Teratoma

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[summary] teratoma (teratoma) is usually a true neoplasm composed of three blastomeres of the organization. Containing immature to mature sk

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[summary] teratoma (teratoma) is usually a true neoplasm composed of three blastomeres of the organization. Containing immature to mature skin, teeth, bone, cartilage, nerve, muscle, fat, epithelial tissue, and sometimes visceral tissue. Tumor component and site independent. More girls than boys. The shape, size and structure of teratoma vary greatly with the location and age. Malignant tumors are mostly solid tumors and poorly differentiated tissues. Benign is mostly cystic and mostly well differentiated tissue. Benign teratoma malignant tendency, and with the age growth, canceration rate is increased gradually. Common parts of the ovary, testis, sacrococcygeal, anterior mediastinum, retroperitoneum and pineal gland.

[cause]

Is one of the most common types of germ cell tumors in children. It is due to the growth and differentiation of the remaining pluripotent stem cells in the gonad or the gonad.

[pathology]

There are three kinds of germ cells, which can be divided into three types: mature teratoma, immature teratoma and malignant teratoma.

[clinical manifestations]

1. Sacrococcygeal teratoma

Type I: after a sacrococcygeal mass is mostly mixed, ranging in size too large can cause skin thinning, even ulceration, necrosis, anal rectum anterior and inferior displacement, without compression. Benign and more common.

Type II: sacrococcygeal mass and extend to the pelvic cavity, anus can refer to the anterior sacral tumor.

Type III: caudal mass and extending into the abdominal cavity, abdominal palpable mass.

Type IV: the mass is located in the sacrum, the sacrum and the tail is slightly raised, and there is no obvious tumor. The huge size of masses more due to difficulties in diagnosis and treatment. Malignant multi.

2. Retroperitoneal teratoma early can not cause any symptoms. Some parents found that children's abdomen gradually rise up to see a doctor, or when a child's physical examination by the doctor to touch the abdominal mass and found that the abdominal boundaries clear, hard and soft, no tenderness, inactive package. A huge tumor of gastrointestinal tract compression symptoms, part of patients with chylous ascites.

3. Ovarian teratomas occurred in 11 ~ 15 years old children. Cystic or mixed mass on the side of the abdomen. Recurrent abdominal pain or sudden pain, accompanied by vomiting and fever (tumor torsion and necrosis).

4. 1 ~ 2 year old testicular teratoma of testicular tumor, teratoma accounted for 2/3. After birth, there is a painless testicular mass, and gradually grow up. Mass was hard without apparent tenderness.

5. For asthma treatment of mediastinal teratoma. Chest X-ray and CT showed cystic lesions in the anterior mediastinum, sometimes calcification.

Diagnosis and differential diagnosis

According to history, careful palpation and dre or bimanual determine the size, location, tumor texture;

X-ray film: can have a bone or tooth shadow. If there is a spine or skull shadow is parasitic fetus.

B ultrasound, CT scan and enhanced MRI examination: to understand the location of the tumor, size, nature, calcification, and adjacent organs adjacent relationship. Attention should be paid to whether the lung metastasis, liver metastasis and retroperitoneal lymph node metastasis.

Detection of tumor markers: serum alpha fetoprotein (AFP) quantitative examination, to determine benign or malignant and used for postoperative monitoring. Determination of serum neuron specific enolase (NSE), chorionic gonadotropin (HCG) and lactate dehydrogenase (LDH), to determine whether other malignant germ cell tumors. Pay attention to the following diseases:

1. Sacrococcygeal teratoma meningocele and differential myelomeningocele congenital central nervous system malformations. Spinal and sacral defects. MRI can be displayed to help identify.

2. Retroperitoneal teratoma and other retroperitoneal tumor identification:

(1) neuroblastoma: solid tumor, large nodular shape; hard, not active; often associated with liver metastasis, bone metastasis and bone marrow metastasis; CT, B ultrasound showed mass around the large vascular growth, irregular calcification.

(2) Wilms tumor: solid solid tumor in the kidney, elongated renal pelvis.

(3) hydronephrosis: renal cystic mass, CT, ultrasound, IVP angiography showed enlargement of renal pelvis or nonvisualized.

3. Ovarian teratoma torsion and identification: acute abdomen ultrasound and CT visible appendicitis cases.

4. Testicular teratoma and hernia, hydrocele hernia, hydrocele: differentiate scrotal cystic mass.

5. Mediastinal teratoma lymphangioma, lymphoma and differentiate: lymphangioma cystic lesions; lymphoma progress fast, solid mass without calcification, with bone marrow metastasis.

[treatment]

1 newborn, small baby teratoma once diagnosed, surgical resection should be as soon as possible, must not wait. For those who have the tendency of infection and rupture, regardless of age should be emergency surgery. Surgical resection of sacral tumors must coccyx, otherwise easy to recurrence and malignancy.

2 staging of malignant tumors

Complete resection of stage I tumor, no residual;

Complete resection of tumor;

The third stage of the tumor was not completely resected, or only biopsy was performed, or the preoperative and intraoperative tumor rupture;

Phase IV distant metastasis.

3 benign teratoma, stage I ovarian immature teratoma and stage I testicular germ cell tumor were all removed without metastasis. Postoperative monitoring of alpha fetoprotein (AFP) and the corresponding tumor markers (monthly examination, after 3 months should be reduced to normal). Newborns should be followed up to 1 years of age. If the AFP is not normal or an upward trend, three drugs should be treated for 6 months.

4 cases of malignant tumor after chemotherapy for 12 months. The commonly used drug for cisplatin, Ashikagayo Oto, Pingyang mycin and vincristine, actinomycin D, cyclophosphamide, adriamycin etc..

5 stage III and IV malignant tumors should be treated with preoperative chemotherapy for 3 to 6 months. Postoperative chemotherapy for 18 to 24 months. Ovarian tumor should be removed at the same time.

[prognosis]

The prognosis of malignant germ cell tumors of the mature, immature ovarian teratoma and testis was good. Malignant tumor patients with chemotherapy sensitivity even if there is lung or liver metastasis may also be cured.

 

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