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Table of Contents    
LETTER TO EDITOR
Year : 2012  |  Volume : 60  |  Issue : 6  |  Page : 660-661

Mature teratoma in cerebellopontine angle in a 70-year-old female: A rare tumor with exceptional location, age, and presentation


Department of Neurosurgery, West China Hospital of Sichuan University, 37 Guo Xue Xiang, Wuhou District, Chengdu - 610 041, China

Date of Web Publication29-Dec-2012

Correspondence Address:
Si Zhang
Department of Neurosurgery, West China Hospital of Sichuan University, 37 Guo Xue Xiang, Wuhou District, Chengdu - 610 041
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.105214

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How to cite this article:
Zhang S, Wang X, Liu X, Hui X. Mature teratoma in cerebellopontine angle in a 70-year-old female: A rare tumor with exceptional location, age, and presentation . Neurol India 2012;60:660-1

How to cite this URL:
Zhang S, Wang X, Liu X, Hui X. Mature teratoma in cerebellopontine angle in a 70-year-old female: A rare tumor with exceptional location, age, and presentation . Neurol India [serial online] 2012 [cited 2019 Aug 25];60:660-1. Available from: http://www.neurologyindia.com/text.asp?2012/60/6/660/105214


Sir,

A 70-year-old female was hospitalized emergently due to headache, vomiting, and gait disturbance of 12-h duration. Neurological examination revealed a right-sided ataxia. Computer tomography (CT) scan and magnetic resonance imaging (MRI) showed a mass lesion in the right cerebellopontine angle (CPA) with intratumoral hemorrhage and calcification [Figure 1]. He was operated through a posterior fossa craniectomy. Intraoperatively, the lesion was inclusion tumor with greyish and thick capsule. Part of the capsule tightly attached to and compressed the occipital bone. The content of the tumor consisted of dark-brown hemorrhagic fat tissue and white calcified tissue. The tumor was totally resected and histopathological examination was consistent with mature teratoma. The patient did not receive post-operative radiotherapy and chemotherapy and post-operative recovery was uneventfully. During a 1-year follow-up, the patient's ataxia gradually improved with Karnofsky Scale more than 90. MRI showed no residual or recurrent tumor.
Figure 1: (a) Computed tomography scans show a lesion located in the right cerebellopontine angle with intratumoral hemorrhage and calcification (b) The right occipital bone is compressed and fused
together with the capsule of the lesion (c) Hyperintensity on Fluidattenuated inversion recovery (d) Heterogeneous intensity on T2- weighted image (e) Magnetic resonance imaging shows hyperintensity
on T1-weighted image (f) The capsule of the lesion was enhanced after administration of gadolinium


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Teratomas are rare developmental tumors and are considered to be derived from the ectopically misplaced germ cells during the closure of embryonic layers. Depending on the rate of differentiation of the germ cells, teratomas can be classified as mature, immature, and malignant. Mature teratomas are benign tumors consisting of completely differentiated ectodermal, mesodermal, and endodermal elements. [1] Only 3.5% of the teratomas are located in the central nervous system and account for 0.5% of all intracranial tumors and 2-4% of all pediatric intracranial neoplasms. Teratomas are mid-line in location in infancy and childhood and are most frequently located in the pineal (51%) and suprasellar (30%) regions. [2] However, non-mid-line cases have occasionally been reported in lateral ventricle and temporal lobe. Teratomas located in CPA are extremely rare, especially mature teratomas in elder patients. The radiological features of intracranial teratomas depend on the content of the tumor. In our patient, CT showed CPA heterogeneous density lesion with intratumoral hemorrhage and calcification. Intratumoral hemorrhage in teratomas rare, [2] the mechanism could be due to pathological deficits in the tumor blood vessel wall such as hyalinization, necrosis, or degeneration.

Radical resection is the optimal treatment. Mature teratomas are usually radioresistant and radiotherapy and chemotherapy are recommended only in immature and malignant teratomas. [3] Although most intracranial mature teratomas can be cured by gross total resection, the deep location and critical surrounding structures make total resection of the CPA mature teratoma difficult. Spillage of the content of the teratomas into the ventricle and/or subarachnoid space intraoperatively would cause various sequelae including tumor recurrence, aseptic meningitis, seizure, or vasospasm. Therefore, we propose that not only a total resection but also keeping the capsule intact intraoperatively should be achieved if possible. Prognosis of the intracranial mature teratomas is favorable because of their benign behavior and the 10-year survival is as high as 93% irrespective of the location. [4] However, we recommended a life-long follow-up as 22-year recurrence and malignant transformation have been reported. [5] Some authors recommend monitoring of tumor activity by alpha-fetoprotein and human chorionic gonadotropin measurements, but no perceptible elevation of the tumor markers is available in mature teratomas. [6]

In conclusion, CPA mature teratomas are extremely rare. [7] The present patient is probably the oldest patient with mature teratoma with intratumoral hemorrhage. Radical resection is considered to be the optimal treatment, and the capsule should be kept unruptured if possible. The prognosis of this lesion is favorable; however, these patients require life-long follow-up.

 
  References Top

1.Curtis JL, Burns RC, Wang L, Mahour GH, Ford HR. Primary gastric tumors of infancy and childhood: 54-year experience at a single institution. J Pediatr Surg 2008;43:1487-93.  Back to cited text no. 1
    
2.Beschorner R, Schittenhelm J, Bueltmann E, Ritz R, Meyermann R, Mittelbronn M. Mature cerebellar teratoma in adulthood. Neuropathology 2009;29:176-80.  Back to cited text no. 2
[PUBMED]    
3.Coulibaly O, El Kacemi I, Fatemi N, Gana R, Saïdi A, Maaqili R, et al. Mature posterior fossa teratoma mimicking infratentorial meningioma: A case report. Neurochirurgie 2012;58:40-3.  Back to cited text no. 3
    
4.Sano K. Pathogenesis of intracranial germ cell tumors reconsidered. J Neurosurg 1999;90:258-64.  Back to cited text no. 4
[PUBMED]    
5.Janzarik WG, Müller K, Lübbert M, Spreer J, Trippel M, Uhlig I, et al. Occurrence of a germinoma 22 years after resection of a mature cerebral teratoma. J Neurooncol 2008;88:217-9.  Back to cited text no. 5
    
6.Bavbek M, Altinörs N, Caner H, Aðildere M, Cinemre O, Güz T, et al . Giant posterior fossa teratoma. Childs Nerv Syst 1999;15:359-61.  Back to cited text no. 6
    
7.Iplikçioðlú AC, Ozer F, Benli K, Bertan V, Ruacan S. Malignant teratoma of the cerebellopontine angle: Case report. Neurosurgery 1990;27:137-9.  Back to cited text no. 7
    


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