Tready tumor is a common type of ovarian germ cell tumor, derived from germ cells, divided into mature teratoma (ie benign teratoma) and immature teratoma (malignant teratoma) ). Benign teratomas contain many components, including skin, hair, teeth, bones, oil, nerve tissue, etc.; malignant teratoma is poorly differentiated, with no or few formed tissues, and the structure is unclear. Early teratoma has no obvious clinical symptoms, and most of them are accidentally discovered during physical examination.
I. Intracranial teratoma
Symptom: Due to intracranial teratoma Tumors mainly occur in the midline areas such as the upper saddle area and the pineal body area, so there are often no obvious signs of brain localization. Most patients with increased intracranial pressure as the first symptom, manifested as headache, nausea, vomiting, bilateral papilledema in the ophthalmologic examination. The teratoma located in the pineal region may have both upper vision, ataxia, precocious puberty, and cranial nerve palsy. In the saddle area, diabetes insipidus, lethargy, visual field of vision, and water and fat metabolism disorders may occur. Cranial fossa can cause cerebellar dysfunction and neck stiffness. Bridge cerebral horn can occur headache vomiting, diplopia, ataxia, deafness, nystagmus, cranial nerve injury.
Check: The imaging features of intracranial teratoma have significant features that allow for a preliminary diagnosis.
(1) Most patients with lumbar puncture have different degrees of pressure increase in lumbar puncture and pressure, and the protein content of cerebrospinal fluid is generally not high.
(2) Most of the brain X-ray films show signs of increased intracranial pressure. If there are teeth, small bones, and calcified images, it is more helpful for qualitative diagnosis.
(3) CT scan CT scan can be seen in irregular shape, nodular and obvious lobulated and uneven density of space-occupying lesions, usually Solid components (high density), cystic (low density) and calcification and ossification are more common in polycystic. Fat was found in all patients, and intratumoral hemorrhage was rare. In a few cases, it can be seen that the oily liquid in the cerebral ventricle swims with the change of body position (caused by the teratoma rupture into the ventricle). It is difficult to distinguish between teratoma and malignant teratoma in plain CT, but the latter capsule becomes The fraction, calcification and fat are relatively small, and the substantial part is more. Benign benign tumors have been growing for many years, and the masses are usually larger when found. In the pineal region, there are almost different degrees of supratentorial ventricle enlargement. After the injection, the solid part is obviously strengthened, the density is extremely uneven, and the wall strengthening can be a plurality of annular shadows.
(4) MRI examination showed that the signals appearing in T1 and T2 images were extremely mixed, but the boundaries were clear, nodular or lobulated, and the benign teratoma borders were edema (T2 image showed clear height) Signal), if there is peripheral edema, suggesting that the tumor is a malignant component or malignant teratoma, the tumor wall and the parenchyma are obviously strengthened after the injection.
(5) The tumor marker CEA may be mildly or moderately elevated. AFP was significantly elevated in immature teratoma and mixed GCT patients with this component.
Treatment method: Benign teratoma is only surgically removed, but it is necessary to emphasize the stereoscopic multi-point material of pathological specimens to avoid missed diagnosis of malignant components. If you can cut it all, you can hope to cure it. Because the tumor is often located in the midline, it is difficult to completely cut the operation. If the whole can not be cut, cerebrospinal fluid shunt can be used to relieve obstructive hydrocephalus. Radiotherapy and chemotherapy are not effective for benign teratoma. Immature and malignant teratoma are treated with radiotherapy after chemotherapy. If the tumor does not disappear, the patient will be resected and the chemotherapy will continue for 2 courses.
Second, gastric teratoma
Symptoms: The main clinical manifestations are abdominal masses, mostly located in the left upper abdomen, bloating , vomiting, hematemesis and/or melena, difficulty breathing, anemia. In neonates or infants, upper abdominal mass and upper gastrointestinal bleeding (common in intermittent melena) are the main clinical manifestations.
Check: (1) X-ray examination 1 The abdominal plain film shows an increased density of uneven density in the upper abdomen or the whole abdomen. The border is unclear and the bowel is squeezed to the front right and below. A strip of bone or a punctate sand-like calcification is visible in the shadow of the mass. 2 Between the leaves of the object. 3 barium enema can be seen in the transverse colon, descending colon and sigmoid colon under pressure, the upper abdomen shows a huge shadow. 4 renal pelvic venography showed a downward shift of the left renal pelvis, and there may be an impression on the upper edge of the bladder.
(2) B-ultrasound showed various pangrams. The tumor was located in the left upper abdomen and the tumor was located between the spleen and kidney. The boundary could be clearly displayed or unclear. The mass may be multi-atrial lobular, and its internal phase may be solid, multiple cystic, or mixed, and may also show calcification.
(3) CT examination If the lesion is huge, even occupying 4/5 of the abdominal cavity, multiple organs are under pressure. The internal structure of the lesion is disordered, the density is uneven, and it is a mixed dense shadow. It can also be composed of solid and cystic components.
(4) Gastroscopic examination is rarely used, only the size of the lesion in the gastric cavity and its surface condition, such as bleeding, erosion and superficial ulcer, can be observed. The biopsy under direct vision is its advantage. However, it does not help the diagnosis of gastric teratoma.
Treatment methods: Most cases of gastric teratoma are benign, and early surgical resection has a good prognosis. Long-term follow-up should be performed after surgery, and AFP should be reviewed regularly. If there is no decrease or decrease, it will increase, suggesting recurrence or metastasis, and further treatment is needed.
Three, testicular teratoma
Symptoms: The high age of testicular teratoma can be divided into children and adults 2 In children, the age of children with testicular teratoma is 1 to 2 years old, and the age of adult testicular teratoma is 25 to 35 years old. The vast majority of patients present with testicular painless masses, which are hard, nodular, or irregular.
Check: B-ultrasound has the effect of judging the nature, size, location of the testicular tumor, the proportion of tumor-storing testicular tissue, and even the choice of treatment. Important clinical value. B-ultrasound of testicular teratoma showed clear mass of the mass, cystic solidity, cartilage in the mass, immature bone tissue or calcification. Serum alpha-fetoprotein (AFP) levels in adults with testicular teratoma are associated with benign and malignant. The AFP level in children with testicular teratoma is in the normal range of the corresponding age group, but the blood AFP level in normal infants is different within 6 months. Therefore, there is no clear clinical suggestion for the level of AFP in infants within 6 months. significance.
Treatment methods: Surgery is the treatment of choice for the treatment of testicular teratoma. For children with testicular teratoma, patients with testicular surgery can be considered according to the normal AFP level, the presence of normal testicular parenchyma in B-ultrasound, and the exclusion of malignant tumors during intraoperative frozen pathological examination.
Testicular dermoid cysts and children with testicular teratoma do not require additional treatment after surgery. Radical orchiectomy and retroperitoneal lymph node dissection were performed in patients with post-pubertal testicular teratoma with retroperitoneal lymph node metastasis. The vast majority of teratoma metastases are consistent with the pathological type of the primary lesion, but embryonic cancer components are also found in metastases of teratoma.
Four ovarian teratoma
Symptom: The incidence of metastasis is high. The mode of metastasis spreads along the peritoneum. Common metastatic sites include pelvic and peritoneal peritoneum, omentum, liver surface, diaphragm, intestine and mesentery. Most of the metastases are surface implanted. Lymph node metastasis is not uncommon.
Check:(1) AFP in patients with serum alpha-fetoprotein (AFP) is lower than ovarian yolk sac tumor, probably because it is immature The endoderm tissue of the teratoma can also secrete a small amount of AFP, and the other may be a mixed type of germ cell malignant tumor. Immature teratoma may be mixed with a small amount of yolk sac tumor components, which can synthesize trace AFP.
(2) Neuronal specific enolase (NSE) Ovarian immature teratoma contains mature or immature nerve cells, and sometimes NSE can be measured in serum, which is a reference for the diagnosis of this disease. significance.
(3) Other B-ultrasound, CT, MRI, laparoscopic, histopathological examination.
Treatment methods: (1) The principle of treatment of ovarian immature teratoma: surgical principle, adopting surgical methods to preserve fertility; after surgery, take effective combination chemotherapy early For recurrent tumors, different specific protocols should be developed based on the reversal of the malignant degree of immature teratomas, combined with different specific conditions.
(2) Surgical treatment 1 The majority of tumors are unilateral, and the patients are often very young. Many advocated unilateral attachment resection and preserved reproductive function. If the patient has no fertility requirements, and the tumor is stage II or III, bilateral attachment and hysterectomy can be performed. The omentum is a common metastatic site, and it is used for omentectomy regardless of the tumor stage. Whether the retroperitoneal lymph nodes are routinely removed, the opinions are not uniform. If there is extensive metastasis of the abdominal cavity, try to reduce the tumor as much as possible, and the tumor is basically cut. 2 surgical treatment of recurrent tumors The recurrence of immature teratoma is still mainly surgical resection, supplemented by effective combination chemotherapy. 3 secondary exploration surgery is currently not recommended.
(3) Chemotherapy is an indispensable treatment for ovarian immature teratoma. After the initial surgery, combined chemotherapy is used early to prevent recurrence and improve survival.
5. Teratoma of the appendix
Symptoms: The size of the teratoma is different. It is difficult to urinate and defecate. Sometimes the buttocks are swollen and there may be masses in the tail. Because the tumor tends to grow sideways to the buttocks, the buttocks often appear asymmetrical. Sometimes the tumor bulges from the perineum. Patients with rectal compression or involvement may have constipation or fecal incontinence. A person with a huge tumor can affect the delivery of his mother. The rectal mass can be touched during rectal examination. Malignant teratomas grow rapidly, with progressive constipation and difficulty urinating.
Check:(1) Laboratory test for high blood AFP (alpha-fetoprotein) test positive rate, peripheral blood-like white blood cell count when there is bacterial infection And neutrophil counts were significantly elevated.
(2) Other auxiliary examination X-ray films showed bone and tooth shadows in the tumor. Lateral images showed a swollen shadow on the tail. The barium enema shows that the rectum is bent forward. Intravenous pyelography helps to determine the extent and location of the tumor, and X-ray examination of the chest and bone is required.
Treatment methods: Surgery is the treatment of choice. The tailbone must be removed together. Tumor cells are often found on the tailbone, and if the resection is not complete, the teratoma will recur even if it is benign. Newborns should be operated as soon as possible after birth to avoid malignant changes. Special attention should be paid to the treatment of the anterior tibial artery during surgery to prevent the risk of bleeding. Pay attention to the lymph node metastasis during surgery. In addition to surgical resection, malignant teratoma of the appendix must be given radiation therapy and chemotherapy.
How to deal with teratoma in pregnancy?
If ovarian teratoma is found during pregnancy, it will be temporarily observed in the first 3 months of pregnancy, and then treated with laparoscopic surgery after 12 weeks. Teratoma is most prone to torsion, acute abdomen occurs, so pregnancy with teratoma should be treated laparoscopically. Teratomas are found in the second trimester of pregnancy and can be awaited at the end of childbirth. Teratoma found before pregnancy is best surgical treatment to avoid tumor growth during pregnancy, but surgery. There is no need for contraception after teratoma surgery.