Elsevier

Current Problems in Diagnostic Radiology

Volume 41, Issue 6, November–December 2012, Pages 210-219
Current Problems in Diagnostic Radiology

Original article
Teratomas: A Multimodality Review

https://doi.org/10.1067/j.cpradiol.2012.02.001Get rights and content

Germ cell tumors (GCTs) may occur in both children and adults and include a broad array of histologic subtypes, such as teratoma, seminoma (known as dysgerminoma in the ovary and germinoma in the pineal gland), choriocarcinoma, yolk sac tumor, embryonal cell carcinoma, and mixed GCT. In adults, GCTs occur most commonly in the gonads. In children, sacrococcygeal tumors predominate. Teratomas are a common form of GCT. They are defined histologically as containing tissues derived from all 3 germ cell layers: ectoderm, mesoderm (most teratomas contain fat, an imaging hallmark, which is a mesodermal derivative), and endoderm. Teratomas are also classified as mature or immature, depending on the degree of differentiation of its components, and in adults, immature tumors are more likely to exhibit malignant behavior.

Section snippets

Intracranial Teratomas

Intracranial teratomas account for up to 50% of fetal brain tumors. In neonates, they comprise 33% of intracranial tumors but only 2%-4% of intracranial tumors in other patients <15 years.6

They typically arise from the pineal gland and involve the third ventricle.6

The mass is often cystic, and the presence of calcification is highly suggestive of the diagnosis. Clinical features include polyhydramnios related to impaired fetal swallowing of amniotic fluid (Fig 1).

Head and Neck Teratomas

The head and neck are common sites of teratomas in children. Tumors may originate from the thyrocervical area, palate, or nasopharynx (FIG 2, FIG 3). As in the cranium, tumors are usually midline and contain cystic spaces. Calcifications within the mass are very characteristic. Polyhydramnios is commonly present because of impaired swallowing.7, 8

Peripartum mortality is often related to difficulty in establishing an airway after delivery; however, survivability is improved when the airway is

Mediastinal Teratomas

The mediastinum is an uncommon location for GCTs. Teratomas account for 75% of mediastinal GCTs and usually occur in the anterior mediastinum near the thymus. They are more commonly encountered in younger patients. Most mediastinal teratomas are of the mature subtype, with only the minority containing immature elements. Immature teratomas in the mediastinum have a low malignant potential. Malignancy occurs in approximately 20% of cases and is seen almost exclusively in men.9 As seen elsewhere,

Retroperitoneal Teratomas

Retroperitoneal teratomas are uncommon, accounting for fewer than 10% of all primary retroperitoneal tumors. Approximately 50% cases arise in the first decade of life. There is a majority of women, with a female-to-male ratio of 2:1 (FIG 10, FIG 11, FIG 12).3, 4, 5, 10

Teratomas in this location tend to be very well developed and can sometimes resemble normal fetal elements, the so-called “fetus-in-fetu” appearance.

Sacrococcygeal Teratomas

The sacrococcygeum is the most common location of GCTs in children. Seventy-five percent of tumors are diagnosed in the neonatal period, with most diagnosed by age 4. Females are affected 4-times more often than males. Up to 27% of sacrococcygeal teratomas are malignant, with the probability of malignancy increasing as the age of the child at presentation increases. Ninety percent of these tumors are benign in children younger than 2 months, but <50% benign in children older than 2 months (FIG

Testicular Teratomas

Teratomas are the second most common testicular neoplasm in children. However, in adults, pure teratomas are rare, and teratomatous elements are most commonly seen as components of mixed GCTs. Although they occur in both children and adults, their natural history contrasts sharply. In children, teratomas, whether mature or immature, behave as a benign lesion. However, during and after puberty, both the mature and immature components of testicular teratomas can metastasize and are thus

Ovarian Teratomas

Ovarian teratomas consist of mature teratomas, immature teratomas, and monodermal teratomas (one tissue type predominates). A common form of monodermal teratomas is struma ovarii, where the tumor is composed mostly of mature thyroid tissue.15, 16

Mature teratomas of the ovary, also known as dermoid cysts, account for 10%-20% of all ovarian neoplasms, with peak incidence in the third decade. In the pediatric population, they are the most common ovarian neoplasm. The presence of fat within the

References (16)

  • B.S. Carver et al.

    Adult and pediatric testicular teratoma

    Urol Clin North Am

    (2007)
  • E. Kocakoc et al.

    Ultrasound evaluation of testicular neoplasms

    Ultrasound Clin

    (2007)
  • F.D. Billmore

    Germ cell tumors

    Surg Clin North Am

    (2006)
  • T. Ueno et al.

    Spectrum of germ cell tumors: From head to toe

    Radiographics

    (2004)
  • P.J. Woodward et al.

    From the archives of the AFIP: A comprehensive review of fetal tumors with pathologic correlation

    Radiographics

    (2005)
  • A. Chaudhary et al.

    Retroperitoneal teratomas in children

    Indian J Pediatr

    (2006)
  • B.A. Sandow et al.

    Best cases from the AFIP: Congenital intracranial teratoma

    Radiographics

    (2004)
There are more references available in the full text version of this article.

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