Development of immature ovarian teratoma after mature teratoma in a girl with familial ovarian teratoma:A case report

BACKGROUND Immature ovarian teratoma is a rare and aggressive neoplasm that affects young women.This report is the first to describe the development of immature teratoma after ovarian cystectomy for mature teratoma of the ovary in an adolescent female with a family history of ovarian teratoma.CASE SUMMARY A 16-year-old girl who had undergone bilateral ovarian cystectomy for mature teratomas 3 years ago showed bilateral adnexal tumors during her regular ultrasonography follow-up every 6 months.She received laparoscopic bilateral ovarian cystectomy,and final histopathology showed grade-1 immature teratoma of the left ovary and mature teratoma of the right ovary.Laparoscopic left salpingo-oophorectomy and staging procedures were performed again.Her mother,maternal aunt,and maternal grandmother had also received surgeries for mature ovarian teratomas.CONCLUSION It is important to have guidance on management of patient and family members with familial ovarian teratomas.

Adenocarcinoma of sigmoid colon with metastasis to an ovarian mature teratoma: A case report

BACKGROUND Colorectal cancer ranks third in global cancer-related mortality,often due to metastases to liver and lungs.Ovarian metastases are less common,accounting for 3.6%to 7.4%of cases.In contrast,mature ovarian teratomas are frequently benign.Tumor-to-tumor metastasis is a rare phenomenon,with a limited number of documented cases.Three cases of mature ovarian teratomas metastasizing from different cancers have been reported.This report focuses on a case of tumor-totumor metastasis from sigmoid colon adenocarcinoma to a mature ovarian teratoma.CASE SUMMARY A 41-year-old Taiwan residents woman with no known systemic diseases presented with lower back pain,which led to imaging revealing malignant lesions in the spine,pelvis,liver,and multiple lung metastases.She was diagnosed with sigmoid colon adenocarcinoma with metastases to the liver,lung,bone,and a left ovarian teratoma.Treatment involved radiotherapy and chemotherapy,resulting in regression of the primary tumor and stable lung and liver lesions.Due to abdominal symptoms,she underwent exploratory surgery,unveiling a mature teratoma in the left ovary with signs of metastatic adenocarcinoma.CONCLUSION Consider resecting mature ovarian teratomas with concurrent colorectal adenocarcinoma to prevent tumor-to-tumor metastasis.

Ruptured teratoma mimicking a pelvic inflammatory disease and ovarian malignancy:A case report

BACKGROUND We report a case of ruptured ovarian teratoma mimicking pelvic inflammatory disease(PID)and ovarian malignancy.The case indicates the need for reviewing the information on ovarian teratomas,as the symptoms are vague,and,therefore,diagnosis and treatment had to be structured accordingly.CASE SUMMARY A 60-year-old woman was admitted to the emergency department with acute lower abdominal pain.She experienced weight loss and increased abdominal girth.Pelvic ultrasound and computed tomography revealed a 14-cm pelvic tumor.Laboratory examination revealed leukocytosis(white blood cell count:12620/μL,segment:87.7%)and high levels of C-reactive protein(18.2 mg/dL).Elevated levels of the tumor marker cancer antigen 19-9(367.8 U/mL,normal value<35 U/mL)were also noted.Due to the impression of a ruptured tuboovarian abscess or a tumor with malignancy,she immediately underwent an exploratory laparotomy.A ruptured ovarian tumor with fat balls,hair strands,cartilage,and yellowish fluid was observed on the right side.Right salpingooophorectomy was performed.A pathological examination revealed a mature cystic teratoma.The patient recovered after surgery and was discharged on postoperative day three.No antibiotics were administered.CONCLUSION This case illustrates the differential diagnosis of an ovarian tumor.Therefore,surgery is the mainstay for treating a ruptured teratoma.

Giant teratoma with isolated intestinal duplication in adult: A case report and review of literature

BACKGROUND A combination of diseases is a rare phenomenon.Their clinical manifestations can vary,and the diagnosis can be challenging.Intestinal duplication is a rare congenital malformation,whereas retroperitoneal teratoma is a tumor in the retroperitoneal space,derived from the remaining embryonic tissue.There are relatively few clinical findings on adult retroperitoneal benign tumors.It is hard to believe that these two rare diseases can happen to the same person.CASE SUMMARY A 19-year-old woman complaining of abdominal pain with nausea and vomiting was admitted.Abdominal computed tomography angiography was suggested for invasive teratoma.Intraoperative exploration revealed that the giant teratoma was connected to an isolated intestinal tract in the retroperitoneum.The postoperative pathological examination revealed that mature giant teratoma was present with intestinal duplication.This was a rare intraoperative finding that was successfully treated surgically.CONCLUSION The clinical manifestations of intestinal duplication malformation are various,and difficult to diagnose before the operation.The possibility of intestinal replication should be considered when intraperitoneal cystic lesions are present.

Rare primary mature teratoma of the liver:A case report

BACKGROUND Primary liver teratoma is an extremely rare tumor usually affecting children under the age of 3 years.Specific signs of teratoma on ultrasound,computed tomography(CT)or magnetic resonance imaging are lacking,which makes morphology the only diagnostic tool.Misdiagnosis of a mature teratoma may lead to excessive liver resection,whereas misdiagnosis of an immature teratoma may result in spread,causing a life-threatening condition.Consequently,a careful tumor examination is important,and the rarest types of tumors must be accounted for.CASE SUMMARY We describe a 52 years old female who presented with a solid mass in the left liver lobe.Contrast-enhanced CT and magnetic resonance imaging(MRI)revealed a round,heterogeneous lesion containing a number of fluid areas and areas of calcification in the middle,and the provisional diagnosis was cholangiocarcinoma.The patient underwent resection of liver segment I.Immunohistochemistry analysis of the resected lesion indicated thyroid follicular epithelium;however,the thyroid gland was intact.10 years prior to presentation the patient underwent a surgery due to mature teratoma of the right ovary,nevertheless the tumor was benign and could not spread to the liver,in addition teratoma of the liver was also benign.This led to the final diagnosis of primary mature liver teratoma.CONCLUSION Primary hepatic teratoma,including heterotopia of the thyroid gland in the liver,is an extremely rare condition in adults that needs to be considered in the differential diagnosis of solid-cystic neoplasms in the liver and cholangiocarcinoma.This case adds to the limited literature on the patient presentation,clinical workup and management of liver teratomas.

Sacrococcygeal Teratoma

Key Facts Synonyms:Sacrococcygeal teratoma(SGT),germ cell tumor of coccyx Definition:Tumors containing hair,teeth,cartilage,and fat extending from the coccyx and potentially growing both internally and externally.

Duodenal mature teratoma causing partial intestinal obstruction:A first case report in an adult

BACKGROUND A teratoma is a germ cell tumor that is composed of tissue derived from two or three germ layers.Duodenal teratomas are extremely rare and have been exclusively reported in neonates and children.This is the third case of a teratoma primarily arising in the duodenum and the first case that occurred in an adult.CASE SUMMARY A 31-year-old male presented with clinical partial gut obstruction(epigastric pain,nausea,and vomiting).The physical examination showed a palpable illdefined mass on the left side of the abdomen.The computed tomography scan revealed a multiseptated cystic tumor at the retroperitoneal area.First,he underwent gastrojejunostomy to relieve the symptoms and was referred to a tertiary-care hospital.The second operation revealed a 10-cm solid-cystic mass originating from the third part of the duodenum and adhering to the abdominal aorta and pancreas.Segmental duodenectomy was performed.The pathological diagnosis was a mature cystic teratoma.The patient was asymptomatic at 5 mo after the operation.CONCLUSION Duodenal teratomas are extremely rare but should be included in the differential diagnosis in patients who present with intestinal obstruction.Radiological imaging is helpful to reach the preoperative diagnosis.Multidisciplinary team planning is essential to avoid injury to the adjacent organ in duodenal operation.

Ovarian teratoma related anti-N-methyl-D-aspartate receptor encephalitis:A case series and review of the literature

BACKGROUND Anti-N-methyl-D-aspartate receptor(NMDAR)encephalitis is a rare but important complication of ovarian teratoma.Between July 2012 and December 2019,six patients with ovarian teratoma-associated anti-NMDAR encephalitis were enrolled in our hospital and their clinical characteristics,treatment,and follow-up were reviewed.We also conducted a systematic literature review of ovarian teratoma related anti-NMDAR encephalitis reports between January 2014 and December 2019.AIM To better understand anti-NMDAR encephalitis through literature review and patients enrolled in our hospital.METHODS The six patients enrolled in the study were those diagnosed with anti-NMDAR encephalitis.Their history,clinical manifestations,and medications were recorded and optimum treatment provided in addition to maintaining a record of the follow-ups.In addition,we also extensively surveyed the literature and provide summarized data from 155 published cases of anti-NMDAR encephalitis from 130 case reports.PubMed and Scopus were the sources of these publications and the time period covered was 6 years ranging from January 2014 through December 2019.RESULTS The six patients enrolled for this study presented with typical symptoms resulting in a diagnosis of ovarian teratoma induced anti-NMDAR encephalitis.Appropriate interventions led to a positive outcome in all the patients,with five of six patients reporting full recovery and the sixth patient recovering with a few deficits.No death was recorded.The literature survey comprising of 155 patients cases across 130 case reports of anti-NMDAR encephalitis clearly indicated an upward trend in the reports/diagnosis in China,particularly in the surveyed time from 2014 through 2019.The majority of patients(150/155)underwent surgical intervention resulting in positive outcome.No treatment intervention was mentioned for one case while the four patients who were not surgically operated succumbed to the disease.CONCLUSION Suspected anti-NMDAR encephalitis should be quickly evaluated for anti-NMDAR antibodies since early diagnosis is important.In case of a tumor,its earliest and complete removal is recommended.Finally,early use of corticosteroids and IgG-depleting strategies(intravenous immunoglobulin or plasma exchange)may improve outcome.

Uniportal video-assisted thoracoscopic surgery for complex mediastinal mature teratoma:A case report

BACKGROUND Mediastinal mature teratoma is the most common histological type of primary extragonadal germ cell tumor.In this report,we describe a rare case of giant mature teratoma located primarily in the anterior mediastinum and causing partial atelectasis of the upper and middle lobes of the right lung,as well as extrinsic compression of the right atrium.CASE SUMMARY A 31-year-old male with a giant mediastinal mature teratoma presented with progressive exertional dyspnea and chest pain for 1 mo.Computed tomography of the chest indicated the diagnosis of anterior mediastinal teratoma.The patient underwent right uniportal anterior approach video-assisted thoracoscopic surgery(VATS).En bloc resection of the giant teratoma,wedge resection of the upper and middle lobes of the right lung,resection of the thymus and partial excision of the pericardium were successfully performed.The pathological diagnosis revealed a mature cystic teratoma with foreign-body reaction that was closely related to the right lung,atrium dextrum,superior vena cava and ascending aorta.An atrophic thymic tissue was also discovered at the external teratoma surface.The patient was discharged on postoperative day 7.CONCLUSION This is the first report of the use of uniportal VATS for complete resection of a teratoma in combination with wedge resection of the right upper and middle lung lobes and partial resection of the pericardium.

Ovarian growing teratoma syndrome with multiple metastases in the abdominal cavity and liver:A case report

BACKGROUND Growing teratoma syndrome(GTS)is an unusual presentation of an amazing transformation of teratoma from malignant to benign on pathology during or after systemic or intraperitoneal chemotherapy.The definitive pathogenesis is still not fully understood due to the lack of large-sample studies.CASE SUMMARY A 53-year-old woman underwent radical surgery and postoperative intraperitoneal chemotherapy due to immature teratoma of the right ovary at the age of 28.She remained well during a 25-year follow-up period after surgery.Multiple asymptomatic solid masses were found in the liver on ultrasonography a month ago.Enhanced computed tomography(CT)of the abdomen revealed multiple masses in the abdominal cavity.The largest one was located in the posterior peritoneum next to the sixth segment of the right liver,about 7.9 cm×7.5 cm in size.Three masses were present inside the liver,and one mass was in the right pelvic floor.Multiple lumps in the abdominal cavity were completely removed by surgery.During the operation,multiple space-occupying lesions were seen,ranging in size from 0.5 to 3 cm,and grayish white in color and hard in texture.Ovarian GTS was finally diagnosed based on postoperative pathology.After surgery,she recovered uneventfully.During a 3-year follow-up,the patient remained free of the disease without any recurrence on CT scan.CONCLUSION GTS is a rare phenomenon characterized by conversion of immature teratoma to mature one during or after chemotherapy and presents as growing and metastasizing masses.The pathogenesis of GTS is unclear,and the prognosis is good after surgical resection.

Posterior Mediastinal Mature Teratoma: A Case Report and Literature Review

Mediastinal mature teratoma is the most common form of germ cell tumors, often located in the anterior mediastinum. A posterior mediastinum location has rarely been described. We report a case of a posterior mediastinal mature teratoma in a 37-year-old patient and a literature review, through which we describe the diagnostic and therapeutic difficulties inherent in this particular location of these tumors.

Cystic benign teratoma of the neck in adult

Teratomas are embryonal neoplasms that arise when totipotential germ cells escape the developmental control of primary organizers and give rise to tumors containing tissue derived from all three blastodermic layers. Teratomas have been reported to occur in various sites and organs. Teratoma of the cervical neck are relatively rare in adulthood. It usually extends from the neck to the thoracic cavity causing local mass effect. In most of the cases intrauterine diagnosis is possible by ultrasound. Because of dyspnea due to mass effect, this condition is treated promptly after birth. However cases of teratoma in adulthood with supraclavicular localization have been reported rarely in the literature. The presented case is of a 25-year-old female with a cervical mass. Histological examination revealed a benign mature teratoma. The patient has been disease free for more than nine years after surgical removal of a neck teratoma.

Ganglioneuroblastoma arising within a retroperitoneal mature cystic teratoma

We discuss an extremely rare case of ganglioneuroblastoma arising within a retroperitoneal mature cystic teratoma. Radiological examinations showed a cystic tumor sandwiched between the pancreas and left kidney. Surgery was scheduled because the tumor seemed to have originated from the pancreas. En-block resection of the tumor with distal pancreatectomy, splenectomy, and left adrenalectomy was performed. In terms of macroscopic appearance, the tumor mainly consisted of a unilocular cystic mass, but the presence of a smaller, solid mass was also noted within the tumor. Histopathologic examination confirmed that the cystic mass was consistent with a mature cystic teratoma of the retroperitoneum, and in addition, a ganglioneuroblastoma was evident in the solid component. Histopathologically, the ganglioneuroblastomatous area was intimately associated with dermoid tissue of the mature cystic teratoma, thus this case was diagnosedto be a mature cystic teratoma with malignant transformation. To best of our knowledge, this is the first reported case of ganglioneuroblastoma arising in a mature cystic teratoma.

Malignant transformation of primary mature teratoma of colon:A case report

BACKGROUND Mature teratoma is a common benign ovarian germ cell tumor,accounting for about 20%of ovarian tumors.The malignant transformation of this tumor is less than 2%.The most common type is squamous cell carcinoma,followed by adenocarcinoma.Malignant transformation of colonic mature teratoma is extremely rare.We here report a case of malignant transformation of primary mature teratoma of the colon.The type of malignant transformation was adenocarcinoma.CASE SUMMARY A 63-year-old woman was admitted to our hospital due to persistent pain in her right lower abdomen for 1 mo,and she had no nausea,vomiting,blood in the stools,or other symptoms.Preoperative colonoscopy showed uplift of the sigmoid colon mucosa and submucosa.The biopsy showed squamous epithelium.However,contrast-enhanced computed tomography of abdomen and pelvis showed a localized thickening of the sigmoid wall,suggesting colon cancer.Endoscopic ultrasonography(EUS)revealed that the structure of the intestinal wall at the base of the lesion was destroyed,and the boundary between the lesion and the surroundings was unclear.According to the findings of the EUS,the patient did not undergo endoscopic submucosal dissection,but underwent radical resection of the tumor.Histologically,squamous epithelium was seen on the mucosal surface of the colon wall,cartilage and glands were seen under the epithelium,and adenocarcinoma was seen on the muscular layer and serous surface.The final pathological diagnosis was malignant teratoma of the colon.We have followed up the patient for 2 mo since the operation,and the patient recovered well.CONCLUSION This case suggests the possibility of mature teratoma in the colon and recognition of malignant types,and it should not be considered as an exclusively ovarian tumor.

Cystic teratoma of the parotid gland:A case report

BACKGROUND Teratoma is a common tumor,but rarely occurs in the parotid region.Only nine cases have been reported in the current literature.Although it is generally detected in infancy or childhood,it is commonly asymptomatic.Computed tomography(CT)and magnetic resonance imaging(MRI)have important roles in the diagnosis of teratoma.CASE SUMMARY A 36-year-old man developed a lump located below the left auricular lobule 3 years ago.Physical examination revealed a nearly-circular tumor in the left parotid gland region with a defined border,firm texture,and significant movement.Calcification,fat,keratinized substances,and typical fat-liquid levels was observed on CT and MRI.A diagnosis of cystic teratoma of the parotid gland was established preoperatively and confirmed by postoperative pathology.Following surgery,the patient developed temporary facial paralysis.There was no recurrence of teratoma during the 15-mo follow-up period.CONCLUSION When an asymptomatic mass in the parotid region is identified,parotid gland teratoma should be included in the differential diagnosis.Imaging examinations are helpful in the diagnosis.

Eustachian tube teratoma: A case report

BACKGROUND Mature teratoma composed of all three basic germ cell layers of the head and neck is a rare disease.Teratomas involving the temporal bone are particularly scarce.CASE SUMMARY A 48-year-old male patient with a history of chronic otitis of the left ear from infancy,for which he had been operated on twice,was referred to our hospital for chronic otitis,cholesteatoma and a middle ear mass.Computed tomography(CT)scan and magnetic resonance imaging(MRI)revealed a eustachian tube teratoma,in which the anterior lower part and posterior upper part were connected by a thin membranaceous tissue.The mass was removed completely under general anesthesia by mastoidectomy.As of last follow-up(2 years post-surgery),the disease had not relapsed.CONCLUSION Pre-operative CT and MRI are necessary for eustachian tube teratoma.Complete surgical resection provided excellent prognosis.

Retroperitoneal teratoma resection assisted by 3-dimensional visualization and virtual reality:A case report

BACKGROUND Primary retroperitoneal tumor is a rare type of tumor with insidious onset,large tumor size at the time of diagnosis,and often extensive involvement of surrounding tissues and blood vessels in the retroperitoneum.Surgery for primary retroperitoneal tumors is technically challenging.Preoperative imaging evaluation is critical for the selection of the optimal surgical approach and can influence complete resection and recurrence rates.Three-dimensional model reconstruction combined with virtual reality is useful for preoperative assessment.CASE SUMMARY A 17-year-old female patient was admitted for abdominal pain lasting for half a year that had been worsening for half a month.Abdominopelvic enhanced helical computed tomography revealed a retroperitoneal space-occupying lesion about 11.3 cm×9.1 cm in size,with well-defined borders in the upper left quadrant of the abdomen.The lesion compressed the left renal artery and vein resulting in vascular displacement and deformation.A multidisciplinary team decided on the optimal treatment approach.Preoperative three-dimensional visualization and virtual reality technology were used to assess and simulate the surgical procedure.Then,retroperitoneal tumor resection along with renal artery reconstruction was decided as the treatment.Complete resection of the retroperitoneal tumor was performed.Stable blood flow was established after renal artery reconstruction.The tumor was diagnosed as mature cystic teratoma(retroperitoneal tumor)by postoperative pathologic analysis.The patient,who recovered well,was discharged after 2 wk and maintains regular follow-ups.CONCLUSION A combination of three-dimensional reconstruction and virtual reality technology before surgery improves the rate of complete resection of retroperitoneal teratoma.

Rectal mature teratoma:A case report

BACKGROUND Rectal mature teratoma is rare and has been reported as a case report in this study.Herein,clinical presentation,magnetic resonance imaging findings,and immunohistochemistry showed a pelvic rectal mature teratoma.The case report and the surgical treatment procedure have been discussed below.CASE SUMMARY A 29-year-old Chinese female showed up with over a 1-mo history of perianal mass that emerged after defecation.Physical examination indicated that the mass was 4 cm×3 cm×3 cm.The intraoperative procedure involved ligation of the sigmoid colon 10 cm above the upper edge of the tumor,followed by ligation of the rectum 3.5 cm above the upper edge of the tumor,and subsequent complete removal of the mass.The histopathology confirmed the mature teratoma.CONCLUSION The tumor can be completely removed using surgery to prevent its recurrence.

Four-year-old anti-N-methyl-D-aspartate receptor encephalitis patient with ovarian teratoma: A case report

BACKGROUND A population-based comparative study in United States shows that the prevalence and incidence of autoimmune encephalitis are comparable to those of infectious encephalitis and its detection is increasing over time.Some patients are complicated with ovarian teratoma.The younger the patient is,the less likely a tumor will be present.CASE SUMMARY This case report describes the successful treatment of anti-N-methyl-D-aspartatereceptor(NMDAR)encephalitis by early laparoscopic ovarian cystectomy and immunotherapy in a 4-year-old female child.And to the best of our knowledge,this detailed case report describes the youngest patient to date with anti-NMDAR encephalitis who underwent laparoscopic ovarian cystectomy.CONCLUSION Although the younger the patient is,the less likely a tumor will be detected,we still emphasize that all patients with suspected or confirmed anti-NMDAR encephalitis should be screened for ovarian tumors if possible.Prompt initiation of immunotherapy and tumor removal are crucial for good outcomes.

Extrapineal mature teratoma of the posterior fossa in a child

Introduction: teratomas are non-malignantgerm cell tumors commonly composed of cell types derived from all of the three germ layers. Intracerebral teratomas typically are midline or paraxial lesions located in the pituitary stalk or the pineal region. We report our experience with mature teratomas of the posterior fossa. Case report: we present the case of an 11-year-old caucasian female with progressive headache that caused interrupted sleep. Cerebral magnetic resonance imaging showed a midline lesion in the posterior fossa with mass effect and without contrast enhancement. Anatomic pathology revealed a mature teratoma. Conclusion: differential diagnosis of midline lesions in pediatric patients must include teratomas in spite of being posterior fossa lesions.