Teratoma

Teratoma is a germogenic neoplasm, which is formed during the intrauterine period from embryonic cells. The structure of the tumor includes elements of embryonic layers that separate into zones of the so-called "gill" slit and into the junction of embryonic furrows.

Teratoma as a germogenic tumor can form in the sex glands - ovaries and testicles, as well as in the sacrococcygeal region, in extragonadal zones, such as the following:

• The retroperitoneal zone.
• Presacral area.
• Mediastinum.
• Plexus of the ventricles of the brain, in the pituitary.
• Head - nose, ears, orbit, neck.
• Oral cavity.

Like other germ cell tumors, the teratoma increases and grows in parallel with the growth of the whole organism and is clinically manifested depending on the classification of the tumor - benign or malignant, and also from the site of localization.

Teratoma: ICD code 10

According to the generally accepted classification of diseases, ICD-10, which is a tool for accurate description of the diagnosis and concretizing heading, the teratoma is fixed in the coded nomenclature of neoplasms, within the block M906-909 - germogenic, nucleated neoplasms.

It happens that doctors use only one code to diagnose a tumor when they describe what a teratoma is: ICD-10-O M9084 / 0 is a dermoid cyst. This code describes a benign neoplasm whose structure includes the mature cells of all three embryonic leaves - ectoderm (skin, hair, nerve tissue), mesoderm (parts of skeletal muscle, cartilage, bones, teeth), endoderms - epithelial cells of bronchi, intestines) .

It should be noted that the dermoid cyst is only one of the varieties of teratomas, but not a synonym, and even more so, not the only histological form. More precise will be the expanded variative definition according to the rubricator, since the teratoma differs according to the histological structure and can be mature, immature, malignant.

Teratoma, ICD-10:

• M 9080/0 - The teratoma is benign.
• M 9080/1 - Teratoma without further clarification (BDU).
• M 9080/3 - malignant teratoma without further clarification (BDU).
• M 9081/5 - Teratocarcinoma.
• M 9082/3 - Malignant teratoma undifferentiated.
• M 9083/3 - Malignant teratoma intermediate.
• M 9084/3 - Teratoma with malignant transformation.

Causes of teratoma

The etiology and causes of the teratoma are not specified, there are several theoretical versions, and one of them found great support among practicing doctors and genetic scientists.

This hypothesis states that the causes of teratoma lie in the germinogenic nature of the tumor.

Germinativ or androblastomas are primary, primordial germ cells of the embryo gonads. These cells form three embryonic leaves - the outer (ectoderm cells), the middle (mesoderm cells), the inner (endoderm cells). In favor of the version of germinogenic etiology, teratoma is a typical localization of tumors in the genital organs, glands. In addition, an indisputable argument can be considered a microscopic structure, which is uniform for all localization of teratom.

Teratoma as a tumor is formed from the epithelium of the gonads, which is the initial basis for the formation and further development of all tissues of the body. Under the influence of genetic, somatic, trophoblastic factors, the polypotent epithelium is able to differentiate into benign and malignant neoplasms. Tumors tend to localize in the epithelium of the reproductive glands of the fetus-ovaries or testicles, but teratomas are much more often than other varieties of germogenic formations in other areas, due to the delay, slow movement of the cells of the embryonic epithelium to genetically determined zones of the gonad bookmark. This occurs during the intrauterine development on the 44-45th week.

Distribution by teratom:

• The sacrococcygeal zone is 25-30%
• Ovaries - 25-30%
• Eggs - 5-7%
• The retroperitoneal space is 10-15%
• Presakralnaya zone - 5-7%
• Sedation - 5%
• Other zones, parts of the body.

In general, it is believed that the causes of teratoma lie in the area of abnormal embryogenesis (chromosomal abnormality of cells). The question of the etiologic base, refined and confirmed clinically, and also statistically, is becoming more urgent due to the fact that benign embryonic tumors became diagnosed more often every year by 2-3%.

[1], [2], [3], [4]

Teratoma in children

In neonatal surgery, among all germinogenic tumors, benign teratoid formations are most common, and malignant ones - teratoblastomas are diagnosed in 15-20% of cases. Teratoma in children is a defect in the intrauterine development, embryogenesis and is localized most often in the sacrococcygeal zone in boys and in ovaries in girls. The statistical ratio of such localization is 30% each. Further, the retroperitoneal space is located in the list of teratoma zones, much less often, only 5-7% of the tumor develops in the testicles of the male fetus, very rarely in the mediastinum.

Clinically, the teratoma in children can manifest at different times. Teratom sacrum can be seen almost in the first hours after birth, in addition, it can be detected using ultrasound before the birth of the child. Ovarian ternate manifests later, most often in the pubertal period, when changes occur in the hormonal system.

1. Statistics show that the teratoma of the coccyx is most often formed in girls and has a benign course, despite a rather large size. Large tumors are more likely to give birth, but if the formation fills the pelvic cavity and does not damage the bone structure, the outcome of labor is favorable (cesarean section is shown and tumor is removed from the second month of life). The structure of the teratoma can be diverse and consist of particles of the intestinal epithelium, bone tissue, and even rudimentary elements.
2. As for ovarian teratomas, they are much more often malignant than similar dermoids in adult women. These teratoblastomas are quickly malignant, they look like multicameral cysts with embryonic growths. The tumor metastasizes into the lungs and has an unfavorable prognosis.
3. Teratoma in male children, germinogenous testicular tumor is diagnosed at the age of 2 years due to its visual manifestation. Unlike neoplasms in the ovaries, testicular teratomas are usually benign and rarely malignant. There are descriptions of rare malignant tumors of testicles in boys of the puberty period, but similar formations are not common.
4. Germinogenic tumors of the retroperitoneal zone, mesenteric teratomas are diagnosed at an early age of up to 2 years. Such formations are statistically diagnosed more often in girls and are quite large. Teratoma of the retroperitoneal space is 95% benign in nature and must be radically removed.
5. Teratoma of the oral cavity is also called pharyngeal polyps. This disease is diagnosed during the intrauterine period or immediately after childbirth. A tumor that reaches a large size can obstruct births and carries the risk of asphyxiation of the infant, but they are rarely malignant and with appropriate surgical obstetrics, the outcome can be favorable in 90% of cases.
6. Teratomas of the brain in 45-50% are malignant, localized in the area of the base of the skull, can metastasize to the lungs. Benign teratomas of this type are somehow capable of malignization, especially in boys (accompanied by pathological endocrine disorders)
7. The most dangerous and, unfortunately, unfavorable prognosis are teratoblastomas, large polycystic tumors, and solid teratomas containing immature, non-defiberted embryonic tissues. Such tumors develop rapidly and are accompanied by metastases. Treatment, which involves teratoma in children, is to remove it. Then, after a morphological study of tumor tissue, there is no need for benign treatment, and malignant tumors are treated accordingly. Modern developments in the field of pediatric oncology make it possible to achieve a much higher survival rate of children with teratoblastomas than 20 years ago. The prognosis depends on the teratoblastoma localization zone, the age of the child and the concomitant pathologies.

Teratoma in the fetus

Fetal teratoma among all types of germigenogenic neoplasms is characterized by a sufficiently large percentage of favorable flow, therefore it is defined as a benign embryonic tumor. The tumor is formed in the early stages of embryogenesis as a result of chromosomal abnormalities, when the cells of the embryonic leaves migrate into atypical zones for normal development, mainly in the so-called "gill" slits and fusion of embryonic furrows.

The most common teratoma in the fetus and newborns in the coccyx, sacrum, such formations are diagnosed in 40% of all cases of detected tumors. The least common teratoma is formed in the neck region - only 4-5% of cases, it can also form in the ovaries or testicles, in the brain, mediastinum, retroperitoneum. Rarity can be considered a teratom located in the face or in the area of the lymph nodes, as a rule, such formations, if any, are visually determined later, at an older age due to the growth and increase of the tumor.

Most often, the fetal teratoma is diagnosed in the sacrococcygeal region - CKT (sacrococcygeal teratoma). This tumor is formed in utero and is 1 case for every 40,000 births. Ratio by gender - 80% of girls, 20% of boys. Cochlear teratomas are fairly large cysts with mucoid or serous contents. The size of the tumor varies from 1 centimeter to 30 centimeters, the most common formations are 8-10 centimeters. Among CCTs, a low percentage of malignancies, but a high risk of concomitant renal pathology (hydronephrosis), rectum and urethra. In addition, CCP requires increased blood supply, which leads to rapid heartbeat of the fetus and carries the risk of heart failure. Deformity of nearby organs is also possible, their anomalies depend on the direction of development and growth of the teratoma (bladder, rectum or vagina). The percentage of unfavorable outcome is very high, more than half of the babies die due to heart failure.

Diagnosis of CCT is accurate enough, coccyx teratoma can be detected already at the 22-1 week of pregnancy, when ultrasound is seen atypically enlarged uterus, as with polyhydramnios. This result gives rise to further examination of the mother and fetus.

The tumor of the cystic structure is subject to prenatal puncturing and emptying. Under the control of ultrasound. It is also recommended to perform a teratoma puncture only after the fetus has formed lungs. Sometimes doctors decide to observe the teratoma right up to the birth, which is performed by the method of caesarean section. After the birth of the child, they immediately operate and conduct a morphological examination of the removed material.

Teratoma in the fetus, statistics:

• Teratoma is diagnosed 1.5 times more often in the female sex.
• Benign organoleid teratomas of the fetus account for 73-75% of all detected prenatal tumors.

Pregnancy and teratoma

Teratoma, although considered most of the benign tumor disease, can become a serious obstacle - not so much for pregnancy as for the birth of a baby. Most often, the neoplasm is formed in the ovaries of a woman long before conception, often manifested only in the period of hormonal changes - pubertal period, with menopause, and also during pregnancy.

The etiology of germinogenic formations has not yet been specified, but it is believed that the cause can be chromosomal cell anomalies. From the type of cells depends on what teratoma will be - immature or mature. Accordingly, the "neighborhood" - pregnancy and teratoma - will develop. If the tumor contains embryonic tissues (nerve, fat, bone, muscle), it is defined as a mature teratoma, if the cells are not nondifferentiated and not morphologically defined, immature, one that is prone to malignancy (transformation into a malignant tumor).

Mature neoplasms are usually benign, but both species need radical removal, there are no other ways to cure teratoma.

Ovulation with teratoma does not suffer, and therefore a completely normal conception occurs. But when pregnancy occurs, and the teratoma continues to develop, serious complications are possible, even until the fetus is terminated. Among the main risks, doctors note the following:

• A sharp increase in the tumor in size, due to hormonal changes in the body and other factors.
• Pressure on nearby organs.
• Torsion of the legs of the cystic teratoma, clinical picture of the "acute abdomen".

Symptoms of teratoma

Clinical symptoms of teratoma appear in the same way as signs of any other kind of germinogenic formations, it all depends on the localization, size and time of tumor formation during embryogenesis. The earlier the teratoma begins, the more potential risks for the development of the organism in childhood and the risk of malignancy of the tumor in adult patients.

Symptoms of the teratoma are determined by the places of its localization, which most often are the sacrococcygeal zone, glands of the genital organs, the retroperitoneal region, the base of the skull, the mediastinum, the oral cavity, and rarely the brain. 1.

CKT - sacrococcygeal teratoma. This tumor "leads" in the statistical primacy, is diagnosed from the first days of birth, mainly in girls. The neoplasm has a rounded shape, it may be located behind the sacral zone, behind the coccyx. CCP is most often large - up to 30 centimeters, in the intrauterine period may cause complications in the development of the fetus, but the greatest danger of the teratoma is for the birth itself. Since CCP is determined by ultrasound before the time of delivery, that is, in the fetus, it is not possible to describe the symptomatology. Teratoblastomy coccyx are very rare, they develop slowly, visually not shown. The main danger of teratoblast is asymptomatic development. Malignant tumor begins to manifest only in the stage when oncoprocess is already started. The first alarm signals can be broken bowel movements and urination (pain). 2.

The etching of the ovary is randomized in girls, young women. Asymptomatic development of the tumor is a characteristic feature of the teratoma, it is extremely rare to have a feeling of pain similar to premenstrual, or heaviness in the lower abdomen. 3.

Teratoma of the testicle is determined more often than germinogenic ovarian formations in women for quite understandable reasons - visual signs. Tumor occurs in boys, young men under the age of 18-20 years. Among all tumors of the testicles, the teratoma is more than 50%. The formation of the tumor occurs in utero, often seen immediately after the birth of the boy. It should be noted that early diagnosis of testicular teratoma allows to speak about 85-90% of successful outcomes after its removal. A later detection of the tumor carries the risk of malignancy, beginning with the pubertal period, the probability of the degeneration of the teratoma into malignant formation is increasing every year. Asymptomatic flow, almost no pain signs in the initial period of formation and development of teratoma are typical properties of such tumors. Pain in the affected testicle can talk about the destruction of the teratoma and its possible malignancy. 4.

Teratoma of the mediastinum with the development process can be manifested by pain in the vaginal space due to pressure on the pleural cavity. In addition, heart rhythm disturbances, fever, shortness of breath may be the first signs of a tumor increase. 5.

Oral cavity throat, throat, or congenital polyp is diagnosed in infancy, often in the intrauterine period with the help of ultrasound. Polyps can be quite large and cause certain difficulties in the process of childbirth (asphyxiation of the child). 6.

Teratoma of the retroperitoneal space is more common in children and manifests itself as symptoms characteristic of gastrointestinal diseases - transient pain in the middle of the abdomen, nausea, indigestion, less often - pain in the heart. Teratoma is located closer to the diaphragm, so it can cause a feeling of lack of air, shortness of breath, especially with tumors of large sizes. 7.

Teratoma of the brain is most often detected in the pituitary or in the base of the skull. Symptoms of teratoma are similar to those of endocrine disorders, the clinic is damaged brain structures, which is caused by compression of tissues and the vascular system.

Summarizing the clinical manifestations of teratoma, it can be noted that such tumors, if not diagnosed in infancy, are asymptomatic, they are called "mute" tumors. The manifestation of the clinic, as a rule, speaks of an increase in teratoma and a significant squeezing of nearby organs, and severe pain can indicate a malignant course of the process.

Types of teratoma

The histological structure of the teratoma can determine its species - mature, immature or teratom with malignant transformation.

There are following types of teratoma:

• Mature teratoma is a tumor consisting of differentiated tissues of embryonic layers (one or three at a time). Most mature teratomas are diagnosed as dermoid cysts. Dermoid cyst, that is, a mature tumor in turn is divided into cystic or solid.
• A solid teratoma is practically a 95% benign neoplasm with a smooth, less often bumpy surface. The structure of a mature solid teratoma may include particles of cartilage, bone embryonic tissue, intestinal epithelial cells, and multiple small cavities (cysts) containing mucus.
• Cystic teratoma is large in size, smooth surface. The structure can be varied, but most often contains 1-2 full-blown cysts, inside which are embryonic particles of sebaceous, fat glands. Between the cysts within the teratoma, hair and their follicles, tooth elements, cartilaginous, muscle tissue, brain tissue are revealed.

The tumor, which is defined as an immature teratoma, is a neoplasm whose structure includes elements of all three embryonic, embryonic leaflets. Most often, immature teratoma is formed at the stage of organogenesis, when the cells are just beginning the process of differentiation. The dimensions of the immature neoplasm may vary, the consistency is multilayered, difficult to detect microscopically. Most often in the immature teratoma there are foci of flat epithelium, focal inclusions of respiratory, intestinal cells. A characteristic feature for formations of this type is the presence of neurogenic epithelial cells, which indicates the possible formation of neuroblastoma. Often, an immature tumor is combined in histology, that is, it contains parts of the tissue of a mature solid teratoma. It is believed that the immature type of neoplasm is potentially dangerous in the sense of transformation into a malignant tumor. Metastasis of malignant teratomas occurs through lymph or blood flow.

Teratoma with malignant transformation is diagnosed as a very rare disease, which is most often transformed into squamous cell carcinoma, melanoma or adenocarcinoma.

Rarely are the types of teratoma, which are related to monodermal formation. It is an ovarian carcinoid, an ovarian tumor alone or in combination with each other. In a teratoma, which is diagnosed as a struma, the tissues of the endocrine glands, usually of the thyroid gland, are contained. The symptomatic of the struma is similar to the clinical manifestations of hyperthyroidism.

Ovarian Terratoma

Teratoma of the ovary is a germogenic tumor that has two kinds - a mature teratoma and an immature teratoma. The tumor is formed from the cells of the embryonic leaflets, which gradually are located and localized in atypical for normal development of the body places. One of the common etiological causes of the formation of the ovarian teratoma is anomalies of chromosomes during embryogenesis.

The ovarian tearatotype, defined as mature, is considered a benign formation, it is called the dermoid cyst.

Immature teratoma is often prone to transformation into a malignant tumor, accompanied by metastases and has an unfavorable prognosis.

Teratoma of the testicle

Among germigenic testicular tumors in men, about 40% is occupied by teratoma of the testicle. It is believed that most of the tumors of the male genital glands are formed from embryonic cells, potentially destined for the production of sperm (germino is a seed). Statistics say that about 5 years, testicular teratoma can develop asymptomatically if it is small. Larger tumors are detected either in the prenatal period with the help of a fetus ultrasound, or immediately after the birth of a child, since their visual diagnosis is not difficult.

Most often, the teratoma begins to increase in the pubertal period and is diagnosed in adolescent boys, such cases account for about 40% of all detected sex gland tumors. In adults, the teratoma is extremely rare - no more than 5-7% of the total number of tumors. Like the ovarian teratoma in women, the testicular tumor is divided into species - mature, immature and prone to malignant transformation.

1. Mature teratoma of the testicle consists of clearly histologically defined tissues, it is not prone to malignancy, rarely metastasizes and is considered a benign neoplasm
2. Immature testicular tumor has a high risk of overgrowing into cancer, often metastasizing. In addition, even after successful treatment with chemotherapy, the immature form of the teratoma is prone to recurrence
3. Malignant teratoma of the testis - a malignant form of teratoma is a rarity and can occur in young men in a testicle unopened in the scrotum. Symptomatically, such a teratoma does not appear, the only sign in the initial stage is an increase in one testicle. Pain is a sign of neglect of the process, often indicative of the terminal stage.

Teratoma of the testicle can be successfully treated under the condition of early diagnosis, in such cases the survival rate is almost 90%. With metastasis, the prognosis is less favorable, only 70-72% of patients survive.

The age-specific statistics of the prevalence of teratoma in men are as follows:

Type of teratoma	Frequency	The age at which a teratoma is diagnosed
Mature teratoma	32-35%	More often - 14-16 years, less often - 25-40 years
Mixed species: seminoma - teratoma	14-15%	20-40 years old
Malignant teratoma	2-7%	35-50 years old

Coccygeal teratoma

Organominoid teratoma of the coccyx is most often diagnosed during the intrauterine period or immediately after birth (small size). In girls, the coccygeal teratoma is found in 80% of all revealed CKT (sacrococcygeal teratomas).

Localization zones - the area of the sacrum, buttocks, coccyx in the direction of the vagina. The tumor has a rounded shape, can reach a gigantic size - 25-30 centimeters, fills the entire space between the bones of the small pelvis in the fetus, displacing the internal organs, rectum and anus.

The description of the clinic of the coccygeal teratoma is more likely visual signs and methods of diagnosis, since the tumor is most often detected using ultrasound in utero. Typical localization, apparent size, asymmetry with respect to the vertebral column, heterogeneity of the structure - these are the characteristic properties of CCP in children under the age of one year. In medical practice, there are rarely cases when the coccygeal teratoma is diagnosed at a later age.

The structure of the teratoma is the embryonic cells of the embryonic leaves, the rudiments of tissues and organs. The teratoma develops slowly, its increase depends on the rate of fluid filling of the cystic cavities, immature teratomas grow faster

Symptomatically, the tumor can manifest as intestinal obstruction and impaired urination in the infant.

The coccygeal teratoma is treated mainly surgically at the age of up to six months, or urgently, but not earlier than 1 month after birth. Despite the fact that the operation carries a risk to the life of the child, its benefits and the potential for a favorable outcome exceed the danger.

[5], [6]

Sacral-coccygeal teratoma

CKT or sacrococcygeal teratoma is the most common type of congenital tumors, fortunately, not diagnosed often, just one case for every 35-40000 births. In girls, CCP is more common, in 80% of cases, in boys, respectively, less often.

The sacrococcygeal teratoma consists of cysts filled with sebaceous elements, a serous fluid in which impregnations of the cells of the nervous system-neuroglia, skin particles, muscle tissue cells, intestinal epithelial cells, cartilaginous tissue, occur. Rarely find part of the twin embryo in the cyst.

The cyst can measure from a centimeter to thirty, often exceeding or comparing with the size of the fetus. The tumor is complicated by concomitant intrauterine pathologies, and also affects the development. Due to the pressure on the nearby fetal organs, the teratoma of the coccyx provokes hydronephrosis, urethral atresia, bone tissue dysplasia, and rectal displacement. At boys as a result of the developed teratoma there can be a delay of lowering of testicles in a scrotum. In addition, a large size CCP requires more intensive blood supply, which leads to heart failure.

The sacrococcygeal teratoma is divided into 4 types:

1. External teratoma, with a minimal presacral bias.
2. Mixed, external internal teratoma.
3. CCP, located mostly in the abdominal cavity.
4. Presacral teratoma.

CCP, as a rule, is characterized by a benign course with adequate actions during pregnancy and in the process of obstetric care. Childbirth can be significantly complicated if the teratoma is large, in addition, an unfavorable prognosis is associated with the traumatic nature of the operation, without which the treatment of CCP is impossible.

Lethality of infants with CCV is about 50%, this is due to the development of intrauterine pathologies, conditions, as well as with teratoma rupture during labor, which leads to anemia, heart failure, and lung hypoplasia. In addition, the risk of lethality and operative intervention is high, but the potential to save the child exceeds the risk of his loss.

Teratoma of the neck

Teratoma of the neck or dermoid cyst is diagnosed in the first hours after birth, very rarely the tumor is so small that it is not determined visually and begins to increase later. If the tumor manifests itself after one year of age, it can cause the child to have difficulty eating, dysphagia. As a rule, there are no pain symptoms, but the first unpleasant sensations may indicate the transformation of the teratoma into a malignant form.

Characteristics of teratoma:

• Teratoma of the neck can have dimensions from 3 to 12-15 centimeters.
• Localization - anterior or posterior triangle of the neck, rarely in combination with the base of the skull (cervical teratomas).
• The structure is dense, less often semi-liquid, loose.
• Asymptomatic current.
• Nespayannost with the skin.
• Slow growth.

Possible symptoms of a developed teratoma of the neck:

• Stridoroznoe breath (whistle, noise).
• Cyanosis of the skin due to compression of the trachea.
• Suffocation.
• Dysphagia.

Teratoma in the neck is very rare and accounts for only 0.5% of all tumors detected in this area. To date, there are no more than 200 detailed descriptions of such tumors, which may indicate either little study of this teratoma, or favorable outcomes of timely treatment in early childhood.

Malignant course is typical for adult patients, in such cases, treatment does not work and the prognosis is very unfavorable.

Theratoma of the mediastinum

The mediastinal theratoma is an abnormality of embryonic development, when the tissues of the embryonic leaves move into atypical zones for embryogenesis. Similar germinogenous tumors are rarely detected in early childhood, as they develop asymptomatically. Localized teratomas in the anterior part of the mediastinum, in front of the pericardium and the main (main) vessels. Increasing, the tumor presses on the pleural cavity, shifts to the back of the mediastinum.

Characteristics of the mediastinal teratoma:

• Tumors, cysts.
• Diameter up to 20-25 centimeters.
• Slow development, the manifestation of clinical manifestations in the pubertal period, during pregnancy.
• Species - epidermoid cyst, dermoid, embryo.

Symptoms:

• The initial stage is asymptomatic.
• Cardiovascular symptoms - pain in the heart, tachycardia, anginal attacks, as well as shortness of breath, coughing up blood.

If the teratoma breaks into the bronchi, the pleura, the clinic is as follows:

• Pulmonary hemorrhage.
• Aspiration pneumonia.
• Irradiating pain in the neck, shoulder area.
• Hiccough.
• Chest bulging.
• Cyanosis of the skin.
• Swelling of the face.
• Hyperthermia.
• Suffocation.

The identification of the mediastinal teratoma, as a rule, is accidental, the tumor is diagnosed when radiography passes on completely different occasions. Teratoma has an oval or round shape, contains cells of bone, fat and cartilage tissue. Teratoma of the mediastinum is prone to suppuration due to close proximity to the pleural cavity, diaphragm. In addition to X-rays, this type of tumor shows pneumography and a blood test for alpha-fetoprotein, chorionic gonadotropin.

Surgical treatment, with timely measures taken and the benign nature of the tumor, the prognosis is quite favorable. Malignant mediastinal teratomas, the percentage of which is 20 to 25% of all tumors in this zone, is unfavorable.

Teratoma of anterior mediastinum

Mediastinum is a zone of the chest that has borders - the sternum, costal cartilage. The mediastinum fasciastium, the anterior surface of the thoracic spine, the cervical ribs, the prefetal fascia, pleura leaves, the diaphragm are also limited.

Teratoma of the mediastinum is most often localized in a typical zone - the anterior part, the base of the heart, in front of the pericardium and the main vessels. A similar kind of tumor can manifest at a young age, less often after 40 years, regardless of sex. Teratoma of the anterior mediastinum develops slowly, however, cystic teratomas are prone to rapid increase and malignization, according to statistics, this happens in 25-30% of cases of diagnosed tumors of this region.

The manifestation of clinical manifestations of teratoma can provoke periods of puberty or hormonal changes in connection with pregnancy, menopause. Also, one of the possible provoking factors is considered a trauma to the chest.

Symptoms that may manifest teratoma of the anterior mediastinum depend on its size, and often are as follows:

• Suffocation.
• Vypiranie piles of cells (often in children).
• Tachycardia due to close proximity to the base of the heart, trunk vessels.
• Cyanosis and swelling of the face.
• If the hormonal activity is high, it is possible to increase the mammary glands in women, in men - gynecomastia.
• Cough, often with blood.
• Possible pulsation in the sternum with a large amount of teratoma.

Mediastinal theratomas, like other similar tumors of other localizations, are divided into 2 species - immature (teratoblastoma) and mature. The most common mature mediastinal teratomas are defined in 90%, the remaining 10% are teratoblastomas or immature teratomas.

Treatment consists in the operative removal of the tumor, which must be carried out as soon as possible. Timely operation is a pledge to reduce the risk of teratoma malignization, as well as neutralization of the potential danger of compression syndrome.

Teratoma of the lung

Teratoma of the lung is usually a dermoid cyst or an embryo. Neoplasm is the accumulation of cells of embryonic leaves that moved during embryogenesis to zones not typical for normal fetal development. Structurally, the teratoma of the lung looks like a cavity containing parts of various tissues - sebaceous glands, cartilage, hair, part of teeth, intestinal epithelium, fat, and neurocytes.

The cyst has a dense capsule, it can grow up to 10 centimeters, but it is extremely rare in the lungs - only 1-1.5% of all tumor processes in this zone. Lung pulmonary dermoid can be detected in young people up to 3-35 years of age, in older age the teratoma of the lung is malignant and is defined as teratoblastoma. Frequent localization is the upper lobe of the left lung, the periphery.

Symptoms of the teratoma do not appear very long, it can be diagnosed only at random in the course of clinical examination. The clinic manifests upon breakthrough cysts from the pleural cavity, into the bronchi, with suppuration, abscess teratoma. When diagnosing, mediastinal tertum, other types of tumors, which are also similar in symptomatology, should be excluded.

Symptoms of advanced teratoma:

• Constant pain in the retina, in the back.
• Trichophysis is a syndrome of wet hair.
• Coughing with blood.
• Decreased body weight.
• Bronchiectasis.

Malignant (immature) teratoma of the lung is quickly transformed into sarcoma and has a very unfavorable prognosis.

Presacral teratoma

This type of teratoma is extremely rare in children, 1 is diagnosed for 3,500-4,000 newborn babies and very often among all permanent cell carcinomas in adults. Presakralnaya tumor is a congenital neoplasm that has several varieties - from dermoid cysts to immature teratomas.

Among all germinogenic neoplasms, the teratomas of the preskarral zone occupy the first place in terms of frequency and prevalence.

Despite the fact that the first descriptions of this tumor were carried out as far back as the 17th century by the obstetrician Philippe Pe, the etiology of teratomas has not yet been elucidated. It is believed that germinogenic formations are a product of impaired embryogenesis, when germ cell cells are transported with blood to untypical zones for them. In contrast to CKT - sacrococcygeal teratoma, the presakralnaya tumor is not visible and develops without clinical manifestations. The manifestation of the clinic consists of transient pains in the lower abdomen, in the region of the coccyx. Further the symptomatology can be manifested in the form of mucous, purulent discharge from the rectum, frequent and unsuccessful urge to defecate, frequent urination.

For medical care, patients are treated when the tumor grows to large sizes and there are such signs:

• Fistula in the rectum.
• Intestinal obstruction.
• Neuralgic manifestations.
• Severe pain.
• Weight loss.

All teratomas of the fiber of the prescalar area are subject to surgical treatment.

The tumor is removed, drained, the wounds are sutured.

The prognosis for timely diagnosis is favorable in 75-80% of cases. Malignancy is possible in elderly people, with neglected teratomas, self-medication and in cases when teratoblastoma develops in the cellulose.

Teratoma of the brain

Teratoma of the brain, intracranial swelling of the slope towards the malignant course and malignant in 50-55% of all cases.

Congenital teratoma of the brain is a rarity, the frequency of their detection is small, yet it is statistically established that in the majority of its teratoma the brain affects boys under the age of 10-12 years.

Teratoma of the brain - the dermoid cyst, is formed in utero, when embryonic cells, whose task to separate and "create" the facial tissue, move to the ventricles of the brain. The reason for this pathology has not been clarified until now, it is believed that the etiology of all germogenic tumors has a relationship with chromosomal abnormalities.

Symptoms in the initial period are not shown, then children can complain of nausea, dizziness, headache. Boys may have endocrine disorders, such as premature, not characteristic of the age period, puberty.

Treatment of the cyst of the brain is surgical, the outcome depends on the location, size of the teratoma, its structure and accompanying diseases of the child.

Mature teratoma

A typical germ cell tumor is a mature teratoma.

Mature teratomas are subdivided into formations without cysts - solid, and cystic - dermoid cyst. Such neoplasms are typical for tumors of young people, for children's oncology. Mature cyst is detected even during fetal development, which serves as an argument in favor of a germinogenic version of the origin of such tumors. Also, mature dermoids can manifest in the clinical sense and later, during pregnancy or menopause, which is due to hormonal changes in the body.

Teratoma, a dermoid cyst consists of embryonic differentiated cells of three embryonic layers. The tumor is a dense hollow capsule filled with parts of the skin, elements of bone, fatty, cartilaginous tissue, scales of the dermis (skin) and even particles of teeth and hair. Most often, the structure of dermoids includes derivatives of ectoderm (skin, bone, cartilaginous tissue).

It is necessary to treat a mature terat surgically, no other method can help neutralize it. Dermoids never resolve for a perfectly understandable reason: the dense, fibrous-fat structure of the capsule does not respond to treatment, in addition, the contents of the cyst from the bone tissue, hair and particles of teeth dissolve by medicinal methods is not possible.

Mature teratoma is characterized by a benign course and a favorable prognosis, such cysts are rarely transformed into oncoprocesses and practically do not give relapses after the operation. Dermoid cysts, mature ovarian teratomas do not interfere with conception, pregnancy. After removal, a semi-annual, less often, annual rehabilitation period is required to restore the function of the ovary and the woman is again able to give birth. Mature cyst in children is subject to removal of pop indications, but if it does not increase and does not carry a functional threat, it is observed and not touched.

Immature teratoma

Virtually all of the sources contain information stating that immature teratoma is a malignant neoplasm. Indeed, teratoblast - an immature teratoma is prone to malignancy due to its structure. Nevertheless, modern medicine has learned quite successfully to treat this tumor under the condition of timely diagnosis.

Immature teratoblastoma contains elements of three embryonic (embryonic) layers that move into the zones of the "gill" slits, into the areas of fusion of embryonic cavities, furrows, in a word, atypical for the normal development of part of the body. Teratoblastoma is not accidentally so named, it is the violation of the chromosome union, pathological changes in the division of blastomeres lead to the formation of a teratoma.

Immature teratomas are much less common than benign neoplasms, yet they remain the most dangerous, as they develop very rapidly and also actively metastasize. In addition, the unfavorable prognosis of teratoblast is due to late detection, the tumor grows without clinical prolongation, pain serves as a signal of almost terminal stage of the process.

Treatment of immature teratomas should be as comprehensive as possible, the strategy and methods depend on the location, age, sex, patient's state of health, and the degree of risk during surgery. As a rule, the removal of the tumor does not give an effect and a quick result, either radiation or combined chemotherapy is needed, perhaps a combination of them.

It is extremely difficult to predict the outcome of therapy, but the earlier the treatment is started, the longer the patient's life expectancy.

Malignant teratoma

Malignant teratoma or teratoblastoma is an embryonic tumor, which is defined as an unripe teratoma. It consists of their epithelial, mesenchymal-like cells, the degree of their maturity depends on the time of formation of teratoblastoma in the period of embryogenesis. As a rule, the malignant teratoma is very large, up to the parameters of the human head. The form is heavy, the color can vary from a whitish-yellow to a mottled color due to the outflow of blood into the tumor capsule.

The structure of teratoblastoma can also be different - solid, cystic (rarely), combined - cystic.

Malignant education is diagnosed at the age of 25-30 years, it grows rapidly and sprouts with metastases to organs located far away from the tumor. The path of metastasis is lymphatic and through the bloodstream.

The onset of teratoblastoma development is asymptomatic, this stage can last up to 5 years. The manifestation is characterized by transitory ailments, pains, weakness. A blood test shows an elevated level of ESR. Strong painful sensations are characteristic of the terminal stage of oncoprocess and speak of an unfavorable prognosis.

The diagnosis of a malignant teratoma can be established by histological examination, when the tumor is already operating.

Treatment only surgical with subsequent stopping measures - radiotherapy, chemotherapy. It should be noted that some teratoblastomas are amenable to treatment, it all depends on the zone of their localization and the degree of metastasis. However, in general, malignant teratomas have an unfavorable prognosis.

Cystic teratoma

Teratoma cystosum or mature cystic teratoma is a dermoid cyst, which is considered the most common tumor among children and young people. The fact that dermoids are found even in newborn infants, speaks of their teratogenic nature, although the etiology of teratoma is still not specified. In addition, cystic teratoma can be detected in women in menopause, most likely due to hormonal changes that cause the growth of the tumor and the manifestation of clinical symptoms.

Cystic teratoma or dermoid cyst is a tumor containing the derived elements of three embryonic leaflets, where ectoderm cells predominate. It is the ectodermal part that is the reason to call the cystic teratom "dermoid" (dermis - skin).

A similar teratoma almost always consists of one chamber, in 95% of cases it is benign, malignancy is extremely rare.

Characteristics of cystic teratoma:

• Dense fibrous capsule.
• Smooth surface.
• The composition - cells of sebaceous, neurocytes, fat glands, hair, particles of bone tissue of the teeth, but more often - scales of the skin.

Diagnosis of dermoid cysts is not difficult, as a rule they are detected visually if they are located under the skin. Internal cysts are determined using ultrasound, a computer tomogram, angiography.

Cystic teratoma rarely maligns, but it must be removed to avoid the risk of transformation into a malignant process. The outcome of treatment is usually favorable, especially in childhood operations.

[7], [8], [9], [10], [11], [12], [13], [14]

Rupture of the teratoma

Before the onset of pregnancy, it is most reasonable to undergo a complete comprehensive examination and, if a teratoma appears, it must be removed in advance. The operation for excising a tumor can be performed both with the help of laparoscopy, and with other methods that depend on the results obtained during the examination. If the ovary or part of it remains safe after removal, conception and pregnancy are possible.

If the pregnancy and the teratoma are determined simultaneously (when registering and due examination, diagnostic measures), then within three months the tumor is subject to observation. Doctors believe that neoplasms up to 6 centimeters in size are often unable to grow dynamically, even during hormonal changes in the body. Such teratomas do not interfere with the bearing of the fetus, and the childbirths proceed normally, but the tumor should be removed in any case, at the postnatal stage.

If the teratoma is large, its size exceeds 6-7 centimeters, it is prone to active growth, especially during pregnancy. The operation is indicated either on a scheduled basis in the second trimester or urgently, with the termination of pregnancy due to the risk of teratoma rupture and a threat to the life of a woman. Urgently also can be removed and a tumor in the third trimester, it is better, if it will be close to the date of birth. In such cases, a cesarean section is performed, simultaneously with it excised and teratom.

In general, teratom can not be considered a disease incompatible with pregnancy, with timely detection of the tumor and adequate, joint efforts of the doctor and the woman herself, the forecast is quite favorable.

Diagnosis of teratoma

In the diagnosis of teratoma, the leading place is occupied by ultrasound examination, screening, carried out even during fetal development. Early diagnosis of teratoma is the key to a favorable outcome of her treatment. Ultrasound helps to identify the tumor, the location of its localization, shape and size, as well as structure, which is one of the parameters for determining the malignant or benign nature of the neoplasm. In addition, ultrasound is able to detect possible metastasis, especially if an ovarian cyst is diagnosed, a testicular testicle or a retroperitoneal tumor.

Diagnosis of a teratoma also includes the following methods and procedures:

• X-ray - an overview, two-projection method, angiography, radiopaque methods. X-ray is indicated for the diagnosis of mediastinal tertum and CCT - sacrococcygeal teratoma.
• CT is computer tomography, which allows you to specify, specify the presence of metastases, their condition.
• Biopsy as a diagnosis of teratoma is carried out by puncturing. Further, the material is studied microscopically, which makes it possible to determine the nature of the neoplasm, the degree of its malignancy.
• A blood test for the level of alpha-fetoprotein and chorionic gonadotropin. This diagnosis of teratoma is carried out according to the indications and is an accurate method, because the tumor is able to synthesize fetal protein and placenta hormone.

[15], [16], [17], [18], [19], [20]

Treatment of teratoma

Treatment of teratoma in 90% is performed surgically. If the teratoma is diagnosed as malignant, it is removed together with nearby tissues and lymph nodes, after that all available and appropriate to the age, the patient's condition methods - radiation therapy, chemotherapy

Treatment of teratoma, diagnosed as a benign tumor, is a radical removal of education. The scope and method of operative actions depends on the size of the teratoma, its location, the age of the patient and the possible accompanying pathologies.

Here are a few options that are suggested in teratotherapy:

1. Teratoma of the ovary. Removal of the tumor within the boundaries of healthy tissue is shown, as well as resection of the ovary or removal of the uterus, appendages in women in the menopause. The choice of method depends on the condition of the cyst, the age of the patient. As a rule, young women of childbearing age try to do such operations, which retain the ability to conceive and procreate. In general, benign teratoma of the ovary (dermoid cyst) is not a contraindication to pregnancy and childbirth.
2. Teratoma of the testicles is often malignant, so the tumor is removed, and then the stopping measures are carried out - radiotherapy, the use of antitumor drugs.

The prognosis of tumor treatment depends on its histological structure, location of localization. Most often, with timely diagnosis and the use of adequate therapy, the outcome is favorable. Immature teratomas are more dangerous, but they are also supervised by modern methods of treatment. The most unfavorable course and result of treatment in combined forms - teratoma and chorionepithelioma, teratoma and seminoma and other combinations.