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Teratoma pathophysiology

Introduction

Overview

Overview

The histopathology of teratoma depends on the histological subtype.Teratoma is a germ cell tumor due to abnormal development of pluripotent cells and renmant of primitive node.

Pathophysiology

Pathophysiology

 
 
 
 
 
 
 
Germ cell
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pathogenesis
 
 
 
 
 
 
 
Malignant transformation
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Mature teratoma
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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Tumors with primitive embryonic ectoderm, mesoderm, and/or endoderm differentiation{{{ }}}
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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Immature teratoma
 

Pathogenesis

  • Mature teratoma arises from a pathological transformation of primordial germ cell during the develompment.[1][2]
  • Mature teratoma comes from a single germ cell tumor after first phase of meiosis and failure of meiosis type II.[3][4][5]
  • Mature teratoma contains a well differentiated tumor with all three germ layers (ectoderm, mesoderm and endoderm).[2]
  • Mature teratoma may be located in the embryonic fusion midline or paraxial, mediastinum, ovary, retroperitoneum, and sacrococcygeal.[6]
  • Immature teratoma may be due to the malignant tranformation of primitive germ cell layers and renmant of primive node.[7][8]
Genetics

Genetics

Genes involved in the pathogenesis of teratoma include:[9]

  • Gain of part or all chromosomes
    • 1p
    • 16p
    • 19
    • 22q
Immunohistochemistry

Immunohistochemistry

  • Neuronal element found in mature or immature teratoma are positive for:[10][11]
  • Carcinoid tumor found in the monodermal teratoma may be positive for:[12]
    • Serotonin and peptides hormones.
Associated conditions

Associated conditions

Conditions associated with teratoma include:

Gross and microscopy pathology

Gross and microscopy pathology

The gross and microscopy features of teratoma are described below:[16][12][17][7][18][19][20][21][22][23][24]

Types Gross pathology Microscopic pathology Images
Mature teratoma
  • Unilateral cystic mass in most cases, rarely solid
  • Predominantly cystic with hair tufts, teeth, and cartilaginous material
  • Unilocular in most cases
  • Capsular compoment is well defined
  • Soft, tan, measured about 3 to 21 cm in diameter
  • Contains three embryonic layers (misoderm, endoderm, and ectoderm)
  • Keratinized squamous cells epithelium
  • Adnexal structures (sebaceous glands, hair follicles)
  • Adipose tissues
  • Lobules of mature cartilage
  • Glands lined by the respiratry mucosa and digestive mucosa
  • Skeletal muscles
  • No cytology atypia
Immature teratoma
  • Solid mass with necrotic and hemorrhagic areas
  • Cystic cavities may be filled with serous or mucinous fluid
  • Capsular is not well defined
  • Tends to be larger than mature cystic teratoma
  • Neural tissues with neuroepithelial rosettes
  • Choroid plexus
  • Immature mesenchymal
  • Presence of primtive elements
  • Cytology atypia
Monodermal teratoma
  • Unilateral mass
  • Well differentiated neoplasm
    References

    References

    1. ↑ Vural, F.; Vural, B.; Paksoy, N. (2015). “Vaginal teratoma: A case report and review of the literature”. Journal of Obstetrics and Gynaecology. 35 (7): 757–758. doi:10.3109/01443615.2015.1004525. ISSN 0144-3615.
    2. ↑ 2.0 2.1 El-Maarri, Osman; Rijlaarsdam, Martin A.; Tax, David M. J.; Gillis, Ad J. M.; Dorssers, Lambert C. J.; Koestler, Devin C.; de Ridder, Jeroen; Looijenga, Leendert H. J. (2015). “Genome Wide DNA Methylation Profiles Provide Clues to the Origin and Pathogenesis of Germ Cell Tumors”. PLOS ONE. 10 (4): e0122146. doi:10.1371/journal.pone.0122146. ISSN 1932-6203.
    3. ↑ Linder, David; McCaw, Barbara Kaiser; Hecht, Frederick (1975). “Parthenogenic Origin of Benign Ovarian Teratomas”. New England Journal of Medicine. 292 (2): 63–66. doi:10.1056/NEJM197501092920202. ISSN 0028-4793.
    4. ↑ Surti U, Hoffner L, Chakravarti A, Ferrell RE (1990). “Genetics and biology of human ovarian teratomas. I. Cytogenetic analysis and mechanism of origin”. Am J Hum Genet. 47 (4): 635–43. PMC 1683780. PMID 2220805.
    5. ↑ Caspi B, Lerner-Geva L, Dahan M, Chetrit A, Modan B, Hagay Z; et al. (2003). “A possible genetic factor in the pathogenesis of ovarian dermoid cysts”. Gynecol Obstet Invest. 56 (4): 203–6. doi:10.1159/000074755. PMID 14614249.
    6. ↑ Comerci JT, Licciardi F, Bergh PA, Gregori C, Breen JL (1994). “Mature cystic teratoma: a clinicopathologic evaluation of 517 cases and review of the literature”. Obstet Gynecol. 84 (1): 22–8. PMID 8008317.
    7. ↑ 7.0 7.1 Varma AV, Malpani G, Agrawal P, Malukani K, Dosi S (2017). “Clinicopathological spectrum of teratomas: An 8-year retrospective study from a tertiary care institute”. Indian J Cancer. 54 (3): 576–579. doi:10.4103/ijc.IJC_294_17. PMID 29798962.
    8. ↑ Keene DJ, Craigie RJ, Shabani A, Batra G, Hennayake S (2011). “Bipartite anterior extraperitoneal teratoma: evidence for the embryological origins of teratomas?”. Case Rep Med. 2011: 208940. doi:10.1155/2011/208940. PMC 3163403. PMID 21949666.
    9. ↑ Kraggerud SM, Szymanska J, Abeler VM, Kaern J, Eknaes M, Heim S et al. (2000) DNA copy number changes in malignant ovarian germ cell tumors. Cancer Res 60 (11):3025-30. PMID: 10850452
    10. ↑ Yoshikata R, Yamamoto T, Kobayashi M, Ota H (2006). “Immunohistochemical characteristics of mature ovarian cystic teratomas in patients with postoperative recurrence”. Int J Gynecol Pathol. 25 (1): 95–100. doi:10.1097/01.pgp.0000172082.17805.6c. PMID 16306792.
    11. ↑ Takayama, Yoshiyasu; Matsumura, Nozomi; Nobusawa, Sumihito; Ikota, Hayato; Minegishi, Takashi; Yokoo, Hideaki (2015). “Immunophenotypic features of immaturity of neural elements in ovarian teratoma”. Virchows Archiv. 468 (3): 337–343. doi:10.1007/s00428-015-1891-8. ISSN 0945-6317.
    12. ↑ 12.0 12.1 Outwater, Eric K.; Siegelman, Evan S.; Hunt, Jennifer L. (2001). “Ovarian Teratomas: Tumor Types and Imaging Characteristics”. RadioGraphics. 21 (2): 475–490. doi:10.1148/radiographics.21.2.g01mr09475. ISSN 0271-5333.
    13. ↑ Liang Z, Yang S, Sun X, Li B, Li W, Liu Z et al. (2017) Teratoma-associated anti-NMDAR encephalitis: Two cases report and literature review. Medicine (Baltimore) 96 (49):e9177. DOI:10.1097/MD.0000000000009177 PMID: 29245365
    14. ↑ Dalmau, Josep; Gleichman, Amy J; Hughes, Ethan G; Rossi, Jeffrey E; Peng, Xiaoyu; Lai, Meizan; Dessain, Scott K; Rosenfeld, Myrna R; Balice-Gordon, Rita; Lynch, David R (2008). “Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies”. The Lancet Neurology. 7 (12): 1091–1098. doi:10.1016/S1474-4422(08)70224-2. ISSN 1474-4422.
    15. ↑ Malayev, Yuliya; Alberts, Jared; Verardi, Mary Ann; Mattison, Anissa R.; Imlay, Sherwin (2015). “Immature Teratoma Associated With Anti–N-Methyl-D-Aspartate Receptor Encephalitis”. The Journal of the American Osteopathic Association. 115 (9): 573. doi:10.7556/jaoa.2015.116. ISSN 0098-6151.
    16. ↑ Yayla Abide, ÇiÄŸdem; Bostancı Ergen, Evrim (2018). “Retrospective analysis of mature cystic teratomas in a single center and review of the literature”. Journal of Turkish Society of Obstetric and Gynecology. 15 (2): 95–98. doi:10.4274/tjod.86244. ISSN 1307-699X.
    17. ↑ Ulbright, Thomas M (2005). “Germ cell tumors of the gonads: a selective review emphasizing problems in differential diagnosis, newly appreciated, and controversial issues”. Modern Pathology. 18 (S2): S61–S79. doi:10.1038/modpathol.3800310. ISSN 0893-3952.
    18. ↑ Jung SE, Lee JM, Rha SE, Byun JY, Jung JI, Hahn ST (2002). “CT and MR imaging of ovarian tumors with emphasis on differential diagnosis”. Radiographics. 22 (6): 1305–25. doi:10.1148/rg.226025033. PMID 12432104.
    19. ↑ da Silva TK, Ribeiro GJ, Scortegagna FA, Zanetti G, Marchiori E (2015). “Teratoma: a set of teeth in the pelvis”. Radiol Bras. 48 (4): 263–4. doi:10.1590/0100-3984.2015.0034. PMC 4567366. PMID 26379326.
    20. ↑ Rathore R, Sharma S, Agarwal S (2018). “Malignant transformation in mature cystic teratoma of the ovary: a retrospective study of eight cases and review of literature”. Prz Menopauzalny. 17 (2): 63–68. doi:10.5114/pm.2018.77304. PMC 6107092. PMID 30150913.
    21. ↑ Caruso PA, Marsh MR, Minkowitz S, Karten G (1971). “An intense clinicopathologic study of 305 teratomas of the ovary”. Cancer. 27 (2): 343–8. doi:10.1002/1097-0142(197102)27:2<343::aid-cncr2820270215>3.0.co;2-b. PMID 5100397.
    22. ↑ Wisniewski M, Deppisch LM (1973). “Solid teratomas of the ovary”. Cancer. 32 (2): 440–6. doi:10.1002/1097-0142(197308)32:2<440::aid-cncr2820320222>3.0.co;2-8. PMID 4722922.
    23. ↑ Moran CA, Suster S (1997). “Primary germ cell tumors of the mediastinum: I. Analysis of 322 cases with special emphasis on teratomatous lesions and a proposal for histopathologic classification and clinical staging”. Cancer. 80 (4): 681–90. PMID 9264351.
    24. ↑ Kao CS, Bangs CD, Aldrete G, Cherry AM, Ulbright TM (2018). “A Clinicopathologic and Molecular Analysis of 34 Mediastinal Germ Cell Tumors Suggesting Different Modes of Teratoma Development”. Am J Surg Pathol. 42 (12): 1662–1673. doi:10.1097/PAS.0000000000001164. PMID 30256256.

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