Details
Category: Volume 09 Issue 04 April 2021
Hits: 753

Title: Clinical-Evolutive and Morphopathological Particularities in Primary Teratocarcinoma of Anterior Mediastinum in Adolescents Clinical Case Presentation and Literature Review

Authors: Babuci S., Gorbatyuk O., Negru I., Petrovici V., Eremia V.

 DOI: https://dx.doi.org/10.18535/jmscr/v9i4.20

Abstract

Extragonadal germ cell tumors are rare in children, being diagnosed starting with the neonatal period and in adolescents, the anterior mediastinum being the most common location involved in the neoplastic process. The term "teratocarcinoma", according to WHO terminology, is used in cases of the combination of teratoma with embryonic carcinoma.The authors present the analysis of the clinical evolution, the results of laboratory and imaging investigations, compared with the data of the histopathological examination of an adolescent with a massive tumor formation of the anterior mediastinum with extension in the left hemithorax.The authors conclude that teratocarcinoma of the anterior mediastinum is characterized by an extremely aggressive behavior, which in a short period of time can reach giant dimensions and advanced stages of the disease, imposing the need for a greater degree of suspicion in the diagnosis of these tumors. Despite the complete ablation of the tumor, the risk of developing metastases in the intrathoracic organs, found postoperatively, which are not always detected preoperatively, persists. Extensive histological examination of the excised specimen is very valuable in assessing the share of immature tissues and malignant germ components, in the case presented a large amount of embryonic carcinoma was identified, which, along with immature teratomatous components, probably determined the aggressive evolution of the neoplasm.

References

  1. Kakkar A., Kaur K., Verma A. Pediatric mediastinal germcell tumors. Mediastinum. 2019; 3:30. http://dx.doi.org/10.21037/med.2019.07.02
  2. Chetaille B., Massard G., Falcoz P.-E. Mediastinal germ cell tumors: anatomopathology, classification, teratomas and malignant tumors. Rev. Pneumol. Clin. 2010; 66:63-70.
  3. Kotlovsky A.M., Bondarenko S.B., Sharoev T.A., Bourkov I.V., Klimchook O.V. Thoracoscopic treatment of a childwith a mediastinal mature teratoma complicated with spontaneous rupture. RussianJ.Pediatr. Surg., Anesth. And Intens. Care. 2014; 4(4):80-4.
  4. Kalhor N., Moran C.A. Primary germ cell tumors of the mediastinum: a review. Mediastinum. 2018; 2:4.doi: 10.21037/med.2017.12.01.
  5. Nuti R., Bodhireddy S., Thirumala S. Mixed germ cell tumor of mediastinum/lung masquerading as hemangioma in fine needle biopsy. Indian J. Pathol. Microbiol. 2013; 56:158-60.
  6. Varma A.V., Malpani G., Agarwal P., Malukani K., Dosi S. Clinicopathological spectrum of teratomas: an 8-year retrospective studyfrom a tertiary care institute. Indian J. Cancer. 2017; 54(3):576-9.
  7. Shimizu K., Nakata M., Hirami Y., Akiyama T., Tanemoto K. Teratoma with malignant transformation in the anterior mediastinum. J. Thor. Cardiovasc. Surg. 2008; 136(1):225-7.
  8. Habacon G.P., DeGuia T. Infestusmorbus: a case of mediastinal teratocarcinoma. Chest. 2015; 148:597A. doi:10.1378/chest.2277014.
  9. Navaro J.M., Torres Y.N., Delgado D.V. Teratocarcinoma mediastinal. Presentacion de un caso. Rev. Electr. Autopsy. 2017; 14:17-20.
  10. Damjanov I., Andrews P. The terminology of terato carcinoma sand teratomas. Nat. Biotechnol. 2007; 25(11):1212. https://doi.org/10.1038/nbt1107-1212a.
  11. Ruiz Cabrera Y.F., Ruiz Cabrera Y., Rodríguez Reyes S.J. Teratocarcinoma de mediastino. Medicentro Electrónica. 2015; 19(2): 118-21.
  12. Zhao H., Zhu D., Zhou Q. Complete resection of a giant mediastinal teratoma occupying the entire right hemithorax in a 14-year-old boy. BMC Surgery. 2014; 14:56.
  13. Fumino S., Sakai K., Higashi M., Aoi S., Furukawa T. et al. Advanced surgical strategy for giant mediastinal germ cell tumor in children J. Ped. Surg. Case Rep. 2017; 27: 51-5.
  14. Razafimanjato N.N., Rajaoharimalala T.G., Abdou Rabi R., Ravoatrarilandy M., Rajaonera A.T. et al. Huge mediastinal teratoma in children: anesthesiological approach, surgical strategy and literature review. J.Xiangya Med. 2019;4:35.doi: 10.21037/jxym.2019.08.02.
  15. Singhal M., Jhavar D. Primary mediastinal giantteratocarcinoma. Indian J. Cancer; 2008. 45:43-4.
  16. Grabski D.F., Pappo A.S., Krasin M.J., Davidoff A.M., Rao B.N., Fernandez-Pineda I. Long-termoutcomes of pediatric and adolescent mediastinal germcelltumors: a single pediatric oncologyinstitutionalexperience. Pediatr. Surg. Int. 2016; 33(2):235-44.
  17. Ong C.C., Teo L.L.S. Imaging of anterior mediastinal tumours. Cancer Imaging. 2012; 12:506-15.
  18. Al-Khalifa M., Alsaad S., Al-Tareef H., Arekat Z., Darwish A. A giantprimary mediastinal teratocarcinoma in a male adult. Hindawi Case Rep. Surg. 2019; Art. ID 7123241. 4 pag. https://doi.org/10.1155/2019/7123241.
  19. Hui M., Tandon A., Uppin S.G., Paruchuri R.K. Postchemotherapy-related changes in mediastinal mixed germ cell tumor masquerading as a vascular neoplasm. Indian J. pathol. Microbiol. 2012; 55(4):531-4.
  20. Yalcin B., Demir H.A., Tanyel F.C., Alcoren Z., Varan Al., et al. Mediastinal germcelltumors in childhood. Pediatr. Hematol. Oncol. 2012; 29(7):633-42.
  21. De Pasquale M.D., Crocoli A., Conte M., Indolfi P., D Angelo P. et al. Mediastinal germcelltumors in pediatric patients: a report fromthe italian Association od Pediatric Hematology and Oncology. Pediatr. Blood Cancer. 2016; 63:808-12.
  22. Feldman D.R., Hu J., Dorff T.B., Lim K., Patil S. et al. Paclitaxel, Ifosfamide, and Cisplatin efficacy for first-line treatment of patients with intermediate – or poor-risk germ cell tumors. J. Clin. Oncol. 2016; 34(21):2478-83.
  23. Le Fevre C., Vigneron C., Schuster H., Walter A., Marcellin L. et al. Metastatic mediastinal mature teratoma with malignant transformation in a young man with an adenocarcinoma in a Klinefelter s syndrome: Case report and review of literature. Cancer Radiother. 2018; 22(3):255-63.

Corresponding Author

Eremia V.

Nicolae Testemitanu” State University of Medicine and Pharmacy

Republic of Moldova