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).
- Midline intracranial tumor arising from multipotential germ cells
- 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
- 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%)
- 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)
- 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
- 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
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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