Teratoma, dermoid cyst: causes, treatment, removal
Nature sometimes presents surprises that are not only about scientific research, debate and discussion, but also a lot of surprise for both scientists and citizens. Possible congenital malformations of the fetus always scare expectant mothers, forced to undergo multiple examinations, and illustrations such diseases in the medical literature rarely anyone indifferent. Meanwhile, not all violations occurring during the embryonic period can be diagnosed in utero, so that a separate species detected after the baby is born. To such defects of a bookmark and the formation of organs include the teratoma – the tumor is as diverse as it is unpredictable.
Teratoma appears as a result of violations of fetal development. This means that these tumors already there at birth, but identifies not always immediately, sometimes before the diagnosis takes years and decades of life. The name comes from the Greek word «τέρατος», which literally means «monster». In fact, the appearance of many of teracom discouraging, but the inside can wait for the most unexpected findings, ranging from derivatives of skin (hair, sebum) to the formed teeth, fragments of tissue of liver, thyroid or bone. If other tumors doctor roughly imagine their structure, in the case of teratoma to predict which formations or tissues it is extremely difficult.
A favorite place of localization of teracom are the ovaries, testes, sacrococcygeal region, neck, but perhaps their occurrence in the mediastinum, retroperitoneal space, brain. If a teratoma of the ovaries are more commonly found in adolescent girls or young women, the tumour Sacro-coccygeal region is visible at birth, the baby requires surgical treatment in infancy.
Teratoma are not always malignant, most cases tumors do not pose a serious threat with timely removal, but still flowing aggressive and metastatic varieties are recorded, too. Among all tumors of early childhood teratoma found in a quarter of cases, and in adults it accounts for no more than 5-7%.
Causes of teracom
Causes of teracom to date are not fully understood, but scientists have two main versions:
- The disruption of the formation of one of the so-called parasitic conjoined twins, which remains highly underdeveloped, but in the tumor it is possible to detect not only individual tissues, but also more complex organs – eyes, limbs, sections of the trunk, etc.
- Pathology of embryo development, when there is a wrong offset tissue primordia at early stages of embryogenesis.
The growth of the embryo, the possible emergence of spontaneous genetic mutations, leading to various kinds of deformities and tumors. At the same time, it is impossible to exclude chromosomal anomalies that have arisen in the germ cells before fertilization. If sperm is regularly updated during the life of the men, eggs are laid to the birth of girls, so the expectant mother so you need to lead a healthy lifestyle, not only to avoid the mutations in your child, but also to ensure healthy genetic material and the offspring of the girl also the mother.
The exact cause of mutations in the chromosomes is difficult to call, but probably all kinds of adverse external factors, such as Smoking, carcinogens in food, water and life, industrial hazards contribute to this process.
The tumor may be quite large by the time of the birth of a child, and grow in life (e.g., ovaries), sometimes reaching enormous size.
In order to understand how in one tumor, the combination of various structures and tissues, it is necessary to recall the development of the embryo of man, which is studied at school in biology lessons. After fertilization the zygote is formed, which carries a full chromosome set, and then it is crushing with the increase of the cell mass, implantation (dip) in the endometrium and the formation of the three embryonic leaves, which will later give rise to all the organs and systems of the body. So, ectoderm (outer embryonic leaf) gives rise to nervous tissue, the skin, tooth enamel, the receptor apparatus of the senses. From endoderm (inner layer) develop liver, pancreas and other organs of the gastrointestinal tract. The average leaf – mesoderm – develops into muscles, bone, connective tissue, blood vessels, kidneys, etc.
In case of violation of movements of cells are the rudiments of the skin from the ectoderm can get in the emerging ovaries, then we’ll see teratoma hair, fragments of surface epithelium, secretion of the sebaceous glands. In some cases, tumors exhibit even formed limbs, head or torso, the cause of what is stopping the development of one of the twins because of chromosomal abnormalities.
Very important processes of cell division, tissue differentiation and formation of organs occur in the first trimester of pregnancy, therefore this period should not only be attentive to the health of the expectant mother, but also to ensure timely visit of a doctor with the ultrasound, genetic counseling, etc.
The types of tumors teratogenic
Depending on the degree of differentiation (development) of tissues that form a tumor, a teratoma is:
Immature teratoma (teratoblastoma) consists of poorly differentiated embryonic tissues, papillary excrescences of the elements of the trophoblast, which later was to become part of the placenta. The combination of the rudiments of the most diverse. Teratoblastomy prone to metastasis, rapid growth and have a poor prognosis.
Mature teratomas are well-differentiated elements from all germ layer, but prevail, as a rule, derivatives of ectoderm (surface epithelium, similar to that in the skin, hair, sebaceous and sweat glands). If you are a Mature teratoma has a cavity, it is called a dermoid cyst. These cysts are characteristic of ovarian localization of the pathological process.
In some cases teratoma the tumor is highly specialized cloth belonging to any single organ (mandarmala teratoma). So, detection of the parenchyma of the thyroid gland in the ovary called the Struma.
Teratoma can be located inside the body (in the tissues of testis, lung, dermoid cyst of the ovary), and outside (in the sacrococcygeal region of neonates). Tumor localization exterior to diagnose quite simply have during the inspection of the baby.
Behavior teratoblastoma (malignant variety) is a little different from other malignancies. They are characterized by infiltrative growth characterized by the germination of the surrounding tissues and organs they metastasize to the lymph nodes and parenchymal organs, spread on serous membranes can bleed, ulcerate, to suppurate. The prognosis of these tumors are very serious, and treatment is not always effective due to the lack of a clear boundary with the healthy tissue and their involvement in the pathological process.
Symptoms and signs of terata different localizations
Teratoma of sacrococcygeal region
Teratoma sacrococcygeal region diagnosed in children at birth and more frequently in girls. The tumor is in most cases benign, but tend to reach large sizes, occupying almost the entire volume of the pelvis with the internal localization, without damaging the bone. Growth in outdoor education is located in the sacrum, perineum, hanging between the thighs of the child, displacing the anus. The tumor mass may even exceed the weight of the infant, and the appearance is quite frightening.
The composition of teratomas sacrococcygeal region may include portions of hepatic tissue, intestinal loops, the limbs are underdeveloped twin, but in all cases, necessarily found the elements of ectodermal origin – the hair, the skin. The presence of a benign teratoma embryonal tissues makes it dangerous in terms of malignancy, especially after six months of a child’s life the growth of tumors.
Externally, the tumor looks like a globular formation of an inhomogeneous consistency: dense plots (fragments of cartilage, bone) alternate with soft (cystic cavity). Feeling her, usually painless. For external or external-internal type of a teratoma difficulties in delivery, so it’s important to decide on a cesarean section.
Options malignant sacrococcygeal teratomas contain a structure such as a cancer, papillary growths of immature tissue from all three embryonic leaves. This tumor grows rapidly in the first days and months of baby’s life, leading to tissue damage of the perineum, squeezing the opening of the urethra and the rectum, which can manifest violation of emptying the bladder and bowel.
The risk for this pathology is associated with the development of heart failure in children, since a large amount of well the tumor is supplied, thus creating an additional burden on the small heart. In utero, during childbirth or after a rupture of the tumor and bleeding, the volume of which can be mapped with all the available blood from a baby.
Signs of a sacrococcygeal teratoma diagnosed in a pregnant woman in the form mnogonogie, severe toxemia (preeclampsia), the divergence of the uterus, in pregnancy, premature birth. Approximately half of fetuses with this pathology die before birth, and born children in need of surgical treatment.
Teratoma of the neck
Teratoma of the neck of the fetus is very rare, in most cases it’s benign, but the involvement in the pathological process of blood vessels, nervous tissue, respiratory system makes it deadly in 80-100% of the time in utero and after the baby is born with such pathology without surgical treatment.
In the composition teratogenous tumors of the neck of the fetus most often find nerve tissue and portions of the parenchyma of the thyroid gland. It is located both on the front and back of the neck. Reaching large size, a tumor can compromise the airway, leading to suffocation and death.
Teratoma of the testis
Teratoma of the testis is diagnosed mainly in young children (under two years), manifesting itself as a benign neoplasm. Adolescents and young men, on the contrary, the tumor is often malignant. Manifestations of the disease in children can be reduced to the asymmetry, the presence of tumor in the scrotum. Adult teratoma of the testis long-term can occur without any symptoms, but at some point begins its growth, there is pain, increase in size of the scrotum on the affected side. To detect epithelial tumor elements, glandular tissue.
Teratoma of the ovary is the most common type of tumors in this group. It can be found in girls and women of reproductive age, but she and the babies and in the elderly. Like other such neoplasms, teratoma of the ovary can be benign or malignant.
Causes teratomas of the ovary are the same as in the case of other tumors, there is disruption in the process of embryonic development and formation of organs. The assumptions about the role of hormonal imbalance in a woman’s body, but the scientific justification of this theory are not yet available.
Depending on the structure of the tumor, secrete solid option (without cavities) and cystic. Cystic teratoma, or dermoid cyst, is the most frequent tumor in girls and young women. It is formed by elements of all three embryonic leaves, but is dominated by derivatives of the ectoderm. Externally, the tumor resembles a pouch with thick walls, filled with sebaceous contents of hair, it is also possible to detect areas of bone or cartilage, and even formed teeth.
A solid teratoma contains formed cysts and well-developed tissues, it is benign and has good prognosis. Options malignant cystic teratomas contain embryonic tissue and even fragments of other tumors, for example, melanoma.
Teratoma of the left ovary as common as right, the symptoms will be similar, but the tumor is right-sided localization can simulate attack of acute appendicitis or other intestinal pathology.
Signs of teratoma of the ovary often has long absent, but as you increase its size there are pains in the abdomen-pull in nature, a violation of urination in the compression of the urinary tract.
Sometimes dermoid cyst located on a thin stalk, creating a risk of torsion of the tumor, disturbances of blood circulation and development pattern of acute abdomen with intense sharp pain. In these cases, the patient in need of emergency surgical care.
Diagnosis and treatment of teracom
To suspect the presence of teratoma, it is necessary to conduct a number of surveys, but sometimes it only takes one glance to determine the diagnosis.
Among the most common methods of diagnosis you can specify:
- X-ray examination, including computed tomography (CT);
- Laboratory determination of tumor markers, hormones and other biologically active substances;
- Morphological study of tumor tissue sections.
When neck teratoma or sacrococcygeal region in a newborn is a lack of inspection in order to suspect a tumor, but it is important to perform timely diagnosis before birth. In such cases, comes to the aid of an ultrasound, which can be applied during pregnancy.
In addition to the examination of fruits, ultrasound is very informative in dermoid ovarian cysts, tumors of the testicles. The method is available and safe, suggests the structure of the teratoma and its impact on the surrounding organs and tissues.
X-ray examination is not only performed to exclude lung metastases in malignant teratoma. It can be used also to detect fragments of bone in teratoma ovaries, and in order to distinguish sacrococcygeal cysts from spina bifida caused by disturbed development of the sacral vertebrae in the fetus.
Angiography is rarely used, but with her help, the doctor evaluates blood flow in the tumor, and also clarifies some of the vessels, the tumor is supplied, which is important for subsequent surgical treatment.
The most informative method of diagnosis is the morphological study of tumor sections. In most cases it is carried out after its removal, but to allow one of the most important issues – the tumor is benign or not.
To clarify the nature of the spread of teratoma to the surrounding tissue patients produce CT and MRI.
Laboratory diagnostic methods have not found wide application in teratogenic tumors, and in General, the analysis of blood or urine characteristic changes occur. However, it is worth noting that most of teracom able to synthesize alpha-fetoprotein or human chorionic gonadotropin, reflecting the presence of embryonic tissue in the tumor. Teratoma of the neck with parts of the tissue of the thyroid gland secretes thyroid-stimulating hormone. These figures show the activity of the tumor, its rate of growth, metastasis and the effectiveness of the therapy.
Teratoma – the tumor is special, and therefore traditional methods of treatment of oncological patients it is not always applicable. One thing remains unchanged: the radical surgical removal of the teratoma is the most effective way of dealing with the disease.
Benign tumors of the testis, ovary, sacrococcygeal region, subject to total destruction in the earliest period after their discovery. If technically possible, dermoid cyst of the right or left ovary in young women and girls are removed laparoscopically. Certain difficulties arise in the surgical treatment of malignant teracom growing other organs and tissues and has no clear boundaries, which could lead to abandonment of parts of a tumor that will later become the source of relapse (resumption) of disease and metastasis.
In addition to the surgery, perhaps radiation treatment and chemotherapy, but teratoma is weakly sensitive to both methods, so they are used mainly in case of impossibility of radical surgery.
Aside from this, there are ways to reduce the swelling even during prenatal development. Thus, the teratoma sacrococcygeal region containing large cysts, a good effect can be obtained by having them puncture under ultrasound control. The decrease in the volume of the tumor tissue after this procedure reduces the risk of preterm birth and rupture of the teratoma in the case of natural delivery, and reduces the load on the uterine wall. In any event, if the Sacro-coccygeal teratoma the shown a speedy C-section, helping to avoid dangerous complications. Caesarean section can be performed when the lungs of the fetus will be able to perform the respiratory function.
Specific ways to prevent teracom does not exist, and the reason for them is unclear. At the same time to claim that lifestyle, nature of work and heredity have no effect, would be unjust. In order to reduce the risk of genetic mutations that lead to tumors, one should try to lead a healthy lifestyle, eliminate bad habits, eat right. This is especially true expectant mothers who are responsible not only for themselves, but for a small man, begins to develop they have «at heart». The future Pope also must not remain on the sidelines. Their role is to support the women you love and care about your health at the stage of pregnancy planning.
Regular doctor visits a pregnant woman allows timely detect possible deviations in the development of the fetus, malformations of organs and the presence of terata, and the correct and timely delivery helps to avoid dangerous complications in the case of ceratoides of the tumor.