Figure 1: This complex pineal-region teratoma demonstrates areas of solid and cystic change and calcification on CT (top left) and areas of hyperintense fat signal intensity on the T1-weighted MR image (top right). Heterogeneous enhancement is a hallmark finding that illustrates the complexity of teratomas on T1 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 due to 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’s syndrome
- Treatment: surgical resection
- Prognosis: majority are lethal in utero or during 1st week of life; patients with malignant teratomas have poor 5-year survival (<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 variable, may be large in neonates (holocranial mass)
- Heterogeneous and containing very low-density fat, hyperdense calcification (teeth), intermediate density soft tissue, and low-density cysts
- Soft tissue may enhance on contrast-enhanced CT
- T1WI: Heterogeneous hyperintensity due to fatty components and calcification
- T2WI: Iso- 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
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