Teratoma

Teratoma is a germ cell neoplasm that forms in the prenatal period from embryonic cells. The tumor structure includes elements of the embryonic layers, separating into the zones of the so-called "branchial" slit and into the junctions of the embryonic grooves.

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

• Retroperitoneal zone.
• Presacral region.
• Mediastinum.
• Plexus of the ventricles of the brain, in the pineal gland.
• Head - bridge of the nose, ears, eye sockets, neck.
• Oral cavity.

Like other germ cell tumors, teratoma increases and grows in parallel with the growth of the entire organism and is clinically manifested depending on the classification of the tumor - benign or malignant, as well as the location.

Teratoma: ICD 10 code

According to the generally accepted classifier of diseases, ICD-10, which is a tool for an accurate description of the diagnosis and a specific rubricator, teratoma is recorded in the coded nomenclature of neoplasms, within the framework of block M906-909 - germ cell, germ cell neoplasms.

It happens that doctors use only one code to diagnose a tumor when describing what a teratoma is: ICD-10–O M9084/0 - dermoid cyst. This code describes a benign neoplasm, the structure of which includes mature cells of all three germ layers - ectoderm (particles of skin, hair, nerve tissue), mesoderm (parts of skeletal muscles, cartilage, bones, teeth), endoderm - epithelial cells of the bronchi, intestines).

It should be noted that a dermoid cyst is only one of the varieties of teratomas, but not a synonym, and even more so, not the only histological form. A more accurate would be an expanded variable definition according to the rubricator, since teratoma differs in histological structure and can be mature, immature, malignant.

Teratoma, ICD-10:

• M 9080/0 – Benign teratoma.
• M 9080/1 – Teratoma without further specification (NFS).
• M 9080/3 – Teratoma, malignant, without further specification (NDS).
• M 9081/5 – Teratocarcinoma.
• M 9082/3 – Malignant teratoma, undifferentiated.
• M 9083/3 – Malignant intermediate teratoma.
• M 9084/3 – Teratoma with malignant transformation.

Causes of teratoma

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

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

Germinativ or androblastomas are the primary, original sex cells of the embryonic gonads. These cells form three germ layers - external (ectoderm cells), middle (mesoderm cells), internal (endoderm cells). The typical localization of tumors in the genitals and glands speaks in favor of the version of the germinogenic etiology of teratomas. In addition, the microscopic structure, which is uniform for all localizations of teratomas, can be considered an indisputable argument.

Teratoma as a tumor is formed from the epithelium of the gonads, which is the initial base for the formation and further development of all tissues of the body. Under the influence of genetic, somatic, trophoblastic factors, the pluripotent epithelium is able to differentiate into benign and malignant neoplasms. Tumors tend to localize in the epithelium of the fetal sex glands - ovaries or testicles, but teratomas are much more often than other types of germ cell formations located in other areas, which is due to a delay, slow movement of embryonic epithelial cells to genetically determined zones of gonad formation. This occurs during the period of intrauterine development at 44-45 weeks.

Distribution of teratomas:

• Sacrococcygeal zone – 25-30%
• Ovaries – 25-30%
• Testicles – 5-7%
• Retroperitoneal space – 10-15%
• Presacral zone – 5-7%
• Mediastinum – 5%
• Other areas, 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 etiological basis, specified and confirmed clinically, as well as statistically, is becoming increasingly relevant due to the fact that benign embryonic tumors have become more frequently diagnosed every year by 2-3%.

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Teratoma in children

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

Clinically, teratoma in children can manifest at different times. Teratoma of the sacrum is visible almost in the first hours after birth, and it can also be detected using ultrasound even before the child is born. Teratoma of the ovaries manifests itself later, most often during puberty, when changes occur in the hormonal system.

1. Statistics show that coccygeal teratoma most often develops in girls and has a benign course, despite its rather large size. Large tumors are more likely to represent childbirth, but if the formation fills the pelvic cavity and does not damage the bone structure, the outcome of the course of labor is favorable (a cesarean section and removal of the tumor are indicated from the second month of life). The structure of the teratoma can be varied and consist of intestinal epithelial particles, 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 quickly become malignant, appearing as multi-chamber cysts with embryonic growths. The tumor metastasizes to the lungs and has an unfavorable prognosis.
3. Teratoma in male children, germ cell tumor of the testicle is diagnosed at the age of up to 2 years due to its visual manifestation. Unlike neoplasms in the ovaries, teratoma of the testicles is usually benign and rarely malignant. There are descriptions of rare malignant tumors of the testicles in boys in the pubertal period, but such formations are not common.
4. Germ cell tumors of the retroperitoneal zone, mesenteric teratomas are diagnosed at an early age of up to 2 years. According to statistics, such formations are diagnosed more often in girls and are quite large. Retroperitoneal teratoma is benign in 95% of cases and is subject to radical removal.
5. Teratoma of the oral cavity is also called polyps of the pharynx. This disease is diagnosed in the prenatal period or immediately after birth. A tumor that reaches large sizes can complicate childbirth and carries a risk of asphyxia of the baby, but they are rarely malignant and with appropriate surgical, obstetric actions, the outcome can be favorable in 90% of cases.
6. Teratomas of the brain are malignant in 45-50%, localized in the area of the base of the skull, and can metastasize to the lungs. Benign teratomas of this type are capable of malignancy in one way or another, especially in boys (accompanied by pathological endocrine disorders)
7. Teratoblastomas, large polycystic tumors, and solid teratomas containing immature, non-definitive embryonic tissues are considered the most dangerous and, unfortunately, have an unfavorable prognosis. Such tumors develop rapidly and are accompanied by metastases. Treatment for teratoma in children involves its removal. Then, after a morphological examination of the tumor tissue, no treatment is required for a benign tumor, while appropriate therapy is administered for malignant tumors. Modern developments in pediatric oncology make it possible to achieve a much higher percentage of survival for children with teratoblastomas than 20 years ago. The prognosis depends on the area of localization of the teratoblastoma, the age of the child, and concomitant pathologies.

Teratoma in the fetus

Teratoma of the fetus among all types of germ cell neoplasms is distinguished by a fairly high percentage of favorable course, 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 germ layers migrate to zones that are atypical for normal development, mainly to the so-called "branchial" slits and the fusion of embryonic grooves.

Teratoma is most common in fetuses and newborns in the coccyx and sacrum areas; such formations are diagnosed in 40% of all cases of detected tumors. Teratoma is least likely to form in the neck area - only in 4-5% of cases; it can also form in the ovaries or testicles, in the brain, mediastinum, and retroperitoneal space. Teratoma located in the face or in the lymph nodes can be considered rare; as a rule, such formations, if they exist, are visually determined later, at an older age due to the growth and enlargement of the tumor.

Most often, teratoma in the fetus is diagnosed in the sacrococcygeal region - SCT (sacrococcygeal teratoma). This tumor is formed in utero and accounts for 1 case per 40,000 births. The gender ratio is 80% girls, 20% boys. Coccygeal teratomas are fairly large cysts with mucoid or serous contents. The tumor size ranges from 1 centimeter to 30 centimeters, the most common formations are 8-10 centimeters. SCTs have a low percentage of malignant tumors, but a high risk of concomitant pathologies of the kidneys (hydronephrosis), rectum and urethra. In addition, SCT requires increased blood supply, which leads to increased fetal heart rate and carries the risk of heart failure. Deformation 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 outcomes is very high, more than half of the babies die due to heart failure.

The diagnostics of the coccygeal CT scan is quite accurate, the teratoma of the coccyx can be detected already at 22-1 weeks of pregnancy, when the ultrasound shows an atypically enlarged uterus, as in polyhydramnios. Such a result gives reason for further examination of the mother and fetus.

A cystic tumor is subject to prenatal puncturing and emptying. Under ultrasound control. It is also recommended to perform a teratoma puncture only after the fetus's lungs have formed. Sometimes doctors decide to monitor the teratoma until the birth, which is performed by cesarean section. After the birth of the child, an operation is immediately performed and a morphological examination of the removed material is carried out.

Teratoma in the fetus, statistics:

• Teratoma is diagnosed one and a half times more often in females.
• Benign fetal organoid teratomas account for 73-75% of all detected prenatal tumors.

Pregnancy and teratoma

Teratoma, although considered a benign tumor disease in most cases, can become a serious obstacle - not so much for pregnancy, but for the birth of a baby. Most often, the tumor forms in a woman's ovaries long before conception, often appearing only during hormonal changes - puberty, menopause, and also during pregnancy.

The etiology of germ cell tumors has not yet been specified, but it is believed that the cause may be chromosomal cellular abnormalities. The type of cell determines whether the teratoma will be immature or mature. Accordingly, the "neighborhood" will develop - pregnancy and teratoma. If the tumor contains embryonic tissues (nerve, fat, bone, muscle), this is defined as a mature teratoma, if the cells are not defined and morphologically not determined - immature, one that is prone to malignancy (transformation into a malignant tumor).

Mature neoplasms are most often benign, but both types require radical removal; there are no other ways to cure teratoma.

Ovulation is not affected by teratoma, so conception is quite normal. But when pregnancy occurs and the teratoma continues to develop, serious complications are possible, including termination of pregnancy. Among the main risks, doctors note the following:

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

Symptoms of teratoma

Clinical symptoms of teratoma appear in the same way as signs of any other type of germ cell formations, everything depends on the localization, size and time of tumor formation during embryogenesis. The earlier the formation of teratoma begins, the greater the potential risks for the development of the organism in childhood and the danger of tumor malignancy in adult patients.

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

SCT – sacrococcygeal teratoma. This tumor is the “leader” in statistical primacy, diagnosed from the first days of birth, mainly in girls. The neoplasm has a round shape, can be located behind the sacral zone, behind the coccyx. SCT is most often large in size - up to 30 centimeters, in the intrauterine period it can cause complications in the development of the fetus, but teratoma poses a greater danger for the birth itself. Since SCT is determined by ultrasound even before the moment of birth, that is, in the fetus, it is not possible to describe the symptoms. Coccygeal teratoblastomas are extremely rare, they develop slowly, and are not visually manifested. The main danger of teratoblastomas is asymptomatic development. A malignant tumor begins to manifest itself only at the stage when the oncological process has already started. The first alarming signals can be impaired defecation and urination (pain). 2.

Ovarian teratoma is detected randomly in girls and young women. Asymptomatic tumor development is a characteristic feature of teratoma; extremely rare, there may be a feeling of pain similar to premenstrual pain or heaviness in the lower abdomen. 3.

Testicular teratoma is determined more often than ovarian germ cell tumors in women for a completely understandable reason - visual signs. The tumor occurs in boys, young men under 18-20 years of age. Among all testicular neoplasms, teratoma accounts for more than 50%. The tumor is formed in utero, often visible immediately after the birth of a boy. It should be noted that early diagnosis of testicular teratoma allows us to talk about 85-90% of favorable outcomes after its removal. Later detection of the tumor carries a risk of malignancy, starting from puberty, the probability of degeneration of teratoma into a malignant tumor increases every year. Asymptomatic course, virtually no pain in the initial period of formation and development of teratoma are typical properties of such neoplasms. Pain in the affected testicle may indicate the destruction of the teratoma and its possible malignancy. 4.

As the mediastinal teratoma develops, it may manifest itself as pain in the retrosternal space due to pressure on the pleural cavity. In addition, irregular heartbeat, increased temperature, and shortness of breath may be the first signs of tumor enlargement. 5.

Teratoma of the oral cavity, pharynx or congenital polyp is diagnosed in infancy, often in the prenatal period using ultrasound. Polyps can be quite large and cause certain difficulties during childbirth (asphyxia of the child). 6.

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

Teratoma of the brain is most often detected in the pineal gland or in the area of the base of the skull. Symptoms of teratoma are similar to signs of endocrine disorders, clinical damage to 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, and it is not for nothing that they are called "silent" tumors. Clinical manifestations, as a rule, indicate an increase in teratoma and significant compression of nearby organs, and severe pain may indicate a malignant course of the process.

Types of teratoma

The histological structure of a teratoma can determine its types – mature, immature, or teratoma with malignant transformation.

The following types of teratoma are distinguished:

• Mature teratoma is a tumor consisting of differentiated tissues of the germ layers (one or three at once). Most mature teratomas are diagnosed as dermoid cysts. A dermoid cyst, that is, a mature tumor, in turn, is subdivided into cystic or solid.
• Solid teratoma is a benign neoplasm with a smooth, less often with a bumpy surface, almost 95% of which are solid. The structure of a mature solid teratoma may include particles of cartilage, bone embryonic tissue, intestinal epithelial cells, as well as multiple small cavities (cysts) containing mucus.
• Cystic teratoma is characterized by large sizes and a smooth surface. It can be of various structures, but most often contains 1-2 full-fledged cysts, inside of which are embryonic particles of sebaceous and fatty glands. Between the cysts within the teratoma, hair and its follicles, elements of teeth, cartilage, muscle tissue, and brain tissue are detected.

A tumor defined as an immature teratoma is a neoplasm whose structure includes elements of all three embryonic, germ layers. Most often, an immature teratoma is formed at the stage of organogenesis, when cells are just beginning the differentiation process. The size of an immature neoplasm can vary, the consistency is multilayered, difficult to determine microscopically. Most often, immature teratoma contains foci of squamous epithelium, focal inclusions of respiratory and intestinal cells. A characteristic feature of this type of formation is the presence of neurogenic epithelial cells, which indicates the possible formation of neuroblastoma. Often, an immature tumor is combined by histology, that is, it contains parts of the tissue of a mature solid teratoma. It is believed that an immature type of neoplasm is potentially dangerous in terms of transformation into a malignant tumor. Metastasis of malignant teratomas occurs through the lymph or bloodstream.

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

Teratoma types that are monodermal formations are rare. These are ovarian carcinoid, ovarian goiter, separately or in combination with each other. Teratoma, which is diagnosed as goiter, contains tissues of endocrine glands, usually the thyroid gland. The symptoms of goiter are similar to the clinical manifestations of hyperthyroidism.

Ovarian teratoma

Ovarian teratoma is a germ cell tumor that has two types - mature teratoma and immature teratoma. The tumor is formed from germ layer cells that gradually calve and are localized in places that are atypical for normal development of the body. One of the generally accepted etiological causes of ovarian teratoma formation is chromosomal abnormalities during embryogenesis.

An ovarian teratoma that is defined as mature is considered a benign formation and is called a dermoid cyst.

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

Testicular teratoma

Among germ cell tumors of the testicles in men, testicular teratoma accounts for about 40%. It is believed that most tumors of the male gonads are formed from embryonic cells potentially intended for sperm production (germino is a seed). Statistics say that testicular teratoma can develop asymptomatically for about 5 years if it is small. Larger tumors are detected either in the prenatal period using ultrasound of the fetus, or immediately after the birth of the child, since their visual diagnosis is not difficult.

Most often, teratoma begins to grow in puberty and is diagnosed in adolescent boys, such cases make up about 40% of all detected tumors of the sex glands. In adults, teratoma is extremely rare - no more than 5-7% of all tumors. Like ovarian teratoma in women, testicular tumors are divided into types - mature, immature and prone to malignant transformation.

1. Mature testicular teratoma consists of clearly histologically defined tissues, it is not prone to malignancy, rarely metastasizes and is considered a benign neoplasm.
2. An immature testicular tumor has a high risk of developing into cancer, often metastasizing. In addition, even after successful treatment with chemotherapy, an immature type of teratoma is prone to recurrence.
3. Malignant teratoma of the testis – a malignant form of teratoma is rare and can occur in young men in a testicle that has not descended into the scrotum. Such teratoma does not manifest itself symptomatically, the only sign in the initial stage is an increase in one testicle. Pain is a sign of the neglect of the process, often indicating a terminal stage.

Testicular teratoma can be treated quite successfully if diagnosed early; in such cases, survival is almost 90%. In the case of metastasis, the prognosis is less favorable; only 70-72% of patients survive.

Age-specific statistics for the prevalence of teratoma in men are as follows:

Type of teratoma	Frequency	Age at which teratoma is diagnosed
Mature teratoma	32-35%	Most often - 14-16 years old, less often - 25-40 years old
Mixed type: seminoma - teratoma	14-15%	20-40 years
Malignant teratoma	2-7%	35-50 years old

Coccygeal teratoma

Organismoid teratoma of the coccyx is most often diagnosed in the prenatal period or immediately after birth (small sizes). In girls, coccygeal teratoma occurs in 80% of all detected SCTs (sacrococcygeal teratomas).

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

Description of the clinic of coccygeal teratoma is rather visual signs and diagnostic methods, since the tumor is most often detected using ultrasound in utero. Typical localization, visible size, asymmetry in relation to the spinal column, heterogeneity of the structure are characteristic properties of the coccygeal teratoma in children under one year old. In medical practice, there are extremely rare cases when coccygeal teratoma is diagnosed at a later age.

The structure of a teratoma is embryonic cells of germ layers, rudiments of tissues and organs. Teratoma develops slowly, its growth depends on the rate of filling of cystic cavities with fluid, immature teratomas grow faster

Symptomatically, the tumor may manifest itself as intestinal obstruction and urinary dysfunction in the infant.

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 child's life, its benefits and the potential for a favorable outcome outweigh the danger.

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Sacrococcygeal teratoma

SCT or sacrococcygeal teratoma is the most common type of congenital tumor, fortunately, it is not diagnosed often, only one case per 35-40000 births. SCT is more common in girls, in 80% of cases, and in boys, respectively, less often.

Sacrococcygeal teratoma consists of cysts filled with sebaceous elements, serous fluid, in which there are inclusions of cells of the nervous system - neuroglia, skin particles, muscle cells, intestinal epithelial elements, cartilaginous tissue. Rarely, parts of a twin embryo are found in the cyst.

The cyst can be from one to thirty centimeters in size, often exceeding or comparable to the size of the fetus. The tumor is complicated by concomitant intrauterine pathologies, and also affects their development. Due to pressure on nearby fetal organs, the coccygeal teratoma provokes hydronephrosis, urethral atresia, bone dysplasia, and displacement of the rectum. In boys, as a result of the developed teratoma, there may be a delay in the descent of the testicles into the scrotum. In addition, large coccygeal teratoma requires a more intensive blood supply, which leads to heart failure.

Sacrococcygeal teratoma is divided into 4 types:

1. External teratoma, with minimal presacral displacement.
2. Mixed, external-internal teratoma.
3. CCT, located mostly in the abdominal cavity.
4. Presacral teratoma.

As a rule, CCT is characterized by a benign course with adequate actions during pregnancy and during obstetrics. Childbirth can be significantly complicated if the teratoma is large, in addition, an unfavorable prognosis is associated with the trauma of the operation, without which treatment of CCT is impossible.

The mortality rate of infants with CCT is about 50%, this is due to the developed intrauterine pathologies, conditions, as well as rupture of the teratoma during childbirth, which leads to anemia, heart failure, and pulmonary hypoplasia. In addition, the risk of mortality is high during surgical intervention, but the potential for saving the child outweighs the risk of losing it.

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 grow later. If the tumor appears after one year of age, it can cause difficulties in eating, dysphagia. There are usually no painful 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 range in size 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 course.
• Not fused with the skin.
• Slow growth.

Possible symptoms of a developed neck teratoma:

• Stridorous breathing (wheezing, noises).
• Cyanosis of the skin due to compression of the trachea.
• Suffocation.
• Dysphagia.

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

Malignant progression is typical for adult patients; in such cases, treatment is ineffective and the prognosis is very unfavorable.

Teratoma of the mediastinum

Teratoma of the mediastinum is an anomaly of embryonic development, when the tissues of the germ layers move to zones atypical for embryogenesis. Such germ cell tumors are rarely detected in early childhood, as they develop asymptomatically. Teratomas are localized in the anterior part of the mediastinum, in front of the pericardium and the main (trunk) vessels. As the tumor grows, it presses on the pleural cavity and shifts to the posterior part of the mediastinum.

Characteristics of mediastinal teratoma:

• Tumors, cysts.
• Diameter up to 20-25 centimeters.
• Slow development, manifestation of clinical manifestations in puberty, during pregnancy.
• Types: epidermoid cyst, dermoid, embryoma.

Symptoms:

• The initial stage is asymptomatic.
• Cardiovascular symptoms – heart pain, tachycardia, angina attacks, as well as shortness of breath, coughing up blood.

If a teratoma ruptures into the bronchi or pleura, the clinical picture is as follows:

• Pulmonary hemorrhage.
• Aspiration pneumonia.
• Radiating pain to the neck and shoulder area.
• Hiccups.
• Protruding chest.
• Cyanosis of the skin.
• Facial swelling.
• Hyperthermia.
• Suffocation.

Teratoma of the mediastinum is usually detected accidentally; the tumor is diagnosed during X-ray examination for completely different reasons. Teratoma has an oval or round shape, contains cells of bone, fat and cartilaginous tissue. Teratoma of the mediastinum is prone to suppuration due to its close location to the pleural cavity and diaphragm. In addition to X-ray, pneumography and blood tests for alpha-fetoprotein and human chorionic gonadotropin are indicated for this type of tumor.

Treatment is surgical, with timely measures and a benign nature of the tumor, the prognosis is quite favorable. Malignant teratomas of the mediastinum, the percentage of which is from 20 to 25% of all tumors in this area, the prognosis is unfavorable.

Teratoma of the anterior mediastinum

The mediastinum is a zone of the chest that has boundaries - the sternum, costal cartilages. The mediastinum is also limited by the retrosternal fascia, the anterior surface of the thoracic spine, the necks of the ribs, the prevertebral fascia, the pleural sheets, and the diaphragm.

Teratoma of the mediastinum is most often localized in its typical area - the anterior part, at the base of the heart, in front of the pericardium and main vessels. This type of tumor can manifest at a young age, less often after 40 years, regardless of gender. Teratoma of the anterior mediastinum develops slowly, but cystic teratomas are prone to rapid enlargement and malignancy, according to statistics, this happens in 25-30% of cases of diagnosed tumors in this area.

The manifestation of clinical manifestations of teratoma can be provoked by periods of puberty or hormonal changes due to pregnancy, menopause. Also, one of the possible provoking factors is considered to be chest trauma.

The symptoms that may manifest as an anterior mediastinal teratoma depend on its size and are often as follows:

• Suffocation.
• Protrusion of the chest (more common in children).
• Tachycardia due to its close location to the base of the heart and main vessels.
• Cyanosis and facial swelling.
• If hormonal activity is high, breast enlargement is possible in women and gynecomastia in men.
• Cough, often with blood.
• Pulsation in the sternum area is possible if the teratoma is large.

Mediastinal teratomas, like other similar tumors in other locations, are divided into 2 types - immature (teratoblastomas) and mature. Mature mediastinal teratomas are the most common, they are determined in 90%, the remaining 10% are teratoblastomas or immature teratomas.

Treatment consists of surgical removal of the tumor, which should be performed as early as possible. Timely surgery is the key to reducing the risk of teratoma malignancy, as well as neutralizing the potential danger of compression syndrome.

Teratoma of the lung

Teratoma of the lung is, as a rule, a dermoid cyst or embryoma. The neoplasm is a cluster of germ layer cells that have moved during embryogenesis to areas that are atypical for normal fetal development. Structurally, teratoma of the lung looks like a cavity containing parts of different types of tissues - sebaceous glands, cartilage, hair, parts of teeth, intestinal epithelium, fat, neurocytes.

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

Symptoms of teratoma do not appear for a very long time, it can be diagnosed only by chance during a medical examination. The clinic manifests itself when the cyst breaks through into the pleural cavity, into the bronchi, with suppuration, abscess of teratoma. When diagnosing, it is necessary to exclude mediastinal teratoma, other types of tumors, which are also similar in symptoms.

Symptoms of advanced lung teratoma:

• Constant pain in the chest area, in the back.
• Trichophysis – wet hair syndrome.
• Coughing up blood.
• Weight loss.
• Bronchiectasis.

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

Presacral teratoma

This type of teratoma is extremely rare in children, 1 diagnosis per 3500-4000 newborns and very common among all presacral tissue tumors in adults. Presacral tumor is a congenital neoplasm that has several varieties - from dermoid cysts to immature teratomas.

Among all germ cell neoplasms, teratomas of the presacral zone occupy first place in frequency and prevalence.

Despite the fact that the first descriptions of this tumor were made in the 17th century by the obstetrician Philippe Pe, the etiology of teratomas is still unclear. It is believed that germ cell tumors are a product of impaired embryogenesis, when germ layer cells are transported with the bloodstream to areas that are not typical for them. Unlike the SCT - sacrococcygeal teratoma, the presacral tumor is not visible and develops without clinical manifestations. The clinical manifestation consists of transient pain in the lower abdomen, in the coccyx area. Further symptoms may manifest themselves in the form of mucous, purulent discharge from the rectum, frequent and ineffective urge to defecate, frequent urination.

Patients seek medical help when the tumor grows to a large size and the following symptoms appear:

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

All teratomas of the presacral tissue are subject to surgical treatment.

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

The prognosis with timely diagnosis is favorable in 75-80% of cases. Malignancy is possible in elderly people, with advanced teratomas, self-treatment and in cases where teratoblastoma develops in the tissue.

Teratoma of the brain

Teratoma of the brain, an intracranial tumor, tends to be malignant and becomes malignant in 50-55% of all cases.

Congenital brain teratoma is a rare occurrence, the frequency of its detection is low, however, it has been statistically established that in most cases, brain teratoma affects boys under the age of 10-12 years.

Teratoma of the brain is a dermoid cyst that is formed in utero when embryonic cells, whose task is to separate and "create" facial tissue, move into the ventricles of the brain. The cause of this pathology has not yet been clarified; it is believed that the etiology of all germ cell tumors is associated with chromosomal abnormalities.

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

Treatment of brain cysts is surgical; the outcome depends on the location, size of the teratoma, its structure and the child’s concomitant diseases.

Mature teratoma

The typical germ cell tumor is a mature teratoma.

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

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

Mature teratoma must be treated surgically; no other method can help neutralize it. Dermoids never dissolve for a very obvious reason: the dense, fibrous-fatty structure of the capsule is not amenable to treatment, and the contents of the cyst, consisting of bone tissue, hair, and tooth particles, cannot be dissolved by medication.

Mature teratoma is characterized by a benign course and a favorable prognosis, such cysts rarely transform into an oncological process and practically do not give relapses after surgery. Dermoid cysts, mature teratomas of the ovaries do not interfere with conception, pregnancy. After removal, a six-month, less often a year rehabilitation period is required to restore the function of the ovary and the woman is again able to give birth. A mature cyst in children is subject to removal based on indications, however, if it does not increase and does not carry functional threats, it is observed and not touched.

Immature teratoma

Almost all sources contain information stating that immature teratoma is a malignant neoplasm. Indeed, teratoblastoma - immature teratoma is prone to malignancy due to its structure. Nevertheless, modern medicine has learned to treat this tumor quite successfully, provided that it is diagnosed in a timely manner.

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

Immature teratomas are much less common than benign neoplasms, however, they remain the most dangerous, as they develop very quickly and also actively metastasize. In addition, the unfavorable prognosis of teratoblastomas is due to the late timing of its detection, the tumor grows without clinical prolongation, pain serves as a signal of the 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, gender, health condition of the patient and the degree of risk during surgical intervention. As a rule, tumor removal does not give an effect and quick result, either radiation or combined chemotherapy is necessary, possibly a combination of both.

Predicting the outcome of therapy is extremely difficult, but the earlier 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 immature teratoma. It consists of epithelial, mesenchymal-like cells, the degree of their maturity depends on the time of formation of teratoblastoma during embryogenesis. As a rule, malignant teratoma is very large, up to the parameters of a human head. The shape is heavy, the color can vary from a whitish-yellow shade to variegated due to the outpouring of blood into the tumor capsule.

Teratoblastoma can also be different in structure: solid, cystic (rare), combined – cystic-solid.

Malignant tumor is diagnosed at the age of up to 25-30 years, grows quickly and metastasizes into organs located quite far 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. Manifestation is characterized by transient ailments, pain, weakness. Blood tests show an elevated ESR. Severe pain is typical for the terminal stage of the oncological process and indicates an unfavorable prognosis.

The diagnosis of malignant teratoma can be established by histological examination when the tumor has already been operated on.

Treatment is surgical only, followed by arresting measures – radiation therapy, chemotherapy. It should be noted that some teratoblastomas are treatable, everything depends on the area 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 that is considered the most common tumor among children and young people. The fact that dermoids are found even in newborn babies indicates their teratogenic nature, although the etiology of teratomas has not yet been clarified. In addition, cystic teratoma can be detected in women during the climacteric period, most likely due to hormonal changes that provoke the growth of the tumor and the manifestation of clinical symptoms.

Cystic teratoma or dermoid cyst is a tumor containing derivatives of three germ layers, where ectodermal cells predominate. It is the ectodermal part that is the basis for calling cystic teratoma a "dermoid" (derma - skin).

Such a 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.
• Composition: sebaceous cells, neurons, sebaceous glands, hair, particles of bone tissue of teeth, but most often – skin scales.

The 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, computed tomography, angiography.

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

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Teratoma rupture

Before pregnancy, it is best to undergo a full comprehensive examination and, if a teratoma is detected, it must be removed in advance. The operation to excise the tumor can be performed using laparoscopy or other methods, depending on the results obtained during the examination. If the ovary or part of it remains intact after removal, then conception and pregnancy are quite possible.

If pregnancy and teratoma are detected simultaneously (during registration and required examination, diagnostic procedures), then the tumor is subject to observation for three months. Doctors believe that neoplasms up to 6 centimeters in size are most often unable to grow dynamically, even during hormonal changes in the body. Such teratomas do not interfere with the bearing of the fetus, and childbirth proceeds normally, but the tumor should be removed in any case, at the postpartum 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 planned, in the second trimester, or urgently, with termination of pregnancy due to the risk of teratoma rupture and a threat to the woman's life. The tumor can also be urgently removed in the third trimester, it is better if it is close to the date of delivery. In such cases, a cesarean section is performed, and the teratoma is excised at the same time.

In general, teratoma cannot 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 prognosis is quite favorable.

Diagnosis of teratoma

In teratoma diagnostics, the leading place is occupied by ultrasound examination, screening, conducted during the period of intrauterine development of the fetus. Early diagnostics of teratoma is the key to a favorable outcome of its treatment. Ultrasound helps to identify the tumor, its location, 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 can detect possible metastasis, especially if an ovarian cyst, testicular teratoma, or retroperitoneal tumor is diagnosed.

Diagnosis of teratoma also includes the following methods and procedures:

• X-ray - overview, two-projection method, angiography, radiocontrast methods. X-ray is indicated for diagnostics of mediastinal teratoma and SCT - sacrococcygeal teratoma.
• CT – computed tomography, which allows to clarify and specify the presence of metastases and their condition.
• A biopsy for teratoma diagnostics is performed using puncturing. The material is then examined microscopically, which allows determining the nature of the neoplasm and its degree of malignancy.
• Blood test for alpha-fetoprotein and human chorionic gonadotropin levels. This diagnostics of teratoma is carried out according to indications and is a clarifying method, since the tumor is capable of synthesizing embryonic protein and placental hormone.

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Treatment of teratoma

Teratoma treatment is performed surgically in 90% of cases. If the teratoma is diagnosed as malignant, it is removed together with nearby tissues and lymph nodes, after which all available and age-appropriate methods are used, such as radiation therapy and chemotherapy.

Treatment of a teratoma diagnosed as a benign tumor consists of radical removal of the formation. The scope and method of surgical actions depend on the size of the teratoma, its location, the patient's age and possible concomitant pathologies.

Here are some options that are suggested in the treatment of teratomas:

1. Ovarian teratoma. Removal of the tumor within the healthy tissue is indicated; ovarian resection or removal of the uterus and appendages in women in the climacteric period can also be performed. The choice of method depends on the condition of the cyst and the patient's age. As a rule, young women of childbearing age are treated with surgeries that preserve the ability to conceive and bear children. In general, benign ovarian teratoma (dermoid cyst) is not a contraindication to pregnancy and childbirth.
2. Testicular teratoma often becomes malignant, so the tumor is removed and then treatment is carried out – radiation therapy, use of antitumor drugs.

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