Teratoma of the neck in relation to the thyroid gland

Primary Malignant Thyroid Teratoma: An Institutional Experience

BACKGROUND

Primary malignant thyroid teratomas are very rare tumors (fewer than 35 previously reported cases in the literature) typically affecting young adult women. While prognosis is poor, there have been some reports of successful treatment regimens. Four cases treated successfully are reported, and a review of the existing literature is provided.

PATIENT FINDINGS

Medical records of four patients with histopathologically confirmed malignant thyroid teratomas treated at the University of Texas MD Anderson Cancer Center between 1994 and 2017 were reviewed. The patients were treated with variable treatment regimens consisting of surgical excision with or without aggressive combination chemotherapy (bleomycin, etoposide, and cisplatin; cyclophasphamide, adriamycin, and cisplatin; actinomycin-D, cyclophosphamide, and etoposide; bleomycin, vincristine, and cisplatin; or vincristine, methotrexate, bleomycin, and cisplatin).

SUMMARY

All four patients were young women <40 years of age. One patient had thyroid surgery alone, another had surgery with postoperative adjuvant chemotherapy, and two patients underwent neoadjuvant chemotherapy with significant tumor regression prior to definitive thyroid surgery. No patients had postoperative radiation therapy. All patients remained alive and disease free a median of 172 months (range 52-282 months) following completion of therapy.

CONCLUSIONS

This case series represents the largest and longest follow-up from a single institution in the literature to date on primary malignant thyroid teratomas. Based on the existing literature and the authors' experience with these four patients, it is suggested that neoadjuvant chemotherapy combined with surgical excision is a promising approach for patients with gross extrathyroidal extension, cervical lymph node metastases, and/or distantly metastatic disease.

Malignant teratoma of the thyroid in a pregnant woman

Most teratomas involving the thyroid gland are benign and occur in children. However, the adult cases reported are mostly malignant. Many of the cases previously described in the medical literature have fatal outcome because of spread of the tumor refractory to treatment. We report a case of primary malignant teratoma of the thyroid in a 38-year-old pregnant black woman. She was treated with a combination of surgery, and postoperative chemotherapy with good initial response.

Benign thyroid teratomas manifest painful cystic and solid composite nodules: three case reports and a review of the literature

Benign thyroid teratomas are rare in adolescents and adults. We report on three cases of benign thyroid teratomas that presented as painful tumors in the neck after puberty. The tumor adjacent to the thyroid in each case showed rapid enlargement with predominant cystic lesions within several months. Ultrasonography and computed tomography revealed few findings suggesting the origin of the tumor. Cytological examination and culture of the aspirate failed to show cells originating from the thyroid or infectious findings, but revealed a small population of columnar epithelial cells or squamous epithelial cells. Chemical analysis of the aspirate showed levels of pancreatic enzymes higher than those in serum. The accumulation of cystic fluid in each case was refractory to drainage treatment or percutaneous ethanol injection therapy. The patients subsequently underwent resection of the tumor, and microscopic examination revealed various types of tissue including pancreas, adipose, cartilage, muscle, and skin, and the cystic wall was lined by gastric, intestinal, respiratory, and stratified squamous epithelium. Surgical resection was curative, and subsequent histologic examination revealed mature benign teratomas of the thyroid. The main characteristic of our cases presented the painful tumors due to the enlarged cystic formation lined by a variety of different types of epithelium, which agreed with previous cases of benign thyroid teratomas in adolescents and adults.

Primary cervical malignant teratoma with a rib metastasis in an adult: five-year survival after surgery and chemotherapy. A case report with a review of the literature

We report a case of a man presenting with a cervical malignant teratoma and a chondrosarcomatous rib metastasis. He was alive and free of recurrence five years and 10 months (= 70 months) after resection of the primary mass, followed by chemotherapy and subsequent resection of the rib tumor. This is the 35th patient reported in the literature and the first description in which an 'adjuvant' or primary chemotherapy was used. Previous patients with a cervical malignant teratoma, reported after lethal outcome, had survivals of one to 22 months (median nine months). In all patients with a preoperative clinical impression of an aggressive, differentiated or undifferentiated malignancy, the definite diagnosis of teratoma could only be made histologically. By analogy to germ cell tumors, the prognosis of malignant teratoma might be improved if complete excision is combined with new, adjuvant chemotherapy protocols for germ cell tumors. Lessons learned from this case are placed in the context of germ cell tumors in general and of non-gonadal malignant teratomas in particular.

Malignant thyroid teratoma of an adult: a long-term survival after chemotherapy

Adult primary malignant teratoma of the thyroid is a rare disease that has a poor outcome despite aggressive therapy. A 32-year-old woman underwent a simple lobectomy of the thyroid for a progressively enlarged nodule in August 1990. Pathologic assessment of the tumor revealed a malignant teratoma. The physical examinations and image studies failed to find tumor in other sites. She subsequently received 6 courses of chemotherapy with cisplatin, etoposide, and bleomycin. She experienced a complete response to chemotherapy and remained disease-free for 6.5 years. This tumor must be included in the differential diagnosis of a thyroid tumor and may be treated as a testicular germ-cell tumor for which chemotherapy may be recommended.

Benign cervical teratoma in an adult: report of a case

Cervical teratomas are rarely encountered in adults. We report herein the case of a 21-year-old woman who was admitted to our hospital for surgical treatment of a neck tumor, 7.5 x 4.5 x 2.7 cm in size, located in the left lower pole of the thyroid. Ultrasonography (US) and computed tomography (CT) revealed a multicystic tumor. The levels of carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), and squamous cell carcinoma-related antigen (SCC) in the cystic fluid were extremely elevated in contrast to the normal levels found in the serum. The tumor was completely excised and histological examination revealed it to be composed of elements derived from the three germ layers, confirming a diagnosis of benign cystic teratoma.

Cervical teratomas: an analysis. Literature review and proposed classification

Cervical teratomas are uncommon lesions usually diagnosed at birth but occasionally reported in older children and adults. During a 58-year span, nine cervical teratomas were identified at our institution (four previously reported): three stillborns with giant tumors; five live newborns; and one adult with a malignant tumor. Of the five newborns, two prematures died within one hour of birth. Of the three survivors, 2 had respiratory distress at birth. These infants were treated with early excision and are well at 7, 6, and 2 years of age. The last patient also had cystic fibrosis. The adult died of metastatic disease 8 months after resection. A literature review disclosed 212 cases in addition to the five reported here. Previous attempts at categorizing cervical teratomas have failed to address clinical patterns and have little prognostic value. We propose a classification based on birth status, age at diagnosis, and the presence or absence of respiratory distress. Group I--stillborn and moribund live newborns: number (N), 27; mortality (M), 100%. Group II--newborn with respiratory distress: N, 99; M, 43.4%. Group III--newborn without respiratory distress: N, 37; M, 2.7%. Group IV--children age 1 month to 18 years: N, 31; M, 3.2%. Group V--adults: N, 23; M, 43.5%. Twenty-six patients in group II and one in group III died without excision of the mass. Seventy-three patients in group II, 36 in group III, and 31 in group IV had extirpation of the tumor. Operative mortality was 11%, 0%, and 3.2%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Cervical teratoma in a fetus and an adult. Two case reports and review of literature

Two cases of cervical teratoma in a 30-weeks fetus and a 26-year-old female have been presented. In the former case a large mass entirely occupied the anterior neck but showed no invasive or metastatic lesions, and in the other case a mass containing multiple cysts was situated in the right lower pole of the thyroid gland. Histologically, both tumors were composed of the elements derived from three germ layers including various epithelial components, cartilage, muscle, and adipose tissue. In addition to these predominantly mature elements, there were some elements showing primitive immature structure in the former case. Positive immunohistochemical staining for thyroglobulin displayed only in the former case and was observed in the compressed thyroid follicles located in the fibrous capsule and several small foci of primitive glandular structure which was an element of the tumor.

Cervical teratomas in the newborn

Cervical teratomas are rare neoplasms which have been infrequently reported. During the period of July 1974 to April 1982, six newborns with this lesion were seen at the Mott Children's Hospital. There were three males and three females, all of whom presented at birth with large semicystic neck masses. In four infants, calcifications were seen on x-ray. Four patients required intubation within the first hours of life for respiratory distress. One child of 33 weeks gestation expired prior to operation because of a hypoplastic left ventricle and bilateral hypoplastic lungs. Cord blood T3 and T4 values were normal in three patients; the TSH was elevated 1.5 and 2 times normal in two of these infants. Four neonates were operated upon within 24 hours of birth and suffered no postoperative complications. One baby presented on the third day of life and expired three hours postoperatively from persistent respiratory distress. The tumors were well encapsulated and arose from or were surrounded by a lobe of the thyroid gland. In each case, the tumor was removed by performing a total thyroid lobectomy. The presence of normal thyroid tissue at the resection margin (in the isthmus) was verified by frozen section. One patient presented with cervical node metastases but is currently free of disease one year postoperatively. These six cases bring the total reported cases in the literature to 136. The 80% mortality in cases not operated upon has been reduced to 15% by prompt operation. This series substantiates the significant respiratory distress that can occur in newborns with cervical teratomas and confirms the need for emergency surgery in this group of patients.

Primary malignant teratoma of the thyroid: case report and literature review of cervical teratomas in adults

A case of primary malignant teratoma of the thyroid in a gravid 37-year-old female is reported and the literature on cervical teratomas in adults reviewed. The patient was treated by total thyroidectomy and left radical neck dissection followed by cervical and mediastinal radiotherapy and chemotherapy. She fied of recurrent tumor and related complications 9 months after discovery of the lesion. This is the 6th case of primary teratoma of the thyroid and the 9th case of cervical teratoma reported in a adult. These tumors are characteristically large, rapidly growing and highly malignant. The longest survival reported is 10 months. The differentiation of this lesion from carcinosarcomas of the thyroid is discussed.

An unusual thyroid tumor in a child

Malignant neoplasms of the thyroid gland are quite rare in children. Winship, in his classic article, could find only 562 cases in the literature. The histopathological patterns resemble those of the adult tumors. Despite early cervical metastasis, the prognosis in general is favorable, with many long-term survivals. Prior exposure to radiation of the head and neck is a definite pre-disposing factor. Teratomas of the neck are a medical curiosity--less than 100 cases are described in the literature. The vast majority of these are found during the neonatal period, and are benign histologically. These are usually large, cystic, bulky masses which produce mechanical obstruction of the upper airway and digestive tract. Only one of these tumors, described by Pupovac in 1896, has been considered malignant. A six-year-old child was examined with a right thyroid mass of three months' duration. The thyroid scan showed a "cold nodule." At surgery, a well-encapsulated mass was found. The pathology showed a predominance of malignant spindle cells, with areas of papillary carcinoma; however, there were well-defined mucous glands present in the tumor. Clinically the child has remained well and asymptomatic. The slides have been extensively reviewed. To my knowledge no such tumor has been previously described. The tumor is considered to be a malignant thyroid tumor growing out of teratomatous tissue.

Sacrococcygeal teratoma in Nigerian children

Two-thirds of all teratomas seen in 31 Nigerian children at Ibadan were situated in the sacrococcygeal region. About one-quarter of all the sacrococcygeal teratomas were malignant as shown on radiological and pathological examinations. The malignant tumours had papillary carcinomatous pattern, probably derived from the choroid plexus. The clinicopathological features of one patient with malignant change is described to illustrate the biological behaviour of this tumour. Malignancy in all the sacrococcygeal tumours appears to be associated with growth of the tumour into the pelvic cavity and metastasis initially to inguinal lymph nodes and later to distant sites. Inferior venacavogram can be of great value in defining the extent of the intrapelvic mass and the displacement of the genito-urinary organs, particularly when surgery is contemplated.

Teratoma of the neck: report of two cases and review of the literature

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