Vols. Videos

Teratoma

Last Updated: May 9, 2021

Figure 1: This complex pineal-region teratoma demonstrates areas of solid and cystic change and calcification on a CT image (top left) and areas of hyperintense fat signal intensity on a T1-weighted MR image (top right). Heterogeneous enhancement is a hallmark finding that illustrates the complexity of teratomas on T1WI after contrast administration (bottom).

Figure 1: This complex pineal-region teratoma demonstrates areas of solid and cystic change and calcification on a CT image (top left) and areas of hyperintense fat signal intensity on a T1-weighted MR image (top right). Heterogeneous enhancement is a hallmark finding that illustrates the complexity of teratomas on T1WI after contrast administration (bottom).

BASIC DESCRIPTION

  • Midline intracranial tumor arising from multipotential germ cells

PATHOLOGY

  • Contains tissue from all three germ cell types, ectoderm, endoderm, and mesoderm
    • Fat, calcification, teeth, soft tissue, sebaceum, and cysts
  • Three types
    • Mature: well-differentiated, WHO grade 1, often with cystic tumor component
    • Immature: intermediate differentiation
    • Malignant: malignant degeneration of immature teratoma, may contain somatic tumors

CLINICAL FEATURES

  • Arises during fetal development as a result of aberrant formation of the primitive streak
  • Mean patient age at diagnosis: 15 years; may be detected on fetal ultrasound
  • Male gender predilection (4:1)
  • Laboratory findings: increased serum carcinoembryonic antigen (CEA) ± α-fetoprotein
  • Common presenting signs/symptoms: macrocephaly/hydrocephalus, Parinaud syndrome
  • Treatment: surgical resection
  • Prognosis: majority are lethal in utero or during first week of life; patients with malignant teratomas have poor 5-year survival rate (<20%)

IMAGING FEATURES

  • General
    • Midline intracranial mass
      • Pineal region, sellar/suprasellar, basal ganglia, and spine
      • Mass effect on tectum, optic chiasm, and hypothalamus common
    • Contains calcifications, solid and fluid/cystic components, and fat
    • Size is variable, can be large in neonates (holocranial mass)
  • CT
    • Heterogeneous and contain very low-density fat, hyperdense calcification (teeth), intermediate-density soft tissue, and low-density cysts
    • Soft tissue may enhance on contrast-enhanced CT imaging
  • MRI
    • T1WI: heterogeneous hyperintensity due to fatty components and calcification
    • T2WI: isointense to hyperintense soft tissue, cysts/fluid; variable hyperintense peritumoral edema
    • T2*GRE: hypointense signal blooming in areas of calcification
    • DWI: diffusion restriction due to hypercellular solid components
    • T1WI+C: soft tissue components enhance, nonenhancing fatty or calcified portions

IMAGING RECOMMENDATIONS

  • MRI without and with intravenous contrast including fat-suppressed sequences; CT imaging to detect calcification

For more information, please see the corresponding chapter in Radiopaedia.

Contributor: Rachel Seltman, MD

DOI: https://doi.org/10.18791/nsatlas.v1.03.01.40

References

Kralik SF, Taha A, Kamer AP, et al. Diffusion imaging for tumor grading of supratentorial brain tumors in the first year of life. AJNR Am J Neuroradiol 2014;35:815–823. doi.org/10.3174/ajnr.A3757.

Liang L, Korogi Y, Sugahara T, et al. MRI of intracranial germ-cell tumours. Neuroradiology 2002;44:382–388. doi.org/10.1007/s00234-001-0752-0.

Liu Z, Lv X, Wang W, et al. Imaging characteristics of primary intracranial teratoma. Acta Radiol 2014;55:874–881. doi.org/10.1177/0284185113507824.

Noudel R, Vinchon M, Dhellemmes P, et al. Intracranial teratomas in children: the role and timing of surgical removal. J Neurosurg Pediatr 2008;2:331–338. doi.org/10.3171/PED.2008.2.11.331.

Osborn AG, Salzman KL, Jhaveri MD. Diagnostic Imaging (3rd ed). Elsevier, Philadelphia, PA; 2016.

Sawamura Y. WHO histological classification of tumors of the central nervous system: germ cell tumors (WHO, 1993). In Sawamura Y, Shirato H, de Tribolet N. (eds), Intracranial Germ Cell Tumors. Springer, Vienna, Austria; 1998;3–4. doi.org/10.1007/978-3-7091-6821-9_2.

Zygourakis CC, Davis JL, Kaur G, et al. Management of central nervous system teratoma. J Clin Neurosci 2015;22:98–104. doi.org/10.1016/j.jocn.2014.03.039.

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