Teratoma – the embryonic and cellular tumor developing from layers endo-ekzo-and mesoderms. Can be good-quality or malignant. Settles down in testicles, ovaries or ekstragonadno. Small benign tumors proceed asymptomatically. Large teratoma cause a sdavleniye of nearby bodies with emergence of the corresponding symptomatology. Malignant new growths can give metastasises. The diagnosis is exposed on the basis of complaints, survey, a X-ray analysis, ultrasonography, KT, MPT, biopsy and other researches. Treatment – operation, radiotheraphy, chemotherapy.
Teratoma – the germinogenny tumor containing sites of fabric or bodies, atypical for a new growth arrangement. Can include hair, bone, muscular, cartilaginous, fatty, ferruterous and nervous tissue, is more rare – parts of a human body (an extremity, a trunk, an eye). It is usually diagnosed at children's and youthful age. Sometimes comes to light vnutriutrobno. The large teratoma which arose in the pre-natal period can interfere with development of a fruit and complicate the course of childbirth.
Teratoma make 24-36% of total of tumors at children and 2,7-7% - at adults. Gradually increase in a size in process of growth of an organism. Often demonstrate during the periods of hormonal reorganization. In most cases teratoma are considered predictively as a favorable disease. Treatment is performed by experts in the field of oncology, gynecology, urology, andrology, neurology, otolaryngology, pulmonology and other specialties (depending on localization of a new growth).
Reasons of development of a teratoma
The reasons of development of a teratoma are definitely not established. It is supposed that the tumor results from violations of an embryogenesis. Teratoma come from primary gametes which in development have to be transformed to ova or to spermatozoa. Sometimes this process is broken, in an organism there are undifferentiated gonotsita which under the influence of certain factors begin to be transformed and give rise to various tissues of a human body.
Teratoma often come to light in fabrics of testicles or ovaries, however can arise and ekstragonadno. The delay of advance of an embryonic epithelium to places of laying of gonads becomes the reason of atypical localization teraty. 25-30% of tumors settle down in ovaries, 25-30% - in a zone of a sacrum and a tailbone, 10-15% - in retroperitoneal space, 5-7% - in testicles, 5-7% in presakralny area, 5% - in a sredosteniye zone. Besides, teratoma can be localized in a brain (more often – in ventricles of a brain or in a zone of a shishkovidny body), jaws, a cavity of a nose or lungs.
There is also a theory according to which a part teraty results from a phenomenon "an embryo in an embryo" - situations when one of two monogerminal twins at early stages of development "is wrapped" around another, and the internal twin turns into a peculiar inclusion parasite, roughly underdeveloped and incapable of independent existence. The proof of this theory are histologic researches of fabrics of some impractical embryos.
Classification and structure teraty
Taking into account features of a histologic structure distinguish:
- Mature teratoma – new growths at which research it is found several differentiated fabrics which are derivatives of one and more germinal leaves.
- Unripe teratoma – tumors when which studying the fabrics of an embryonic structure which are derivatives of three germinal leaves come to light.
- Malignant teratoma – unripe or are (more rare) the mature teratoma which are combined with horionkartsinomy, seminomy or embryonic cancer.
Allocate mature teratoma of a cystous and solid structure. The solid tumor represents dense, smooth or hilly knot. Knot fabric on a section non-uniform, light gray, with small cysts and dense inclusions (the centers of bone and cartilaginous tissue). The mature cystous teratoma looks as large smooth knot. On a section the large cysts containing slime, muddy liquid or kashitseobrazny weight are visible. In cavities bone and cartilaginous inclusions, teeth or hair can be found.
At a microscopic research mature solid and cystous teraty the similar picture comes to light. The basis of new growths is presented by fibrous fabric in which chaotic inclusions of other fabrics are visible: multilayered flat epithelium, epithelium of mucous membranes, bone, cartilaginous, fatty and gladkomyshechny tissue, tissue of peripheral nerves and brain. Sometimes in a teratoma fragments of tissue of lungs and kidneys, and also sites of the ferruterous structure reminding tissue of a mammary gland, pancreas and salivary glands are found. Cystous mature teratoma represent dermoidny cysts which walls are covered with the epithelium containing hair follicles, grease and sweat glands.
Unripe teratoma on a section light gray, with small cysts, contain inclusions of an unripe integumentary epithelium, a neurogenetic epithelium, cross-striped muscles and cartilaginous tissue. Mature teratoma are considered as benign tumors, unripe are considered as potentially malignant. Ozlokachestvleniye is observed seldom. At a malignization of a new growth give limfogenny and hematogenic metastasises. On the structure metastatic tumors remind an unripe teratoma or some of its components.
Separate types teraty
Teratoma of a small egg make about 40% of total of germinogenny new growths at men. Small tumors can proceed asymptomatically, large knots easily are found as cause external deformation of a small egg. Usually begin to grow in the pubertatny period. At adult men come to light extremely seldom. Can be mature, unripe and malignant. Special danger is constituted by the teratoma which are seldom found unripe in the field of the neostarted-up small egg – similar new growths long enough proceed asymptomatically, do not come to light at usual survey and are diagnosed at late stages.
Teratoma of an ovary are diagnosed more often than small egg tumors. Make 20% of total of new growths of ovaries. In most cases represent mature knots of a cystous structure. Sometimes unripe teratoma meet. Often proceed asymptomatically, become a casual find when carrying out researches in connection with suspicion of other diseases. Can become more active during the periods of hormonal reorganization (at teenage age, in the period of a gestation, more rare – in the period of a climax).
Sacral and coccygeal teratoma – the most widespread congenital tumor. The sacral and coccygeal teratoma represents roundish opukholevidny education with a diameter from 1-2 to 30 cm. The girl suffer more often than boys. Large teratoma provoke the shift of internals and can cause violations of development of a fruit. Anomalies of development of a basin, the rectum shift, an atresia of an urethra or are possible. Big tumors with intensive blood supply can provoke development of heart failure. Taking into account features of an arrangement allocate 4 look teraty: mainly external, external and internal, internal and presakralny. Large teratoma can complicate the course of childbirth. New growths delete in the surgical way to the first half a year of life of the child.
Teratoma of a neck – seldom found new growth. It is usually diagnosed right after the birth. Small tumors sometimes remain not distinguished and come to light after growth activization. The size of a teratoma can fluctuate from 3 to 10-15 cm. Depending on a condition of nearby anatomic educations (existence or lack of a sdavleniye) proceed asymptomatically or are shown by the complicated breath, cyanosis of skin, suffocation and difficulties at meal.
Teratoma sredosteniye usually settle down in a forward sredosteniye, near large vessels and a pericardium. Long time are not shown in any way. Usually begin to grow in teenage age or in the period of a gestation. About 20-25 cm can increase. Squeeze lungs, heart, a pleura and blood vessels. Sdavleniye of internals is followed by heartbeat increase, heartaches, short wind and cough. At break of a teratoma of a sredosteniye in a bronchial tube or a pleural cavity there is a cyanosis of skin, suffocation, temperature increase of a body, asymmetry of a thorax, the hiccups irradiating pains in the area on the party of defeat. Perhaps pulmonary bleeding and development of aspiration pneumonia.
Teratoma of a brain comes to light seldom. It is usually diagnosed for boys of 10-12 years. It is inclined to a malignization, malignant regeneration is observed more than in half of cases. Long time proceeds asymptomatically. At increase makes a headache, sick and dizziness.
Diagnostics of a teratoma
For identification sacral and coccygeal teraty the leading role is played by adequate inspection of a fruit during pre-natal development. The diagnosis is usually exposed by results of obstetric ultrasonography. In other cases diagnostics is performed on the basis of complaints, the given objective survey, laboratory and tool researches. At teratoma of a sredosteniye and sacral and coccygeal new growths appoint a survey X-ray analysis, if necessary conduct X-ray contrast researches and an angiography.
High-informative way of diagnostics teraty is KT of the struck area. The technique allows to define a form, the size and a structure of a tumor, and also to estimate its interrelation with other anatomical structures. At suspicion appoint KT, MPT, a thorax X-ray analysis, a stsintigrafiya and other researches to existence of metastasises. As the specifying method apply blood test on a horionichesky gonadotrophin and alpha . The final diagnosis is exposed taking into account results of a punktsionny biopsy and the subsequent microscopic research of material.
Treatment and the forecast at a teratoma
Treatment is surgical. Benign tumors usually excise within healthy fabrics. An exception are ovary teratoma. To girls and women of reproductive age at this disease carry out a partial resection of ovaries, in the preklimakterichesky and climacteric period carry out an adneksektomiya, nadvlagalishchny amputation of a uterus with appendages. The volume of surgical intervention at malignant teratoma is defined localizations and prevalence of a new growth. In the postoperative period appoint radiotheraphy and chemotherapy.
The forecast depends on localization and features of a histologic structure of a teratoma. At mature and unripe benign tumors an outcome usually favorable except for large sacral and coccygeal teraty. Survival at new growths of this localization makes about 50%. Malformations, a sdavleniye of internals or a rupture of a teratoma in labor become a cause of death. At malignant tumors the forecast is defined by prevalence of process. Teratoma from seminomy proceed more favorably to comparison with teratoma in combination with horionepiteliomy or embryonic cancer.