4/10/2017 TeratomaLibrePathology

Teratoma
FromLibrePathology

Teratomaisacommongermcelltumour.Mostarebenign.
Somearemalignant.Somearequiteweird. Teratoma
Diagnosisinshort

Contents
1 General
1.1 Classification
2 Matureteratoma
2.1 Images
2.1.1 Case1
2.1.2 Case2
2.1.3 Case3
2.2 Fetusinfetu
3 Immatureteratoma Matureteratoma.H&Estain.
3.1 Images
3.2 Grading(immature)
3.3 IHC(immature) LM classicallyallthreegermlayers:
4 Monodermalteratomas endoderm(skin,(mature)CNS),
4.1 Strumaovarii mesoderm(muscle,bone,connective
4.1.1 Images tissue,blood),ectoderm(internal
4.2 Strumalcarcinoid
organs)
4.2.1 Images
4.3 Epidermoidcyst Subtypes matureteratoma,immatureteratoma,
5 Signout strumalcarcinoid,strumaovarii,fetus
5.1 Matureteratoma infetu(subtypeofmatureteratoma)
5.1.1 Blockletters
5.2 Residualgermcelltumour LMDDx mixedgermcelltumour,squamouscell
5.2.1 Micro carcinoma,epidermoidcystofthetestis
6 Seealso (testisonly)
7 References
Gross maycontainidentifiablehairand/or
teeth,typicallycysticandsolid
Grossing orchiectomygrossing
General notes

Maybebenignormalignant. Staging testicularcancerstaging

Aresupposedtoconsistsofallthreegermlayersthisis Site ovary,testis,other
notalwaystrue.
Maybeassociatedwithsacralagenesis.[1]
Teratomaonlyrecurrencesofgermcelltumourshave Associated ovariantorsion(iflarge)
goodprognosis.[2] Dx
Symptoms +/abdominalpain(ovariantorsion)
Importantnote:
Prevalence commonesp.matureteratoma
Prognosis benignormalignant,recurrenceswith

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Thesiteofthetumour,ageandsexareveryimportantfor (malignant)teratomausu.favourable
predictingthebehaviourofateratoma:[3]
Clin.DDx malignantmass(germcelltumour,
Immatureteratomasmayhaveabenignor
malignantbehaviour. metastasis)
Matureteratomasmayhaveabenignormalignant
behaviour.
CNSteratomasareoverrepresentedinmales.[4]
Intracranialteratomasareusuallylocatedinmidlinelocationssuchasthepinealregion,suprasellar
cistern,basalganglia,andthalamus.[5]

Classification
1.Mature.
Commoninfemales.
Usuallybenign.
Maturecomponentmaygiverisetoamalignancylikeelsewhereinthebody.
Mostcommonmalignancyarisingfromamatureteratoma:squamouscellcarcinoma.
2.Immature.
Uncommon.
Oftenmalignant.
3.Monodermal.
Rare.
Highlyspecialized.

Matureteratoma
Featuresthreegermcelllayers(usually):[6]

1.Ectoderm:
Skin,(mature)CNS.
2.Mesoderm:
Muscle,bone,connectivetissue,blood.
3.Endoderm:
Internalorgans.

Note:

Mayconsistofskinonlyinwhichcaseitiscommonlycalledadermoid.

DDx:

Immatureteratoma.
Mixedgermcelltumour.
Epidermoidcystofthetestis.

Images

Case1

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Matureteratomalow Matureteratomahigh
mag.(WC/Nephron) mag.(WC/Nephron)

Case2

MTlowmag.(WC) MTintermed.mag. MThighmag.(WC)

(WC)

Case3

Neuraltissuein Neuraltissuein Neuraltissuein

teratomalowmag. teratomaintermed. teratomahighmag.
(WC) mag.(WC) (WC)

Fetusinfetu

Groupedwithmatureteratoma,asitisconsideredawelldevelopedmatureteratoma.[7][8]
Ithasbeensuggestedtheyaredistinctfromteratomas.[9]
Theycouldbethoughtofasaparasitictwin.

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Features:

Discretemassconsistingofmaturetissuesthatformwelldevelopedstructureswiththenormalanatomical
relations.
Separatedfromteratomabythepresenceofavertebralcolumn.[10]

Immatureteratoma
Features:

Immatureifneuraltissueispresent:[11]
Vaguelyresemblespseudostratifiedrespiratoryepithelium.
Islandsofsmallhyperchromaticcells"blastema".
+/Cartilage.
+/Adipocytes.
+/Colonictypemucosa.
+/Stratifiedsquamousepithelium(skin).

DDx:[12]

Cerebellum.
Retina.

Images

Primitive Primitive Teratomamature

neuroepitheliumhigh neuroepithelium components
mag.(WC/Nephron) intermedmag. (WC/Nephron)
(WC/Nephron)

Otherimages:

Immatureteratomamyxomatousstroma(webpathology.com)(http://www.webpathology.com/image.asp?
n=5&Case=35).
Immatureteratomablastema(webpathology.com)(http://www.webpathology.com/image.asp?
n=6&Case=35).
Immatureteratomaprimitiveneuroepithelium(webpathology.com)
(http://www.webpathology.com/image.asp?n=7&Case=35).
Immatureteratomaprimitiveneuroepithelium(ouhsc.edu)
(http://moon.ouhsc.edu/kfung/jty1/opaq/PathQuiz/N0C001PQ01M.htm).

Grading(immature)
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Basedonquantityofimmatureneuroepithelium:[13][14][15]

G0matureteratomanoimmatureneuroepithelium.
G1lessthanonelowerpowerfield(LPF)ofimmatureneuroepitheliumLPFdefinedfieldat4X
magnification.
G213LPFs.
G3morethan3LPFs.

Note:

LPFnotadequatelydefinedseeLPFitis.SameBSasHPF.

IHC(immature)

Features:

Primitiveneuroepithelium:[16]
Neuronspecificenolase(NSE)+ve.
NeuronspecificBtubulin+ve.
Synaptophysin+ve.

Monodermalteratomas
Strumaovarii

Features:

Thyroidtissuepresentcolloidisseen.
Maydeveloppathologiesseeninthethyroidgland.

Notes:

Variousquantityrequirements:
Weietal.statethatthethyroidtissuemustcomprise>50%ofthemassorhaveathyroidassociated
malignancy(e.g.papillarythyroidcarcinoma)forthelabelstrumaovarii.[17]
NucciandOlivastatethethyroidtissuemustbe"predominant".[18]
Benignthyroidtissueisnotuncommoninteratomas(520%).[17]

Images

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Strumaovariilow Strumaovariihigh
mag.(WC/Nephron) mag.(WC/Nephron)

Strumalcarcinoid

Features:[19][20]

Hascomponentsthatsuggest:
1.Carcinoid(neuroendocrinetumour).
Nucleiwithstippledchromatin(saltandpepperchromatin).
2.Thyroidcysticspaces/follicularlikestructures.

Images

Strumalcarcinoid Strumalcarcinoid
intermed.mag. highmag.
(WC/Nephron) (WC/Nephron)

Epidermoidcyst

Someauthorsconsiderepidermoidcystasamonodermalteratoma.[21]

Signout
Matureteratoma

Mass,RightOvary,Excision:
Matureteratomawithdermalelementsandmatureneuraltissue.
NEGATIVEforevidenceofmalignancy.

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Blockletters

CYST("DERMOID"),RIGHTOVARY,CYSTECTOMY:
MATURECYSTICTERATOMA.

CYST,LEFTOVARY,CYSTECTOMY:
MATURECYSTICTERATOMA.
NEGATIVEFORMALIGNANCY.

Residualgermcelltumour

ANTERIORCAVALMASS,RESECTION:
RESIDUALMATURETERATOMA,COMPLETELYEXCISEDINTHEPLANEOFSECTION.

Micro

Thesectionsshowovarianparenchymawithalesionconsistingofbenigndermal,gastrointestinalandneural
elements.Theneuralelementsshowfocaldegenerativechangeswithmacrophages,andgiantcells.Siderophages
arepresent.Thelesionisexcisedintheplanesofsection.

Seealso
Germcelltumours.
Ovariantumours.

References
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