Difference between revisions of "Teratoma"

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#redirect [[Germ cell tumours#Teratoma]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Teratoma_2_low_mag.jpg
| Width      =
| Caption    = Mature teratoma. [[H&E stain]].
| Micro      = classically all three [[germ layers]]: endoderm (skin, (mature) CNS), mesoderm (muscle, bone, connective tissue, blood), ectoderm (internal organs)
| Subtypes  = [[mature teratoma]], [[immature teratoma]], [[struma carcinoid]], [[struma ovarii]]
| LMDDx      = [[mixed germ cell tumour]], [[squamous cell carcinoma]]
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[ovary]], [[testis]], other
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      =
| Symptoms  =
| Prevalence = common - esp. mature teratoma
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  =
| Other      =
| ClinDDx    =
}}
'''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.<ref name=omim176450>{{OMIM|176450}}</ref>
 
Important note:
*The site of the tumour, age and sex are very important for predicting the behaviour of a teratoma:<ref>URL: [http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/GermCell_11protocol.pdf http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/GermCell_11protocol.pdf]. Accessed on: 29 April 2012.</ref>
**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):<ref>{{cite book |author=Moore, Keith L.; Persaud, T.V.N.|title=The Developing Human: Clinically Oriented Embryology |publisher=Saunders |location= |year=2002 |pages= 83 |edition=7th |isbn=978-0721694122 |oclc= |doi= |accessdate=}}</ref>
#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=====
<gallery>
Image:Teratoma_2_low_mag.jpg | Mature teratoma - low mag. (WC/Nephron)
Image:Teratoma_2_high_mag.jpg | Mature teratoma - high mag. (WC/Nephron)
</gallery>
 
====Fetus in fetu====
*Grouped with ''mature teratoma'', as it is considered a well-developed mature teratoma.<ref name=pmid3045784>{{Cite journal  | last1 = Heifetz | first1 = SA. | last2 = Alrabeeah | first2 = A. | last3 = Brown | first3 = BS. | last4 = Lau | first4 = H. | title = Fetus in fetu: a fetiform teratoma. | journal = Pediatr Pathol | volume = 8 | issue = 2 | pages = 215-26 | month =  | year = 1988 | doi =  | PMID = 3045784 }}</ref><ref name=pmid17183856>{{Cite journal  | last1 = Basu | first1 = A. | last2 = Jagdish | first2 = S. | last3 = Iyengar | first3 = KR. | last4 = Basu | first4 = D. | title = Fetus in fetu or differentiated teratomas? | journal = Indian J Pathol Microbiol | volume = 49 | issue = 4 | pages = 563-5 | month = Oct | year = 2006 | doi =  | PMID = 17183856 }}</ref>
**It has been suggested they are distinct from teratomas.<ref>{{Cite journal  | last1 = Basu | first1 = A. | last2 = Jagdish | first2 = S. | last3 = Iyengar | first3 = KR. | last4 = Basu | first4 = D. | title = Fetus in fetu or differentiated teratomas? | journal = Indian J Pathol Microbiol | volume = 49 | issue = 4 | pages = 563-5 | month = Oct | year = 2006 | doi =  | PMID = 17183856 }}</ref>
***They could be thought of as a parasitic twin.
 
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.<ref name=pmid17334616>{{Cite journal  | last1 = Majhi | first1 = AK. | last2 = Saha | first2 = K. | last3 = Karmakar | first3 = M. | last4 = Sinha Karmakar | first4 = K. | last5 = Sen | first5 = A. | last6 = Das | first6 = S. | title = Fetus in fetu--a mystery in medicine. | journal = ScientificWorldJournal | volume = 7 | issue =  | pages = 252-7 | month =  | year = 2007 | doi = 10.1100/tsw.2007.56 | PMID = 17334616 }}</ref>
 
===Immature teratoma===
Features:
*Immature if neural tissue is present:<ref>RS. 2 May 2010.</ref>
**Vaguely resembles pseudostratified respiratory epithelium.
*Islands of small hyperchromatic cells - "blastema".
*+/-Cartilage.
*+/-Adipocytes.
*+/-Colonic type mucosa.
*+/-Stratified squamous epithelium (skin).
 
DDx:<ref>{{Ref BITFS|34}}</ref>
*[[Cerebellum]].
*[[Retina]].
 
=====Images=====
<gallery>
Image:Immature_teratoma_high_mag.jpg | Primitive neuroepithelium - high mag. (WC/Nephron)
Image:Primitive_neuroepithelium_intermed_mag.jpg | Primitive neuroepithelium - intermed mag. (WC/Nephron)
Image:Teratoma_intermed_mag.jpg | Teratoma - mature components (WC/Nephron)
</gallery>
 
Other images:
*[http://www.webpathology.com/image.asp?n=5&Case=35 Immature teratoma - myxomatous stroma (webpathology.com)].
*[http://www.webpathology.com/image.asp?n=6&Case=35 Immature teratoma - blastema (webpathology.com)].
*[http://www.webpathology.com/image.asp?n=7&Case=35 Immature teratoma - primitive neuroepithelium (webpathology.com)].
*[http://moon.ouhsc.edu/kfung/jty1/opaq/PathQuiz/N0C001-PQ01-M.htm Immature teratoma - primitive neuroepithelium (ouhsc.edu)].
 
====Grading (immature)====
Based on quantity of immature neuroepithelium:<ref name=pmid17080330>{{cite journal |author=Harms D, Zahn S, Göbel U, Schneider DT |title=Pathology and molecular biology of teratomas in childhood and adolescence |journal=Klin Padiatr |volume=218 |issue=6 |pages=296–302 |year=2006 |pmid=17080330 |doi=10.1055/s-2006-942271 |url=}}</ref><ref name=pmid15761467>{{cite journal |author=Ulbright TM |title=Germ cell tumors of the gonads: a selective review emphasizing problems in differential diagnosis, newly appreciated, and controversial issues |journal=Mod. Pathol. |volume=18 Suppl 2 |issue= |pages=S61–79 |year=2005 |month=February |pmid=15761467 |doi=10.1038/modpathol.3800310 |url=http://www.nature.com/modpathol/journal/v18/n2s/full/3800310a.html}}</ref><ref name=pmid7814189>{{cite journal |author=O'Connor DM, Norris HJ |title=The influence of grade on the outcome of stage I ovarian immature (malignant) teratomas and the reproducibility of grading |journal=Int. J. Gynecol. Pathol. |volume=13 |issue=4 |pages=283–9 |year=1994 |month=October |pmid=7814189 |doi= |url=}}</ref>
*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:<ref name=pmid11598856>{{cite journal |author=Craver RD, Lipscomb JT, Suskind D, Velez MC |title=Malignant teratoma of the thyroid with primitive neuroepithelial and mesenchymal sarcomatous components |journal=Ann Diagn Pathol |volume=5 |issue=5 |pages=285–92 |year=2001 |month=October |pmid=11598856 |doi=10.1053/adpa.2001.27918 |url=}}</ref>
**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=====
<gallery>
Image:Struma_ovarii_-_low_mag.jpg | Struma ovarii - low mag. (WC/Nephron)
Image:Struma_ovarii_-_high_mag.jpg | Struma ovarii - high mag. (WC/Nephron)
</gallery>
====Strumal carcinoid====
Features:<ref name=pmid18509188>{{Cite journal  | last1 = Gorin | first1 = I. | last2 = Sastre-Garau | first2 = X. | title = Strumal carcinoid tumor of the ovary. | journal = J Clin Oncol | volume = 26 | issue = 16 | pages = 2780-1 | month = Jun | year = 2008 | doi = 10.1200/JCO.2008.16.1620 | PMID = 18509188 }}</ref><ref>{{Cite journal  | last1 = Tamsen | first1 = A. | last2 = Mazur | first2 = MT. | title = Ovarian strumal carcinoid in association with multiple endocrine neoplasia, type IIA. | journal = Arch Pathol Lab Med | volume = 116 | issue = 2 | pages = 200-3 | month = Feb | year = 1992 | doi =  | PMID = 1346363 }}</ref>
*Has components that suggest:
*#Carcinoid ([[neuroendocrine tumour]]).
*#*Nuclei with stippled chromatin (salt-and-pepper chromatin).
*#[[Thyroid]] - cystic spaces/follicular-like structures.
 
=====Images=====
<gallery>
Image:Strumal_carcinoid_-_intermed_mag.jpg | Strumal carcinoid - intermed. mag. (WC/Nephron)
Image:Strumal_carcinoid_-_high_mag.jpg | Strumal carcinoid - high mag. (WC/Nephron)
</gallery>
 
===Sign out===
====Mature teratoma====
<pre>
CYST ("DERMOID"), RIGHT OVARY, CYSTECTOMY:
- MATURE CYSTIC TERATOMA.
</pre>
 
 
 
==See also==
*[[Germ cell tumours]].
*[[Ovarian tumours]].
 
==References==
{{Reflist|2}}
 
[[Category:Gynecologic pathology]]
[[Category:Germ cell tumours]]

Revision as of 22:49, 12 July 2013

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, struma carcinoid, struma ovarii
LM DDx mixed germ cell tumour, squamous cell carcinoma
Site ovary, testis, other
Prevalence common - esp. mature teratoma

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

  1. Mature.
    • Common in females.
    • Usually benign.
    • Mature component may give rise to a malignancy like elsewhere in the body.
  2. Immature.
    • Uncommon.
    • Often malignant.
  3. Monodermal.
    • Rare.
    • Highly specialized.

Mature teratoma

Features - three germ cell layers (usually):[3]

  1. Endoderm:
    • Skin, (mature) CNS.
  2. Mesoderm:
    • Muscle, bone, connective tissue, blood.
  3. 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.

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:

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:

Images

  • Struma ovarii - low mag. (WC/Nephron)

  • Struma ovarii - high mag. (WC/Nephron)

Strumal carcinoid

Features:[14][15]

  • Has components that suggest:
    1. Carcinoid (neuroendocrine tumour).
      • Nuclei with stippled chromatin (salt-and-pepper chromatin).
    2. Thyroid - cystic spaces/follicular-like structures.
Images

  • Strumal carcinoid - intermed. mag. (WC/Nephron)

  • Strumal carcinoid - high mag. (WC/Nephron)

Sign out

Mature teratoma

CYST ("DERMOID"), RIGHT OVARY, CYSTECTOMY:
- MATURE CYSTIC TERATOMA.


See also

References

  1. ↑ Online 'Mendelian Inheritance in Man' (OMIM) 176450
  2. ↑ URL: http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/GermCell_11protocol.pdf. Accessed on: 29 April 2012.
  3. ↑ Moore, Keith L.; Persaud, T.V.N. (2002). The Developing Human: Clinically Oriented Embryology (7th ed.). Saunders. pp. 83. ISBN 978-0721694122.
  4. ↑ Heifetz, SA.; Alrabeeah, A.; Brown, BS.; Lau, H. (1988). "Fetus in fetu: a fetiform teratoma.". Pediatr Pathol 8 (2): 215-26. PMID 3045784.
  5. ↑ 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.
  6. ↑ 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.
  7. ↑ 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.
  8. ↑ RS. 2 May 2010.
  9. ↑ Taxy, J.; Husain, A; Montag, A. (2009). Biopsy Interpretation: The Frozen Section (1st ed.). Lippincott Williams & Wilkins. pp. 34. ISBN 978-0781767798.
  10. ↑ 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.
  11. ↑ 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.
  12. ↑ 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.
  13. ↑ 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.
  14. ↑ 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.
  15. ↑ 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.
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