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Aim: This study aimed to evaluate the clinical characteristics and outcomes of recurrent sacrococcygeal germ cell tumors (SC-GCTs). Materials and Methods: This study was conducted with patients diagnosed with SC-GCTs between 2002 and 2022. Epidemiology, diagnostic and treatment methods, anatomic/histopathological classifications and recurrence were evaluated. Results: This study included 55 patients (Female/Male: 45/10). According to Altman’s-classification, 16 patients (29.1%) were Type I, 14 (25.5%) Type II, 12 (21.8%) Type III and 13 (23.6%) Type IV. Histologically, 69.1% of the lesions were mature teratomas, 14.5% were immature teratomas, and 16.4% were malignant teratomas. Eleven patients developed recurrent sacrococcygeal teratoma (recurrence age: 5 months-12 years). According to Altman’s classification, 2/11 patients were Type II, 5/11 patients were Type III, and 4/11 patients were Type IV. The pathological results of the original tumors were mature teratoma in 4/11 patients, immature teratoma in 4/11 patients, and malignant teratoma in 3/11 patients. Malignant relapse with yolk sac tumor was detected in 6/11 patients, mature teratoma in 4/11 patients, and immature teratoma in 1/11 patients. Conclusion: The risk of malignancy increases with age and Altman’s Type III and IV. Recurrent tumors may have different histopathological types from the original tumor. The risk of recurrence as a malignant tumor after immature teratomas was higher than mature teratomas.

Aim: This study aimed to evaluate the clinical characteristics and outcomes of recurrent sacrococcygeal germ cell tumors (SC-GCTs). Materials and Methods: This study was conducted with patients diagnosed with SC-GCTs between 2002 and 2022. Epidemiology, diagnostic and treatment methods, anatomic/histopathological classifications and recurrence were evaluated. Results: This study included 55 patients (Female/Male: 45/10). According to Altman's-classification, 16 patients (29.1%) were Type I, 14 (25.5%) Type II, 12 (21.8%) Type III and 13 (23.6%) Type IV. Histologically, 69.1% of the lesions were mature teratomas, 14.5% were immature teratomas, and 16.4% were malignant teratomas. Eleven patients developed recurrent sacrococcygeal teratoma (recurrence age: 5 months-12 years). According to Altman's classification, 2/11 patients were Type II, 5/11 patients were Type III, and 4/11 patients were Type IV. The pathological results of the original tumors were mature teratoma in 4/11 patients, immature teratoma in 4/11 patients, and malignant teratoma in 3/11 patients. Malignant relapse with yolk sac tumor was detected in 6/11 patients, mature teratoma in 4/11 patients, and immature teratoma in 1/11 patients. Conclusion: The risk of malignancy increases with age and Altman's Type III and IV. Recurrent tumors may have different histopathological types from the original tumor. The risk of recurrence as a malignant tumor after immature teratomas was higher than mature teratomas. [ABSTRACT FROM AUTHOR]

Introduction: Mediastinal teratomas present unique surgical challenges during resection. Here, we describe a novel use of Indocyanine Green (ICG) for real time identification of tumor borders and resection planes of a malignant mediastinal teratoma and right lung nodule. Case presentation: A 13-year-old male with Klinefelter's Syndrome presented for right upper quadrant pain, difficulties walking and eating, and with elevated alpha-fetoprotein (AFP) and beta human chorionic gonadotropin (β-hCG). A CT scan demonstrated a lobulated right-sided mediastinal mass, as well as an isolated right middle lobe lung nodule. The patient underwent elective resection. He was injected with 3 mg/kg ICG one day prior to his planned operation. After median sternotomy, ICG imaging aided in the identification of the mediastinal mass, tumor borders and resection planes, particularly where the tumor was continuous with the right lobe of the thymus and along the deeper structures of the mediastinum. The right lung nodule was similarly visualized and resected. Pathologic examination of the mass revealed components of immature teratoma, choriocarcinoma, yolk sac tumor, and seminoma. The lung nodule demonstrated only chronic inflammation and compressive atelectasis from the tumor's mass effect. The patient recovered well and was discharged on post operative day 6. He follows with the oncology team for outpatient chemotherapy. Conclusion: Though rare, teratomas in the mediastinum can occasionally be malignant and have the potential to involve adjacent structures, thereby creating a technical challenge at surgery. This case demonstrates the usefulness of ICG for intraoperative visualization of tumors to facilitate safe resection and improved outcomes.

Primary intracranial germ cell tumors are rare, occurring more frequently in children and young adults in midline locations of the brain. Teratomas are an uncommon variant of germ cell neoplasm, although they account for a high proportion of fetal brain tumors. Here, we report a 27-year-old male who presented with a heterogeneously enhancing lesion in the left thalamus, without evidence of systemic disease. Histologic and immunohistochemical analysis were consistent with immature teratoma; next-generation sequencing was negative for targetable molecular alterations. The patient received chemotherapy and radiotherapy post-excision. Following the initial resection, ventriculoperitoneal shunt placement was performed due to left temporal horn entrapment. Nine months later, imaging revealed mediastinal and hilar adenopathy as well as pleural disease, with encasement and compression of pulmonary vasculature, and multiple, bilateral pulmonary nodules. Fine needle aspiration showed malignant cells with an immunohistochemical profile similar to the original tumor, consistent with metastases. Though germ cell tumors are known to spread via cerebrospinal fluid or blood, metastasis outside of the CNS from a primary intracranial germ cell tumor is a rare complication. Spread via ventriculoperitoneal shunt, which may have occurred in the present case, has also rarely been observed.

ABSTRACT: Primary intracranial germ cell tumors are rare, occurring more frequently in children and young adults in midline locations of the brain. Teratomas are an uncommon variant of germ cell neoplasm, although they account for a high proportion of fetal brain tumors. Here, we report a 27-year-old male who presented with a heterogeneously enhancing lesion in the left thalamus, without evidence of systemic disease. Histologic and immunohistochemical analysis were consistent with immature teratoma; next-generation sequencing was negative for targetable molecular alterations. The patient received chemotherapy and radiotherapy post-excision. Following the initial resection, ventriculoperitoneal shunt placement was performed due to left temporal horn entrapment. Nine months later, imaging revealed mediastinal and hilar adenopathy as well as pleural disease, with encasement and compression of pulmonary vasculature, and multiple, bilateral pulmonary nodules. Fine needle aspiration showed malignant cells with an immunohistochemical profile similar to the original tumor, consistent with metastases. Though germ cell tumors are known to spread via cerebrospinal fluid or blood, metastasis outside of the CNS from a primary intracranial germ cell tumor is a rare complication. Spread via ventriculoperitoneal shunt, which may have occurred in the present case, has also rarely been observed.

Somatic malignancies arising in mature teratomas are exceedingly rare entities and even more so are those arising in immature teratomas. Here, we present a unique case of a 13-year-old who initially underwent ovarian sparing cystectomy for a 7.7 cm left ovarian mass with a pre-operative diagnosis of mature cystic teratoma. Histologically, all 3 germ cell layers were present and immature neuroepithelial tubules were also identified. Subsequent sections revealed a nodular lesion composed of neuropil, neuroblasts with a spectrum of maturation, and Schwannian-type stroma. The neuroblasts were diffusely positive for PHOX2B. Neuroblastoma arising in an immature teratoma has only been described in the literature once previously in an adult patient. [ABSTRACT FROM AUTHOR]

The mediastinum is the most prevalent site of extragonadal teratomas. Patients with mediastinal mature teratomas are usually young adults, and the condition does not show significant sexual differences. Mediastinal teratomas are mostly located in the anterior mediastinum. Patients are usually asymptomatic, although they can have several complications when the teratomas become large or rupture. Most mediastinal teratomas can be diagnosed using CT. Diagnosing ruptured or malignant teratomas is challenging because of their atypical clinical and radiological presentations. In this article, we describe various manifestations of mediastinal teratomas, with an emphasis on radiologic features.

Mediastinal teratomas present unique surgical challenges during resection. Here, we describe a novel use of Indocyanine Green (ICG) for real time identification of tumor borders and resection planes of a malignant mediastinal teratoma and right lung nodule. A 13-year-old male with Klinefelter's Syndrome presented for right upper quadrant pain, difficulties walking and eating, and with elevated alpha-fetoprotein (AFP) and beta human chorionic gonadotropin (β-hCG). A CT scan demonstrated a lobulated right-sided mediastinal mass, as well as an isolated right middle lobe lung nodule. The patient underwent elective resection. He was injected with 3 mg/kg ICG one day prior to his planned operation. After median sternotomy, ICG imaging aided in the identification of the mediastinal mass, tumor borders and resection planes, particularly where the tumor was continuous with the right lobe of the thymus and along the deeper structures of the mediastinum. The right lung nodule was similarly visualized and resected. Pathologic examination of the mass revealed components of immature teratoma, choriocarcinoma, yolk sac tumor, and seminoma. The lung nodule demonstrated only chronic inflammation and compressive atelectasis from the tumor's mass effect. The patient recovered well and was discharged on post operative day 6. He follows with the oncology team for outpatient chemotherapy. Though rare, teratomas in the mediastinum can occasionally be malignant and have the potential to involve adjacent structures, thereby creating a technical challenge at surgery. This case demonstrates the usefulness of ICG for intraoperative visualization of tumors to facilitate safe resection and improved outcomes. [ABSTRACT FROM AUTHOR]

The mediastinum is the most prevalent site of extragonadal teratomas. Patients with mediastinal mature teratomas are usually young adults, and the condition does not show significant sexual differences. Mediastinal teratomas are mostly located in the anterior mediastinum. Patients are usually asymptomatic, although they can have several complications when the teratomas become large or rupture. Most mediastinal teratomas can be diagnosed using CT. Diagnosing ruptured or malignant teratomas is challenging because of their atypical clinical and radiological presentations. In this article, we describe various manifestations of mediastinal teratomas, with an emphasis on radiologic features. [ABSTRACT FROM AUTHOR]

Malignant thyroid teratoma (MTT) is a very rare thyroid malignancy. These neoplasms have been reported only in case reports and small-sized case se ries so far. In this study, we searched for MTTs in the Surveillance, Epidemiology, and End Result (SEER) program during 1975-2016. Subsequently, we incorporated the SEER data with published MTT cases in the literature to analyze the characteristics and prognostic factors of MTTs. Integrated data were analyzed using chi-square or Fisher's exact test for categorical covariates, and t-test or Mann-Whitney test for continuous variables. We included 28 studies with 36 MTT cases and found additional 8 cases from the SEER program for final analyses. Our results showed that MTT is typically seen in adult females. These neoplasms were associated with an aggressive clinical course with high rates of extrathyroidal extension (80%) and nodal involvement (62%). During follow-up, the development of recurrence and metastases were common (42% and 46%, respectively), and one-third of patients died at the last follow-up. Large tumor size (P = 0.022) and the presence of metastases during follow-up (P = 0.008) were associated with a higher mortality rate. In conclusion, our study demonstrated the characteristic features of MTT patients and outlined some parameters associated with a negative outcome which could help clinicians better predict the clinical course of these neoplasms. [ABSTRACT FROM AUTHOR]

Abstract Background A tumor comprising of different types of tissues (such as hair, muscle, bone, etc.) is known as a teratoma. It is a type of germ cell (cells that make sperm or eggs) tumor. When these germ cells have rapid cancerous growth, then such a teratoma is called a malignant teratoma. We have studied the differences between gonadal and extra-gonadal malignant teratomas and the effects of chemotherapy in both genders. Methods The samples of 3799 male and 1832 female patients with malignant teratoma samples, between the ages of 1 and 85+ years, were selected from the years 1973 to 2014. Trends in incidence, estimated prevalence, incidence rates, and frequency were calculated in gonadal and extra-gonadal tumors with age adjustment. The five-year observed, expected, and relative survival rates were analyzed to study the prognosis. Results The gonadal took over a majority percentage of malignant teratomas compared with the extra-gonadal (90% vs. 10% in male; 83% vs. 17% in female). For the male, the total of the gonadal and the extra-gonadal were all significantly decreased from 1973 to 2014 (p

Primary thyroid teratomas are exceedingly rare. Mature and immature variants recapitulate their gonadal counterparts (predilection for infants/children, triphasic germ layer differentiation, and favorable outcome). On the other hand, the so-called malignant teratomas affect predominantly adults and elderly, are highly aggressive, and, according to a few published cases, harbor DICER1 mutations. We describe three highly aggressive sporadic malignant teratoid thyroid tumors in 2 females (17 and 45 years) and one male (17 years). Histology showed triphasic neoplasms composed of solid nests of small primitive monomorphic cells embedded in a cellular stroma with primitive immature rhabdomyosarcoma-like (2) or pleomorphic sarcoma-like (1) phenotype. The third component was represented by TTF1+/PAX8+ primitive teratoid epithelial tubules reminiscent of primitive thyroid follicles and/or Wilms tumor, admixed with scattered respiratory- or enteric-type tubules, neuroepithelial rosettes, and fetal-type squamoid nests. Foci of cartilage were seen in two cases, but none contained mature organoid adult-type tissue or skin adnexa. SALL4 was expressed in the small cell (2) and stromal (1) component. Other germ cell markers were negative. Molecular testing revealed a known "hotspot" pathogenic DICER1 mutation in two cases. In addition, case 1 had a missense TP53 variant. This type of thyroid malignancy is distinct from genuine teratomas. The immunoprofile suggests primitive thyroid- or branchial cleft-like differentiation. Given that "blastoma" is a well-accepted terminology in the spectrum of DICER1-associated malignancies, the term "thyroblastoma" might be more convenient for these malignant teratoid tumors of the thyroid gland. Relationship of thyroblastoma to the DICER1 syndrome remains to be addressed. [ABSTRACT FROM AUTHOR]

A 3-year-old Quarter Horse mare presented with an approximate 1-month history of progressive weight loss, anorexia and lethargy that abruptly worsened 48 h before death. Post-mortem examination revealed free flocculent fluid and a large mass within the ventral abdomen that dorsally displaced the caecum and large intestine. An ovarian teratocarcinoma with metastasis to regional lymph nodes was diagnosed histologically. Although benign teratomas are the second most common ovarian neoplasm in equids, reports of malignant teratomas in horses are rare. This report documents an unusual presentation of a rarely reported malignant neoplasm of the reproductive tract in horses. [ABSTRACT FROM AUTHOR]

Introduction: Primary intracranial germ cell tumors are rare neoplasms derived from gonadal cells. They are categorized as germinoma, non-germinomatous germ cell tumor (NGCCT), or teratoma, with the latter two sparking controversy regarding the role of different treatment strategies. We provide the largest multicenter analysis of treatment outcomes for iGCTs to date. Methods: The Surveillance, Epidemiology, and End Result (SEER) database were used to record patient demographics, tumor, and treatment characteristics. Cox proportional hazards model and multiple comparisons for the Logrank test with Sidak correction was applied to compare the different treatment regimens and survival. Results: 1043 iGCT cases were divided into three cohorts of Germinoma, Malignant Teratoma (MT), and NGGCT. The mean age was 17.7 years for germinoma, 9.5 years for MT, and 14.4 years for NGGCT groups. Males comprised 77% of overall patient population. For Germinomas, both biopsy (hazard ratio [HR] = 4.6) and resection (HR = 14.1) had significantly worse survival outcomes compared to solo radiation therapy, with no difference between radiation and chemotherapy. For MT, no treatment combination had significantly different survival outcomes compared to resection alone. For NGGCTs, resection + chemotherapy + radiotherapy (HR = 0.012) and resection + chemotherapy (HR = 0.0049) had significantly better survival compared to resection alone. Conclusion: In germinomas, radiotherapy alone had superior survival outcomes compared to biopsy and resection, but no change in survival when compared to chemotherapy alone. Addition of radiotherapy or chemotherapy did not improve survival in MTs when compared to resection alone. Adding chemotherapy in NGGCT patients undergoing resection improved survival compared to resection alone. [ABSTRACT FROM AUTHOR]

Primary malignant teratoma of thyroid gland is a rare neoplasm. There are case reports and case series in the literature. Malignant teratoma of thyroid gland was reported to be an aggressive neoplasm. In the current case report we aimed to present a 39 years old women with malignant thyroid teratoma diagnosed with histopathologic and immunohistochemical methods. [ABSTRACT FROM AUTHOR]

Background: A tumor comprising of different types of tissues (such as hair, muscle, bone, etc.) is known as a teratoma. It is a type of germ cell (cells that make sperm or eggs) tumor. When these germ cells have rapid cancerous growth, then such a teratoma is called a malignant teratoma. We have studied the differences between gonadal and extra-gonadal malignant teratomas and the effects of chemotherapy in both genders.Methods: The samples of 3799 male and 1832 female patients with malignant teratoma samples, between the ages of 1 and 85+ years, were selected from the years 1973 to 2014. Trends in incidence, estimated prevalence, incidence rates, and frequency were calculated in gonadal and extra-gonadal tumors with age adjustment. The five-year observed, expected, and relative survival rates were analyzed to study the prognosis.Results: The gonadal took over a majority percentage of malignant teratomas compared with the extra-gonadal (90% vs. 10% in male; 83% vs. 17% in female). For the male, the total of the gonadal and the extra-gonadal were all significantly decreased from 1973 to 2014 (p < 0.05). For the female, there were no significant trends. As for prevalence, incidence, and frequency, there were two separate peaks of malignant teratomas. One peak was at under 1 year old, which was composed of the extra-gonadal tumor; the other peak was at 20-24 for male and 10-34 for female, which was composed of the gonadal tumor. This separation of the gonadal and extra-gonadal showed a significant difference (p < 0.05). As for the prognosis, the extra-gonadal tumor showed significantly lower survival rates than the gonadal (p < 0.05). In the short term, the survival rate of the chemotherapy group was higher than the supportive care group. However, in the long term, the survival rate of the chemotherapy group was lower than the supportive care group.Conclusion: The gonadal and extra-gonadal malignant teratomas show lots of differences. Chemotherapy might not help improve survival rates. [ABSTRACT FROM AUTHOR]

Summary A 17-year-old female emu ( Dromaius novaehollandiae ) was presented for clinical evaluation due to a 3-week history of anorexia and progressive weight loss. The emu died after sedation. At necropsy examination, the ovary and the majority of the oviduct were effaced by a multinodular cystic mass and accompanied by 6 l of coelomic effusion. Histopathology revealed a neoplasm composed of well-differentiated, poorly organized tissues derived from ectoderm, mesoderm and endoderm. Tissues within the neoplasm expressed glial fibrillary acidic protein, desmin and cytokeratins AE1/AE3, respectively, confirming the diagnosis of teratocarcinoma. [ABSTRACT FROM AUTHOR]

A mediastinal germ cell tumor with a sarcomatous component is extremely rare and is accompanied by a poor prognosis. Clinical and radiologic diagnosis is very difficult. Herein, we report a rare case of anterior mediastinal malignant teratoma containing a growing liposarcomatous component and detail the diagnostic process. The case was diagnosed by repeated transthoracic needle biopsy and correlated with changes in follow-up chest computed tomography and serum tumor markers. We also provide a review of the literature. [ABSTRACT FROM AUTHOR]

Pathological hypoxia exists in solid tumors and it creates a microenvironment for tumor cells which has a critical and complicated implication for cancer. Hypoxia can also activate autophagy which plays a dual role in cancer. In this study the authors analyzed the effect of hypoxia, the autophagy inhibitor 3-methyladenine (3-MA), cis-diamminedichloroplatinum (CDDP, cisplatin), and any combination of them on PA-1 cells (a human ovarian cancer cell line) with a series of assays, focusing on autophagy induction, cell growth inhibition, and cell death by CDDP. CDDP caused apoptosis in normoxic PA-1 cells and autophagy upon hypoxia treatment decreased apoptosis induction in hypoxic cells by CDDP, which has implications in cancer chemotherapy resistance. [ABSTRACT FROM AUTHOR]

Sinonasal teratocarcinosarcoma is an extremely rare malignant tumor arising in the sinonasal tract, having combined histological features of teratoma and carcinosarcoma. Here, we are presenting a case of sinonasal teratocarcinosarcoma in a 28-year-old male patient. A 28-year-old male patient presented with left-sided nasal obstruction and recurrent epistaxis for last 2 months. On examination, a polypoid mass was noted in the left nasal cavity. The mass was surgically resected. Paraffin-embedded sections were made and stained with hematoxylin and eosin. Microscopic examination revealed intimate admixture of carcinomatous (adenocarcinoma), sarcomatous (chondrosarcoma), primitive neuroendocrine and teratoid elements (immature squamous elements). These findings clearly suggest the diagnosis of sinonasal teratocarcinosarcoma. Sinonasal teratocarcinosarcoma is highly malignant and locally aggressive. About 60% of the patients do not survive beyond 3 years. Total excision and extensive sampling are necessary to reach the diagnosis. Early diagnosis and management can give a better prognosis. [ABSTRACT FROM AUTHOR]

The article presents a case study of a dead 16-yr-old female emu which suffered from carcinomatosis. Topics discussed include malignant transformation of teratomas of emu, presence of fibrosis on the surface of oviduct, effect of teratocarcinomas on adenomucinosis, splenic lymphoid depletion as reported by histologic findings, and development of peritoneal mucinous carcinomatosis in women with ovarian teratomas.

Teratoma of the orbit is rare; very few cases have been published in literature. A case of orbital teratoma in a neonate is presented where the proptosis was massive enough to obscure the eyeball. Clinically, the diagnosis of teratoma was considered. As there was no possibility of salvaging the eye, exenteration of the orbit was done. Orbital teratomas are generally benign. Histopathological examination revealed the features of malignant teratoma. [ABSTRACT FROM AUTHOR]

Background Single-stage procedures for reconstruction of large cricotracheal defects have been limited in success and malignant immature teratomas in the larynx of an adult have never been reported. Methods and Results This was a case report and literature review. A 27-year-old man presented with 2 weeks of new-onset stridor and was found to have a mass obstructing 80% of the subglottis and trachea. He underwent a noncircumferential partial cricotracheal resection with a resultant 7-cm luminal defect, followed by osteocutaneous radial forearm flap semi-rigid reconstruction. A novel technique was used to allow a functional and patent airway, which may be applied to other partial luminal reconstructive defects. Postoperatively, the patient was decannulated and has good speech quality and swallowing function. This work was performed at the Henry Ford Health System. This project was reviewed and was granted full approval by the Henry Ford Health System Institutional Review Board. Conclusions This is the first reported case of malignant immature teratoma to involve the larynx, trachea, and recurrent laryngeal nerve in an adult patient, and the first single-stage technique described to use free tissue transfer without prefabrication for a 7-cm airway defect. © 2012 Wiley Periodicals, Inc. Head Neck, 2013 [ABSTRACT FROM AUTHOR]

Comparisons of incidence estimates of testicular cancer subtypes beyond seminoma and non-seminoma are virtually missing in the epidemiologic literature. We analysed incidence data from population-based German cancer registries to provide subtype-specific incidences of testicular cancer. We pooled data from nine cancer registries from 1998 to 2003. We estimated incidence and mortality time trends of West and East Germany. Incidence and mortality were standardized by the European standard population. The annual percentage incidence change from 1961 through 1989 was 4.9% in East Germany and 3.0% from 1970 through 2004 in Saarland. Incidence increases were the most pronounced among adolescents and young men aged 15–49 years. In 1998–2003, the seminoma incidence rate was 5.1 per 100 000; among non-seminomas, the rates were the highest for malignant teratoma (1.6 per 100 000), followed by embryonal carcinoma (1.2 per 100 000). Testicular lymphomas were rare (0.1 per 100 000). The incidence of testicular cancer among children aged 0–14 years was nearly constant from 1987 through 2004. Majority of these cancers were yolk sac tumours (0.1 per 100 000). In East and West Germany, rates of embryonal carcinoma in the early periods were considerably lower than the rates of malignant teratoma. In the most recent periods, rates of embryonal carcinoma became quite similar to the rates of malignant teratoma. The mortality decline started in West Germany roughly 12 years earlier than in East Germany. The later start of the mortality decline in East Germany may be because of a later introduction of platinum-based chemotherapy compared to West Germany. [ABSTRACT FROM AUTHOR]

Summary: Sinonasal teratocarcinosarcoma (SNTCS) is a rare malignant neoplasm with 63 reported cases to date. Patients are exclusively adults, with a mean age of 60 years and marked male predominance. Histologically, these tumors are characterized by the presence of admixed epithelial and mesenchymal components. The histogenesis of SNTCS remains uncertain and genetic studies have not been reported to date. Two SNTCSs from the archives of Memorial Sloan-Kettering Cancer Center and one submitted from St Luke''s-Roosevelt Hospital Center were evaluated by fluorescent in situ hybridization for amplification of chromosome12p, an event usually associated with the genesis of bona fide germ cell neoplasms (including mediastinal and testicular teratomas). Microscopic examination revealed admixed epithelial and mesenchymal elements in all 3 cases; benign squamous and glandular epithelium and neuroepithelial tissue were identified, the squamous epithelium demonstrating “fetal-like” cytoplasmic clearing. Mesenchymal proliferations were recognized ranging from well-differentiated smooth muscle to high-grade sarcoma. A malignant germ cell component was not identified in any of the cases. Fluorescent in situ hybridization evaluation demonstrated only 2 copies of chromosome 12 per case. Although the histogenesis of SNTCS remains uncertain, we have found an absence of 12p amplification in 3 cases. Our findings suggest that 12p amplification, if it occurs at all in this setting, is exceptional and that SNTCS is a somatic-type neoplasm exhibiting divergent differentiation rather than a germ cell tumor. [Copyright &y& Elsevier]

Abstract: Objectives. : Malignant transformation of mature cystic teratomas is rare, with squamous cell carcinoma being the most common type. The prognosis is generally poor when disease has spread beyond the ovary. We conducted this study to review our experience with this disease and describe our current treatment modality. Methods. : During a 22-year period (1983–2005), we identified 17 women treated for squamous cell carcinoma arising in a mature cystic teratoma of the ovary. All pathologic diagnoses were confirmed at our institution. A retrospective chart review and comprehensive review of the literature were conducted. Results. : The median age was 55 (mean, 54.8; range, 37–75). Eight cases were stage I, 5 were stage II, and 4 were stage III. Mean tumor size was 14.2 cm. All patients underwent surgery, with positive lymph nodes noted in 0 of 10 cases that included lymph node dissection. Ten patients received adjuvant treatment—6 with chemotherapy and 4 with chemoradiation. Six patients had recurrent disease in the pelvis after adjuvant treatment. Four patients died of disease. The overall 1-year survival rate was 60%. The 4 patients with stages IA–IIB disease treated with adjuvant platinum-based chemotherapy and radiation survived at 12–56 months'' follow-up. Conclusions. : Squamous carcinomas arising in mature cystic teratomas are commonly large ovarian tumors that occur in perimenopausal women and often present as an incidental pathologic finding. While the prognosis seems highly dependent on surgical stage, there is a lack of consensus in the literature regarding adjuvant treatment. Platinum-based chemotherapy with pelvic radiation may be a reasonable adjuvant therapy for early-stage disease. [Copyright &y& Elsevier]

Abstract: Teratocarcinosarcomas are rare malignant neoplasms histologically characterized by the presence of benign and malignant epithelial and mesenchymal elements. They are seen almost exclusively in the sinonasal tract of men. We report two cases of teratocarcinosarcomas involving the posterior pharyngeal wall in a 55-year-old male and 60-year-old men. The tumors consisted of epithelial components including squamous, neuroendocrine, and glandular structures; neuroepithelium, and mesenchymal components with prominent rhabdomyoblastic, osteoblastic and chondroid differentiation. Immunohistochemical studies demonstrated markers characteristic of each component. The tumors were resected, and the patients received postoperative radiation therapy. One patient is alive with recurrent tumor 33 months after treatment and the other died 26 months after radiation therapy with distant metastasis. [Copyright &y& Elsevier]

Objectives: To present a case of metastatic struma ovarii, to review the literature on malignant struma ovarii and to discuss the management in locoregional and metastatic disease., Methods: We present a case of an 82-year-old patient with a malignant struma ovarii and liver metastasis. The patient was treated with pelvic surgery, total thyroidectomy, radioactive iodine therapy and TSH suppression therapy with levothyroxine. We performed a PubMed search for case reports of metastatic struma ovarii., Results: 43 cases of metastatic struma ovarii were identified. 53.5% of patients presented with metastatic disease at diagnosis. Mean time to development of metastasis was 6.9 years in the group with initial locoregional disease. First-line treatment was pelvic surgery in all patients. Thyroidectomy was performed in 83.7% of patients, subsequent radioactive iodine therapy in 79.1%, followed by TSH suppression therapy in 46.5% of patients. Mean time of follow-up after diagnosis of metastases was 3.6 years, ranging from 0.5 to 24 years. At the end of the follow-up, 51.1% of patients were free of disease, 34.9% were alive with disease, 7.0% died of disease and 7.0% were lost to follow-up., Conclusion: The majority of patients with metastatic struma ovarii were treated with pelvic surgery, total thyroidectomy and radioactive iodine therapy. Suppression of TSH with levothyroxine was given in less than half of the patients. In non-metastatic setting, the same approach could be considered depending on the patient profile.