1/27. Malignant teratoma of the thyroid with primitive neuroepithelial and mesenchymal sarcomatous components.A 15-year-old black girl had a near total resection of a malignant thyroid teratoma with bilateral nodal involvement and mediastinal extension. A predominant neuroepithelial pattern had ependymal rosettes and mitoses, stained for neuron-specific enolase, neuron-specific B tubulin, and synaptophysin. A malignant spindle cell component stained for smooth-muscle actin, muscle actin, and to a lesser extent S-100. Loose myxoid tissue resembled primitive cartilage. Epithelial membrane antigen and cytokeratin identified epithelial foci. chromogranin a, MIC2, glial fibrillary acidic protein, and thyroid stimulating hormone receptor stains were negative. There was focal anaplasia. dna ploidy by laser scanning cytometry was 1.2. The tumor from the left and right thyroid lobes exhibited trisomy 8, the right also had hyperdiploid cell lines. She was treated with aggressive combination chemotherapy and radiation. Presently there is no residual disease 16 months after diagnosis. Malignant thyroid teratoma is an aggressive tumor, with 15 of 27 reported patients dying 2 weeks to 3 years after diagnosis. survivors have been treated with total or subtotal resection, combination chemotherapy with agents effective in the treatment of germ cell tumors as well as sarcomas, and radiation for either recurrent or residual disease. The heterologous elements, lacking MIC2 staining and t(11;22), support the diagnosis of malignant teratoma rather than a neuroepithelial tumor. trisomy 8 is the first cytogenetic abnormality described in malignant thyroid teratoma. Therapy should be tailored to the management of all transformed histologies.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
2/27. Course and outcome of a pregnancy with a giant fetal cervical teratoma diagnosed prenatally.We report the course and outcome of a pregnancy involving a giant fetal neck teratoma which was diagnosed at 23 weeks of gestation. Sonographic surveillance of the fetal neck revealed continuing growth of the tumor with development of polyhydramnios. Three-dimensional ultrasound provided additional detailed information on the external extent of the lesion. color Doppler ultrasound showed intense arterial and venous flow with low resistance indices. cesarean section under general anesthesia was planned in close cooperation with the neonatologist, pediatric surgeon and anesthesiologist because the size of the neck mass precluded vaginal delivery. cesarean section was performed at 34 weeks of gestation following preterm rupture of the membranes. Orotracheal intubation was not successful because of compression of the airway and a tracheostomy could not be performed because of the risk of severe fetal hemorrhage from the tumor. The neonate died from respiratory insufficiency 66 min after birth.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
3/27. Sacrococcygeal teratoma: prenatal assessment, fetal intervention, and outcome.PURPOSE: To understand the natural history and define indications for fetal intervention in sacrococcygeal teratoma (SCT), the authors reviewed all cases of fetal SCT presenting for evaluation. methods: Prenatal diagnostic studies including ultrasound scan, magnetic resonance imaging (MRI), echocardiography and pre- and postnatal outcomes were reviewed in 30 cases of SCT that presented between September 1995 and January 2003. RESULTS: The mean gestational age (GA) at presentation was 23.9 weeks (range, 19 to 38.5) with 3 sets of twins (10%). overall outcomes included 4 terminations, 5 fetal demises, 7 neonatal deaths, and 14 survivors. Significant obstetric complications occurred in 81% of the 26 continuing pregnancies: polyhydramnios (n = 7), oligohydramnios (n = 4), preterm labor (n = 13), preeclampsia (n = 4), gestational diabetes (n = 1), hellp syndrome (n = 1), and hyperemesis (n = 1). Fetal intervention included cyst aspiration (n = 6), amnioreduction (n = 3), amnioinfusion (n = 1), and open fetal surgical resection (n = 4). Indications for cyst aspiration and amnioreduction were maternal discomfort, preterm labor, and prevention of tumor rupture at delivery. Although 15 SCTs were solid causing risk for cardiac failure, only 4 fetuses met criteria for fetal debulking based on ultrasonographic and echocardiographic evidence of impending high output failure and favorable anatomy at 21, 23.6, 25, and 26 weeks' gestation. Intraoperative events included maternal blood transfusion (n = 1), fetal blood transfusion (n = 2), chorioamniotic membrane separation (n = 2), and fetal arrest requiring successful cardiopulmonary resuscitation (CPR) (n = 1). In the fetal resection group, 3 of 4 survived with mean GA at delivery of 29 weeks (range, 27.6 to 31.7 weeks), mean birth weight of 1.3 kg, hospital stay ranging from 16 to 34 weeks, and follow-up ranging from 20 months to 6 years. Postnatal complications in the fetal surgery group included neonatal death (n = 1, secondary to premature closure of ductus arteriosus with cardiac failure), embolic event (n = 1, resulting in unilateral renal agenesis, jejunal atresia), chronic lung disease (n = 1), and tumor recurrence (n = 1). CONCLUSIONS: For fetal SCT, the rapidity at which cardiac compromise can develop and the high incidence of obstetric complications warrant close prenatal surveillance. Amnioreduction, cyst aspiration, and surgical debulking are potentially life-saving interventions.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
4/27. meningioma in mature cystic teratoma of the ovary.A case of meningioma arising in a mature cystic teratoma of the ovary in a 60-year-old woman is described. The tumor was located in the right ovary, and salpingo-oophorectomy was performed. The right ovary was 10 x 10 x 8 cm in size and contained an unilocular cyst. In the wall, a solid nodule measuring 3 x 3 x 2 cm was noted. Histologically, the cyst wall was composed of typical mature cystic teratoma. In contrast, the mural nodule was composed of the proliferating spindle- and polygonal-shaped cells showing positive staining for epithelial membrane antigen and microcystic change was prominent. These findings were consistent with microcystic meningioma. The arachnoidal cells around mature brain tissue may be the origin of this unusual tumor. To the best of our knowledge, this is the first case of mature cystic teratoma with meningioma of the ovary reported in English medical literature. This case may further indicate the totipotential nature of mature cystic teratoma.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
5/27. Laparoscopic management of teratoma of the round ligament.This paper describes the case of an asymptomatic woman who underwent laparoscopy as part of a work-up for infertility. A previous transvaginal ultrasound had shown an echogenic adnexal mass, independent of the ovary. The intraoperative finding was a tumor of the round ligament that was resected and determined to be a mature teratoma. The case is reported due to the unusual location for that type of tumor; and in addition, it is the first description of a teratoma in the round ligament managed by laparoscopy.- - - - - - - - - - ranking = 173.866175405keywords = ligament (Clic here for more details about this article) |
6/27. The use of cardiopulmonary bypass and extracorporeal membrane oxygenation for support during removal of two teratomas and hydrops fetalis.The removal of massive tissue tumors often leads to rapid blood loss and decreased lung compliance because of large volume shifts. cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenation (ECMO) have both been used as a means of support during resection of saccrococcygeal teratomas. hydrops fetalis is the accumulation of fluid in extravascular spaces and body cavities. This leads to edema and sometimes hypoxia. ECMO has been used for support during treatment of hydrops fetalis. This patient was diagnosed, via sonogram, at 30 weeks gestation to have two teratomas and hydrops fetalis. Because of the risk of hemorrhage and poor lung compliance during removal of these types of tumors, CPB and ECMO were used. This support allowed for successful removal of the tumors. Following removal of the tumors, the patient failed to wean from CPB because of the severity of hydrops. The patient remained on extracorporeal support for treatment of hydrops fetalis. This report describes the perfusion techniques used for support during the removal of teratomas and the treatment of hydrops fetalis.- - - - - - - - - - ranking = 5keywords = membrane (Clic here for more details about this article) |
7/27. A case of a mature cystic teratoma of the uterosacral ligament successfully treated by laparoscopic surgery.An asymptomatic tumor was found in the pelvic cavity of a 49-year-old woman during a routine examination. With a diagnosis of mature cystic teratoma of the right ovary, laparoscopic surgery was performed. The intraoperative finding showed the presence of a cystic tumor firmly attached to the uterosacral ligament in a position distant from the bilateral ovaries. Laparoscopic excision was performed, and the diagnosis of mature cystic teratoma of the uterosacral ligament was made histopathologically. This is the first report in the literature of successful laparoscopic treatment for a mature cystic teratoma of the uterosacral ligament.- - - - - - - - - - ranking = 202.84387130583keywords = ligament (Clic here for more details about this article) |
8/27. Pediatric embryonal tumor of the cerebellum with rhabdoid cells and novel intracytoplasmic inclusions: distinction from atypical teratoid/rhabdoid tumor.We report a case of embryonal tumor with novel inclusion bodies occurring in the cerebellum of a 12-year-old girl. The tumor was histopathologically composed of small undifferentiated cells intermingled with a small number of rhabdoid cells, which had an ultrastructural feature of intermediate filament whorls. Immunohistochemically, the neoplasm showed a polyphenotype, including glial fibrillary acidic protein (GFAP), S-100, synaptophysin, chromogranin a, cytokeratin, vimentin, smooth muscle actin, and desmin. However, epithelial membrane antigen (EMA) immunoreactivity was absent. The MIB-1 labeling index was high (25.6%). Ultrastructurally, there was no evidence of neuronal or myogenic differentiation. The small neoplastic cells contained numerous small intracytoplasmic inclusions stained pink by eosin and red by Masson's trichrome stain. The inclusion body was a densely packed, granulovesicular structure at the electron microscopic level, and was immunoreactive for vimentin, GFAP, desmin, and actin. reverse transcription-PCR and immunohistochemistry showed the expression of INI1 at the rna and protein levels, respectively. In conclusion, this tumor was differentiated from atypical teratoid/rhabdoid tumor by the absence of EMA and the presence of INI1 mRNA and protein, and diagnosed as an unclassified, embryonal tumor. Eosinophilic, granulovesicular inclusions of the tumor cells are novel cytoplasmic inclusions in the brain tumor.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
9/27. Management of prenatally diagnosed tracheal obstruction: access to the airway in utero prior to delivery.A fetus of 23-weeks gestation presented with polyhydramnios, and was found on sonography to have a large anterior cervical teratoma. At 26 weeks the mother went into premature labor and the membranes ruptured; at this time the uterus was of 32-weeks size secondary to polyhydramnios. A cesarean section was performed through a low transverse uterine incision, and the fetal head and shoulders were delivered with the cord intact. An endotracheal tube was placed, and the cord was then divided. The baby was taken to the neonatal intensive care unit for stabilization prior to planned resection, but suffered pharyngeal hemorrhage followed by endotracheal tube dislodgement several hours after birth, and expired. Despite an unfortunate outcome, this case illustrates the feasibility and potential value of in utero airway access in cases of prenatally diagnosed tracheal obstruction.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
10/27. Epignathus combined with cleft palate, lobulated tongue, and lingual hamartoma: report of a case.A case of epignathus combined with cleft palate, lobulated tongue, and lingual hamartoma is reported. A newborn female presented with a large skin-covered mass arising from the palate, cleft palate, and lobulated tongue with a soybean-sized lingual lesion. The palatal and lingual masses were removed on the 9th day after birth. A cystic lesion was also found on the nasal septum after removal of the palatal mass; this lesion was resected at its base. Glossoplasty was performed after excision of the lingual lesion. Histologically, the palatal mass was diagnosed as epignathus. The cystic lesion was suspected to be meningothelial tissues on the basis of hematoxylin-eosin (HE) and immunohistochemical staining: vimentin and epithelial membrane antigen were positive, and factor viii was negative. The mass of the tongue dorsum was diagnosed as hamartoma. No recurrence of epignathus or evidence of meningocele have been observed after 5 years of follow up.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
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