibiting CT findings of a mediastinal tumor, measuring ≥ 6 cm, in addition to characteristic GCTSM findings. Moreover, surgery should be performed carefully in such cases.
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Affiliation(s)
- Daisuke Sato
- grid.260969.20000 0001 2149 8846Department of Respiratory Surgery, Nihon University School of Medicine, 30-1, Ohyaguchi-Kamicho, Itabashi-Ku, Tokyo, 173-8610 Japan
| | - Asami Izu
- grid.260969.20000 0001 2149 8846Department of Pathology and Microbiology, Nihon University School of Medicine, 30-1, Ohyaguchi-Kamicho, Itabashi-Ku, Tokyo, 173-8610 Japan
| | - Masashi Sakakibara
- grid.260969.20000 0001 2149 8846Department of Respiratory Surgery, Nihon University School of Medicine, 30-1, Ohyaguchi-Kamicho, Itabashi-Ku, Tokyo, 173-8610 Japan
| | - Sohei Hayashi
- grid.260969.20000 0001 2149 8846Department of Respiratory Surgery, Nihon University School of Medicine, 30-1, Ohyaguchi-Kamicho, Itabashi-Ku, Tokyo, 173-8610 Japan
| | - Riken Kawachi
- grid.260969.20000 0001 2149 8846Department of Respiratory Surgery, Nihon University School of Medicine, 30-1, Ohyaguchi-Kamicho, Itabashi-Ku, Tokyo, 173-8610 Japan
| | - Mie Shimamura
- grid.260969.20000 0001 2149 8846Department of Respiratory Surgery, Nihon University School of Medicine, 30-1, Ohyaguchi-Kamicho, Itabashi-Ku, Tokyo, 173-8610 Japan
| | - Shinobu Masuda
- grid.260969.20000 0001 2149 8846Department of Pathology and Microbiology, Nihon University School of Medicine, 30-1, Ohyaguchi-Kamicho, Itabashi-Ku, Tokyo, 173-8610 Japan
| | - Hiroyuki Sakurai
- grid.260969.20000 0001 2149 8846Department of Respiratory Surgery, Nihon University School of Medicine, 30-1, Ohyaguchi-Kamicho, Itabashi-Ku, Tokyo, 173-8610 Japan
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Lobo J, Rodrigues Â, Henrique R, Christiansen A, Beyer J, Moch H, Bode PK. Morphological spectrum and molecular features of somatic malignant transformation in germ cell tumours. Histopathology 2022; 81:84-98. [PMID: 35438203 DOI: 10.1111/his.14667] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/20/2022] [Accepted: 04/16/2022] [Indexed: 11/28/2022]
Abstract
AIMS Somatic malignant transformation (SMT) arising in germ cell tumours (GCTs) is an infrequent, but clinically relevant event. There is only limited knowledge on the morphological spectrum of SMT, and therapeutic management of these patients is poorly defined. In this work we revisit two consecutive case series (n=756) of GCTs. Clinicopathological data of SMT arising in GCT were determined, with focus on the histopathological spectrum, and molecular aspects were obtained by Fluorescence in situ Hybridization (FISH) and Next Generation Sequencing (NGS). METHODS AND RESULTS 30 male patients (28 primary testicular, 2 primary extragonadal) were included. These patients represent 4% of GCT patients diagnosed in two institutes (University Hospital Zurich and IPO Porto). The most common SMT were adenocarcinoma (n=8), embryonic-type neuroectodermal tumours (ENETs, n=8) and rhabdomyosarcoma (n=6), but a wide range of challenging morphologies were depicted, including low-grade neuroglial tumour, adenosquamous carcinoma, neuroblastoma and neuroendocrine carcinoma. SMT was found in 15 primary tumour samples and in 27 metastatic samples of these 30 patients, the latter showing poorer overall-survival. Adenocarcinoma occurred only in metastasis post-chemotherapy and in one primary retroperitoneal GCT with SMT, but not in GCT of the testis. 12p gains were identified by FISH in all cases. NGS results were available in 6 patients. Clinical trials and/or targeted treatments based on the molecular profile of SMT were recommended in 4 patients. CONCLUSIONS SMT arising in GCTs represents a diagnostic challenge and should be confirmed by a specialized uropathologist. NGS based treatment recommendations may improve outcome of these patients.
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Affiliation(s)
- João Lobo
- Department of Pathology, Portuguese Oncology Institute of Porto (IPOP), R. Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal.,Cancer Biology and Epigenetics Group, IPO Porto Research Center (GEBC CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto) & Porto Comprehensive Cancer Center (P.CCC), R. Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal.,Department of Pathology and Molecular Immunology, Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS-, UP, ), Rua Jorge Viterbo Ferreira 228, 4050-513, Porto, Portugal
| | - Ângelo Rodrigues
- Department of Pathology, Portuguese Oncology Institute of Porto (IPOP), R. Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal.,Cancer Biology and Epigenetics Group, IPO Porto Research Center (GEBC CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto) & Porto Comprehensive Cancer Center (P.CCC), R. Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal.,Department of Pathology and Molecular Immunology, Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS-, UP, ), Rua Jorge Viterbo Ferreira 228, 4050-513, Porto, Portugal
| | - Rui Henrique
- Department of Pathology, Portuguese Oncology Institute of Porto (IPOP), R. Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal.,Cancer Biology and Epigenetics Group, IPO Porto Research Center (GEBC CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto) & Porto Comprehensive Cancer Center (P.CCC), R. Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal.,Department of Pathology and Molecular Immunology, Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS-, UP, ), Rua Jorge Viterbo Ferreira 228, 4050-513, Porto, Portugal
| | - Ailsa Christiansen
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstrasse 12, CH, 8091, Zurich, Switzerland
| | - Jörg Beyer
- Universitätsklinik für Medizinische Onkologie, Inselspital, Universitätsklinik der Universität Bern, Bern University, Switzerland
| | - Holger Moch
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstrasse 12, CH, 8091, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Rämistrasse 71, 8006, Zurich, Switzerland
| | - Peter Karl Bode
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstrasse 12, CH, 8091, Zurich, Switzerland
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Manabe T, Kajiyama K, Iwanami T, Hanagiri T, Sako T. Unusual giant multilocular thymic cyst with mature teratoma including a carcinoid component in the mediastinum. Surg Case Rep 2022; 8:24. [PMID: 35092531 PMCID: PMC8800978 DOI: 10.1186/s40792-022-01373-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/17/2022] [Indexed: 11/17/2022] Open
Abstract
Background Teratoma is the second most common mediastinal neoplasm, but malignant transformation in mature teratomas is uncommon, and cases of carcinoid tumor with teratoma are described in only a few studies. In addition, multilocular thymic cyst associated with mature mediastinal teratoma is also a rare entity. There have been no reports of case with the coexistence of these three pathological lesions. Case presentation The patient was a 24-year-old man who was referred to our hospital due to a 2-day history of left shoulder pain, a feeling of severe chest tightness and high fever. Pre-operative computed tomography (CT) showed a large, fluid-filled and well-demarcated multilocular cyst in the anterior to superior mediastinum measuring up to 12 cm in size. Contrast-enhanced CT also revealed that the tumor contained a solid component with slight contrast enhancement and spotty wall-thickening septation. Therefore, cystic thymoma, thymic cyst, cystic teratoma, or germ cell tumor with an inflammatory reaction were considered as differential diagnoses. The patient underwent tumor extirpation under median sternotomy. The pathological diagnosis was multilocular thymic cyst with mature teratoma including carcinoid tumor (Grade 2) in the mediastinum. Conclusions The relationship between thymic cyst, teratoma and carcinoid tumor is unclear at present; therefore, further research is needed to clarify the relationship between these entities. In this report, we present a case of multilocular thymic cyst with mature teratoma including a carcinoid component in the mediastinum that was detected by complete surgical resection.
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Affiliation(s)
- Takehiko Manabe
- General Thoracic Surgery, Kitakyushu General Hospital, Higashijono, Kokurakita, Kitakyushu, Fukuoka, 802-8517, Japan.
| | - Kenta Kajiyama
- General Thoracic Surgery, Kitakyushu General Hospital, Higashijono, Kokurakita, Kitakyushu, Fukuoka, 802-8517, Japan
| | - Takashi Iwanami
- General Thoracic Surgery, Kitakyushu General Hospital, Higashijono, Kokurakita, Kitakyushu, Fukuoka, 802-8517, Japan
| | - Takeshi Hanagiri
- General Thoracic Surgery, Kitakyushu General Hospital, Higashijono, Kokurakita, Kitakyushu, Fukuoka, 802-8517, Japan
| | - Tatsuhiko Sako
- General Thoracic Surgery, Kitakyushu General Hospital, Higashijono, Kokurakita, Kitakyushu, Fukuoka, 802-8517, Japan
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El-Zaatari ZM, Ro JY. Mediastinal Germ Cell Tumors: A Review and Update on Pathologic, Clinical, and Molecular Features. Adv Anat Pathol 2021; 28:335-350. [PMID: 34029275 DOI: 10.1097/pap.0000000000000304] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Mediastinal germ cell tumors (MGCTs) are the most common extragonadal germ cell tumors (GCTs) and most often arise in the anterior mediastinum with a male predilection. MGCTs also have a predilection for patients with Klinefelter syndrome and possibly other genetic conditions. MGCTs, as GCTs at other extragonadal sites, are thought to arise from germ cells improperly retained during migration along the midline during embryogenesis. Similar to their counterparts in the testes, MGCTs are classified into seminomatous and nonseminomatous GCTs. Seminomatous MGCT represents pure seminoma, whereas nonseminomatous MGCTs encompass pure yolk sac tumors, embryonal carcinoma, choriocarcinoma, mature or immature teratoma, and mixed GCTs with any combination of GCT types, including seminoma. Somatic-type or hematologic malignancies can also occur in association with a primary MGCT. MGCTs share molecular findings with GCTs at other sites, most commonly the presence of chromosome 12p gains and isochromosome i(12p). Treatment includes neoadjuvant chemotherapy followed by surgical resection of residual tumor, with the exception of benign teratomas, which require only surgical resection without chemotherapy. In this review, we highlight and provide an update on pathologic, clinical, and molecular features of MGCTs. Immunohistochemical profiles of each tumor type, as well as differential diagnostic considerations, are discussed.
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Affiliation(s)
- Ziad M El-Zaatari
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX
| | - Jae Y Ro
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX
- Weill Medical College of Cornell University (WCMC), New York, NY
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Chatani S, Onaya H, Kato S, Inaba Y. Adenocarcinoma and neuroendocrine tumor arising within presacral teratoma associated with Currarino syndrome: A case report. Indian J Radiol Imaging 2019; 29:327-331. [PMID: 31741605 PMCID: PMC6857249 DOI: 10.4103/ijri.ijri_148_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 09/03/2019] [Accepted: 09/11/2019] [Indexed: 11/17/2022] Open
Abstract
We present a case of a 59-year-old woman with a malignant tumor arising within presacral teratoma associated with Currarino syndrome (CS). A characteristic crescent-shaped sacrum was detected on preoperative image examination and the presacral mass was pathologically diagnosed as a malignant tumor associated with CS. To our knowledge, this is the first case report of presacral teratoma associated with CS coexisting with both adenocarcinoma and a neuroendocrine tumor.
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Affiliation(s)
- Shohei Chatani
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku Nagoya 464-8681, Japan
| | - Hiroaki Onaya
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku Nagoya 464-8681, Japan
| | - Seiichi Kato
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku Nagoya 464-8681, Japan
| | - Yoshitaka Inaba
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku Nagoya 464-8681, Japan
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