Teratoma examination

Intracranial teratoma mainly occurs in suprasellar region, pineal region and other midline regions, and its imaging features have obvious characteristics, which can make a preliminary diagnosis.

(1) Most patients with lumbar puncture have different degrees of pressure increase, and the protein content of cerebrospinal fluid is generally not high.

(2) Most brain X-rays show signs of increased intracranial pressure. If teeth, small bones and calcified images are found, it will be more helpful for qualitative diagnosis.

(3)CT scan CT plain scan shows that the tumor is irregular in shape, nodular and lobulated, with uneven density, usually with solid components (high density), cystic lines (low density), calcification and ossification, and polycystic is more common. Fat components can be seen in all patients, and intra-tumor bleeding is rare. In a few cases, the oily fluid in the ventricle can swim with the change of body position (caused by teratoma protruding into the ventricle). Teratoma and malignant teratoma are difficult to distinguish on plain CT scan, but the latter has less cysts, less calcification and fat, and more solid parts. Benign teratomas often grow for many years, and the tumors are usually very large when they are found. Almost all patients in the pineal region have different degrees of supratentorial ventricular enlargement. After injection, the solid part was obviously enhanced and the density was extremely uneven. The wall of the capsule can be reinforced in a plurality of annular shadows.

(4) The signal on T1and (4) T2 image on 4)MRI are extremely mixed, but the boundary is clear, and they are nodular or lobulated. There is no edema at the boundary of benign teratoma (T2 image shows clear high signal). If there is peripheral edema, it means that the tumor is malignant or malignant teratoma, and the tumor wall and parenchyma are obviously strengthened after injection.

(5) The tumor marker CEA can be slightly or moderately increased. The AFP of immature teratoma and mixed GCT patients containing this component increased significantly.

2. Gastric teratoma

(1)X-ray examination ① Abdominal plain film shows the shadow of uneven density increase in the middle and upper abdomen or the whole abdomen. The boundaries are not clear, and the intestines are squeezed to the lower right front. Strip-like or punctate sand-like calcification can be seen in the mass shadow. ② Barium meal fluoroscopy showed that the stomach was compressed and deformed, and the small intestine moved down; Filling defect can be seen in the stomach, and it can also expand, with a gas-liquid plane and a large amount of effusion; Or the contrast agent in the stomach is distributed along the tumor, or it can gather between the lobules of the tumor. ③ Barium enema showed that the transverse colon, descending colon and sigmoid colon were displaced downward under pressure, and the upper abdomen showed huge dense shadows. ④ Pyelography showed that the left renal pelvis was displaced downward, and there might be impression on the upper edge of bladder.

(2)B-ultrasound shows a variety of sonograms. The tumor was found in the left upper abdomen between the spleen and kidney, and the boundary could be clearly displayed or not. The tumor can be multilocular and lobulated, and its internal acoustic semester can be solid, polycystic or mixed, and there may be calcification.

(3) If (3) the lesions on 3)CT are huge, even occupying 4/5 of the abdominal cavity, multiple organs are compressed and displaced. The internal structure of the lesion is disordered, the density is uneven, and it is mixed with dense shadows, and it can also be composed of solid and cystic components.

(4) Gastroscopy is rarely used. We can only observe the size and surface of gastric cavity lesions, such as bleeding, erosion, superficial ulcer and so on. Biopsy under direct vision is its advantage, but it is not helpful for the diagnosis of gastric teratoma.

3. Testicular teratoma

B-ultrasound has important clinical value in judging the nature, size, location, proportion and even choosing treatment methods of tumors in testicular tissue. B-ultrasound findings of testicular teratoma are clear boundary, solid cyst, cartilage, immature bone tissue or calcification in the mass. Serum alpha-fetoprotein (AFP) level in adult patients with testicular teratoma is correlated with benign and malignant. The AFP level of children with testicular teratoma is within the normal range of the corresponding age group, but the blood AFP level of normal infants is quite different within 6 months, so the AFP level of infants within 6 months has no clear clinical significance.

4. Ovarian teratoma

(1) The low serum alpha-fetoprotein in patients with yolk sac tumor of ovary may be due to the fact that endoderm tissue of immature teratoma can also secrete a small amount of alpha-fetoprotein, and another possibility is that many germ cell malignant tumors are mixed. Immature teratoma can be mixed with a small amount of yolk sac tumor and can synthesize a small amount of AFP.

(2) Immature ovarian teratoma with neuron-specific enolase (NSE) contains mature or immature nerve cells, and sometimes NSE can be detected in serum, which is of reference significance for the diagnosis of this disease.

(3) Other B-ultrasound, CT, MRI, laparoscopy and histopathological examination.

5. Sacrococcygeal teratoma

(1) The positive rate of AFP (alpha-fetoprotein) in blood is high, and the white blood cell count and neutrophil count in peripheral blood are obviously increased when there is bacterial infection.

(2) X-ray plain films of other auxiliary examinations showed that there were bone and tooth shadows in the tumor. Lateral image shows tumor shadow in sacrococcygeal region. Barium enema shows that the rectum bends forward. Intravenous pyelography is helpful to determine the scope and location of tumor, and X-ray examination of chest and bones is also needed.