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Difference between revisions of "Teratoma"
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fix ectoderm & endoderm - thanks JD
(→Mature teratoma: fix mixed up ectoderm & endoderm) |
(fix ectoderm & endoderm - thanks JD) |
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| Width = | | Width = | ||
| Caption = Mature teratoma. [[H&E stain]]. | | Caption = Mature teratoma. [[H&E stain]]. | ||
| Micro = classically all three [[germ layers]]: | | Micro = classically all three [[germ layers]]: ectoderm (skin, (mature) CNS), mesoderm (muscle, bone, connective tissue, blood), endoderm (internal organs) | ||
| Subtypes = [[mature teratoma]], [[immature teratoma]], [[strumal carcinoid]], [[struma ovarii]] | | Subtypes = [[mature teratoma]], [[immature teratoma]], [[strumal carcinoid]], [[struma ovarii]], [[fetus in fetu]] (subtype of ''mature teratoma'') | ||
| LMDDx = [[mixed germ cell tumour]], [[squamous cell carcinoma]] | | LMDDx = [[mixed germ cell tumour]], [[squamous cell carcinoma]], [[epidermoid cyst of the testis]] (testis only) | ||
| Stains = | | Stains = | ||
| IHC = | | IHC = | ||
| Line 12: | Line 12: | ||
| Molecular = | | Molecular = | ||
| IF = | | IF = | ||
| Gross = | | Gross = may contain identifiable hair and/or teeth, typically cystic and solid | ||
| Grossing = | | Grossing = [[orchiectomy grossing]] | ||
| Staging = [[testicular cancer staging]] | |||
| Site = [[ovary]], [[testis]], other | | Site = [[ovary]], [[testis]], other | ||
| Assdx = ovarian torsion (if large) | | Assdx = ovarian torsion (if large) | ||
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| Rads = | | Rads = | ||
| Endoscopy = | | Endoscopy = | ||
| Prognosis = benign | | Prognosis = benign or malignant, recurrences with (malignant) teratoma usu. favourable | ||
| Other = | | Other = | ||
| ClinDDx = malignant mass ([[germ cell tumour]], metastasis) | | ClinDDx = malignant mass ([[germ cell tumour]], metastasis) | ||
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*Are supposed to consists of all three [[germ layers]] - this is not always true. | *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> | *May be associated with sacral agenesis.<ref name=omim176450>{{OMIM|176450}}</ref> | ||
*Teratoma only recurrences of germ cell tumours have good prognosis.<ref name=pmid10680894>{{Cite journal | last1 = Michael | first1 = H. | last2 = Lucia | first2 = J. | last3 = Foster | first3 = RS. | last4 = Ulbright | first4 = TM. | title = The pathology of late recurrence of testicular germ cell tumors. | journal = Am J Surg Pathol | volume = 24 | issue = 2 | pages = 257-73 | month = Feb | year = 2000 | doi = | PMID = 10680894 }}</ref> | |||
Important note: | Important note: | ||
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**Immature teratomas may have a benign or malignant behaviour. | **Immature teratomas may have a benign or malignant behaviour. | ||
**Mature teratomas may have a benign or malignant behaviour. | **Mature teratomas may have a benign or malignant behaviour. | ||
*CNS teratomas are overrepresented in males.<ref>{{Cite journal | last1 = Zygourakis | first1 = CC. | last2 = Davis | first2 = JL. | last3 = Kaur | first3 = G. | last4 = Ames | first4 = CP. | last5 = Gupta | first5 = N. | last6 = Auguste | first6 = KI. | last7 = Parsa | first7 = AT. | title = Management of central nervous system teratoma. | journal = J Clin Neurosci | volume = 22 | issue = 1 | pages = 98-104 | month = Jan | year = 2015 | doi = 10.1016/j.jocn.2014.03.039 | PMID = 25150764 }}</ref> | |||
**Intracranial teratomas are usually located in midline locations such as the pineal region, suprasellar cistern, basal ganglia, and thalamus.<ref>{{Cite journal | last1 = Lee | first1 = YH. | last2 = Park | first2 = EK. | last3 = Park | first3 = YS. | last4 = Shim | first4 = KW. | last5 = Choi | first5 = JU. | last6 = Kim | first6 = DS. | title = Treatment and outcomes of primary intracranial teratoma. | journal = Childs Nerv Syst | volume = 25 | issue = 12 | pages = 1581-7 | month = Dec | year = 2009 | doi = 10.1007/s00381-009-0974-8 | PMID = 19693515 }}</ref> | |||
===Classification=== | ===Classification=== | ||
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Note: | Note: | ||
*May consist of skin only - in which case it is commonly called a ''dermoid''. | *May consist of skin only - in which case it is commonly called a ''dermoid''. | ||
DDx: | |||
*[[Immature teratoma]]. | |||
*[[Mixed germ cell tumour]]. | |||
*[[Epidermoid cyst of the testis]]. | |||
====Images==== | ====Images==== | ||
=====Case 1===== | |||
<gallery> | <gallery> | ||
Image:Teratoma_2_low_mag.jpg | Mature teratoma - low mag. (WC/Nephron) | Image:Teratoma_2_low_mag.jpg | Mature teratoma - low mag. (WC/Nephron) | ||
Image:Teratoma_2_high_mag.jpg | Mature teratoma - high mag. (WC/Nephron) | Image:Teratoma_2_high_mag.jpg | Mature teratoma - high mag. (WC/Nephron) | ||
</gallery> | |||
=====Case 2===== | |||
<gallery> | |||
Image: Mature ovarian teratoma with mature neural elements -- low mag.jpg | MT - low mag. (WC) | |||
Image: Mature ovarian teratoma with mature neural elements -- intermed mag.jpg | MT - intermed. mag. (WC) | |||
Image: Mature ovarian teratoma with mature neural elements -- high mag.jpg | MT - high mag. (WC) | |||
</gallery> | |||
=====Case 3===== | |||
<gallery> | |||
Image: Choroid plexus in teratoma -- low mag.jpg | Neural tissue in teratoma - low mag. (WC) | |||
Image: Choroid plexus in teratoma -- intermed mag.jpg | Neural tissue in teratoma - intermed. mag. (WC) | |||
Image: Choroid plexus in teratoma -- high mag.jpg | Neural tissue in teratoma - high mag. (WC) | |||
</gallery> | </gallery> | ||
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Features: | Features: | ||
*Thyroid tissue present - colloid is seen. | *Thyroid tissue present - colloid is seen. | ||
**May develop pathologies seen in the [[thyroid gland]] | **May develop pathologies seen in the [[thyroid gland]]. | ||
Notes: | |||
*Various quantity requirements: | |||
**Wei ''et al.'' state that the thyroid tissue ''must'' comprise >50% of the mass ''or'' have a thyroid-associated malignancy (e.g. [[papillary thyroid carcinoma]]) for the label ''struma ovarii''.<ref name=pmid26374222>{{Cite journal | last1 = Wei | first1 = S. | last2 = Baloch | first2 = ZW. | last3 = LiVolsi | first3 = VA. | title = Pathology of Struma Ovarii: A Report of 96 Cases. | journal = Endocr Pathol | volume = | issue = | pages = | month = Sep | year = 2015 | doi = 10.1007/s12022-015-9396-1 | PMID = 26374222 }}</ref> | |||
**Nucci and Oliva state the thyroid tissue must be "predominant".<ref name=Ref_GP524>{{Ref GP|524}}</ref> | |||
*Benign thyroid tissue is not uncommon in teratomas (5-20%).<ref name=pmid26374222/> | |||
====Images==== | ====Images==== | ||
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Image:Struma_ovarii_-_high_mag.jpg | Struma ovarii - high mag. (WC/Nephron) | Image:Struma_ovarii_-_high_mag.jpg | Struma ovarii - high mag. (WC/Nephron) | ||
</gallery> | </gallery> | ||
===Strumal carcinoid=== | ===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> | 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> | ||
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Image:Strumal_carcinoid_-_high_mag.jpg | Strumal carcinoid - high mag. (WC/Nephron) | Image:Strumal_carcinoid_-_high_mag.jpg | Strumal carcinoid - high mag. (WC/Nephron) | ||
</gallery> | </gallery> | ||
===Epidermoid cyst=== | |||
Some authors consider [[epidermoid cyst]] as a monodermal teratoma.<ref>{{Cite journal | last1 = Aneiros-Fernandez | first1 = J. | last2 = Arias-Santiago | first2 = S. | last3 = Cancela-Diez | first3 = B. | last4 = O'Valle | first4 = F. | last5 = Cachaza | first5 = JA. | title = Intratesticular epidermoid cyst: a rare tumor. | journal = J Clin Med Res | volume = 2 | issue = 6 | pages = 281-3 | month = Dec | year = 2010 | doi = 10.4021/jocmr474w | PMID = 22043263 }}</ref> | |||
==Molecular== | |||
[[Testis]] - divided into ''prepubertal'' and ''postpubertal'': | |||
*Postpubertal (testicular) teratoma typically have ''isochromosome 12p i(12p)''.<ref name=pmid16547466>{{Cite journal | last1 = Poulos | first1 = C. | last2 = Cheng | first2 = L. | last3 = Zhang | first3 = S. | last4 = Gersell | first4 = DJ. | last5 = Ulbright | first5 = TM. | title = Analysis of ovarian teratomas for isochromosome 12p: evidence supporting a dual histogenetic pathway for teratomatous elements. | journal = Mod Pathol | volume = 19 | issue = 6 | pages = 766-71 | month = Jun | year = 2006 | doi = 10.1038/modpathol.3800596 | PMID = 16547466 }}</ref> | |||
**Prepubertal tumours lack this molecular change. | |||
[[Ovary]]: | |||
*[[Mixed germ cell tumour]]s of the ovary also typically have i(12p).<ref name=pmid16547466/> | |||
**Pure ''mature teratomas'' and pure ''immature teratomas'' do not have this changes. | |||
==Sign out== | ==Sign out== | ||
===Mature teratoma=== | ===Mature teratoma=== | ||
<pre> | |||
Mass, Right Ovary, Excision: | |||
- Mature teratoma with dermal elements and mature neural tissue. | |||
- NEGATIVE for evidence of malignancy. | |||
</pre> | |||
====Block letters==== | |||
<pre> | <pre> | ||
CYST ("DERMOID"), RIGHT OVARY, CYSTECTOMY: | CYST ("DERMOID"), RIGHT OVARY, CYSTECTOMY: | ||
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[[Category:Gynecologic pathology]] | [[Category:Gynecologic pathology]] | ||
[[Category:Germ cell tumours]] | [[Category:Germ cell tumours]] | ||
[[Category:Neuropathology]] | |||