Teratoma
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| Teratoma | |
|---|---|
| Diagnosis in short | |
 Mature teratoma. H&E stain. | |
|
| |
| LM | classically all three germ layers: endoderm (skin, (mature) CNS), mesoderm (muscle, bone, connective tissue, blood), ectoderm (internal organs) |
| Subtypes | mature teratoma, immature teratoma, strumal carcinoid, struma ovarii |
| LM DDx | mixed germ cell tumour, squamous cell carcinoma |
| Site | ovary, testis, other |
|
| |
| Associated Dx | ovarian torsion (if large) |
| Symptoms | +/- abdominal pain (ovarian torsion) |
| Prevalence | common - esp. mature teratoma |
| Prognosis | benign |
| Clin. DDx | malignant mass (germ cell tumour, metastasis) |
Teratoma is a common germ cell tumour. Most are benign. Some are malignant. Some are quite weird.
General
- May be benign or malignant.
- Are supposed to consists of all three germ layers - this is not always true.
- May be associated with sacral agenesis.[1]
Important note:
- The site of the tumour, age and sex are very important for predicting the behaviour of a teratoma:[2]
- Immature teratomas may have a benign or malignant behaviour.
- Mature teratomas may have a benign or malignant behaviour.
Classification
- Mature.
- Common in females.
- Usually benign.
- Mature component may give rise to a malignancy like elsewhere in the body.
- Most common malignancy arising from a mature teratoma: squamous cell carcinoma.
- Immature.
- Uncommon.
- Often malignant.
- Monodermal.
- Rare.
- Highly specialized.
Mature teratoma
Features - three germ cell layers (usually):[3]
- Endoderm:
- Skin, (mature) CNS.
- Mesoderm:
- Muscle, bone, connective tissue, blood.
- Ectoderm:
- Internal organs.
Note:
- May consist of skin only - in which case it is commonly called a dermoid.
Images
Mature teratoma - low mag. (WC/Nephron)
Mature teratoma - high mag. (WC/Nephron)
Fetus in fetu
- Grouped with mature teratoma, as it is considered a well-developed mature teratoma.[4][5]
- It has been suggested they are distinct from teratomas.[6]
- They could be thought of as a parasitic twin.
- It has been suggested they are distinct from teratomas.[6]
Features:
- Discrete mass consisting of mature tissues that form well-developed structures with the normal anatomical relations.
- Separated from teratoma by the presence of a vertebral column.[7]
Immature teratoma
Features:
- Immature if neural tissue is present:[8]
- Vaguely resembles pseudostratified respiratory epithelium.
- Islands of small hyperchromatic cells - "blastema".
- +/-Cartilage.
- +/-Adipocytes.
- +/-Colonic type mucosa.
- +/-Stratified squamous epithelium (skin).
DDx:[9]
Images
Primitive neuroepithelium - high mag. (WC/Nephron)
Primitive neuroepithelium - intermed mag. (WC/Nephron)
Teratoma - mature components (WC/Nephron)
Other images:
- Immature teratoma - myxomatous stroma (webpathology.com).
- Immature teratoma - blastema (webpathology.com).
- Immature teratoma - primitive neuroepithelium (webpathology.com).
- Immature teratoma - primitive neuroepithelium (ouhsc.edu).
Grading (immature)
Based on quantity of immature neuroepithelium:[10][11][12]
- G0 - mature teratoma; no immature neuroepithelium.
- G1 - less than one lower power field (LPF) of immature neuroepithelium; LPF defined field at 4X magnification.
- G2 - 1-3 LPFs.
- G3 - more than 3 LPFs.
Note:
- LPF not adequately defined - see LPFitis. Same BS as HPF.
IHC (immature)
Features:
- Primitive neuroepithelium:[13]
- Neuron-specific enolase (NSE) +ve.
- Neuron-specific B tubulin +ve.
- Synaptophysin +ve.
Monodermal teratomas
Struma ovarii
Features:
- Thyroid tissue present - colloid is seen.
- May develop pathologies seen in the thyroid gland, e.g. papillary thyroid carcinoma.
Images
Struma ovarii - low mag. (WC/Nephron)
Struma ovarii - high mag. (WC/Nephron)
Strumal carcinoid
- Has components that suggest:
- Carcinoid (neuroendocrine tumour).
- Nuclei with stippled chromatin (salt-and-pepper chromatin).
- Thyroid - cystic spaces/follicular-like structures.
- Carcinoid (neuroendocrine tumour).
Images
Strumal carcinoid - intermed. mag. (WC/Nephron)
Strumal carcinoid - high mag. (WC/Nephron)
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Mature teratoma
CYST ("DERMOID"), RIGHT OVARY, CYSTECTOMY:
- MATURE CYSTIC TERATOMA.
See also
References
- ↑ Online 'Mendelian Inheritance in Man' (OMIM) 176450
- ↑ URL: http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/GermCell_11protocol.pdf. Accessed on: 29 April 2012.
- ↑ Moore, Keith L.; Persaud, T.V.N. (2002). The Developing Human: Clinically Oriented Embryology (7th ed.). Saunders. pp. 83. ISBN 978-0721694122.
- ↑ Heifetz, SA.; Alrabeeah, A.; Brown, BS.; Lau, H. (1988). "Fetus in fetu: a fetiform teratoma.". Pediatr Pathol 8 (2): 215-26. PMID 3045784.
- ↑ Basu, A.; Jagdish, S.; Iyengar, KR.; Basu, D. (Oct 2006). "Fetus in fetu or differentiated teratomas?". Indian J Pathol Microbiol 49 (4): 563-5. PMID 17183856.
- ↑ Basu, A.; Jagdish, S.; Iyengar, KR.; Basu, D. (Oct 2006). "Fetus in fetu or differentiated teratomas?". Indian J Pathol Microbiol 49 (4): 563-5. PMID 17183856.
- ↑ Majhi, AK.; Saha, K.; Karmakar, M.; Sinha Karmakar, K.; Sen, A.; Das, S. (2007). "Fetus in fetu--a mystery in medicine.". ScientificWorldJournal 7: 252-7. doi:10.1100/tsw.2007.56. PMID 17334616.
- ↑ RS. 2 May 2010.
- ↑ Taxy, J.; Husain, A; Montag, A. (2009). Biopsy Interpretation: The Frozen Section (1st ed.). Lippincott Williams & Wilkins. pp. 34. ISBN 978-0781767798.
- ↑ Harms D, Zahn S, Göbel U, Schneider DT (2006). "Pathology and molecular biology of teratomas in childhood and adolescence". Klin Padiatr 218 (6): 296–302. doi:10.1055/s-2006-942271. PMID 17080330.
- ↑ Ulbright TM (February 2005). "Germ cell tumors of the gonads: a selective review emphasizing problems in differential diagnosis, newly appreciated, and controversial issues". Mod. Pathol. 18 Suppl 2: S61–79. doi:10.1038/modpathol.3800310. PMID 15761467. http://www.nature.com/modpathol/journal/v18/n2s/full/3800310a.html.
- ↑ O'Connor DM, Norris HJ (October 1994). "The influence of grade on the outcome of stage I ovarian immature (malignant) teratomas and the reproducibility of grading". Int. J. Gynecol. Pathol. 13 (4): 283–9. PMID 7814189.
- ↑ Craver RD, Lipscomb JT, Suskind D, Velez MC (October 2001). "Malignant teratoma of the thyroid with primitive neuroepithelial and mesenchymal sarcomatous components". Ann Diagn Pathol 5 (5): 285–92. doi:10.1053/adpa.2001.27918. PMID 11598856.
- ↑ Gorin, I.; Sastre-Garau, X. (Jun 2008). "Strumal carcinoid tumor of the ovary.". J Clin Oncol 26 (16): 2780-1. doi:10.1200/JCO.2008.16.1620. PMID 18509188.
- ↑ Tamsen, A.; Mazur, MT. (Feb 1992). "Ovarian strumal carcinoid in association with multiple endocrine neoplasia, type IIA.". Arch Pathol Lab Med 116 (2): 200-3. PMID 1346363.