How to detect teratoma

Teratoma is an uncommon disease, and it often occurs in human nerves, which seriously affects people's health. Therefore, it is extremely important to do a correct examination when teratoma occurs. Let's see what examinations should be done for teratoma.

1. Intracranial teratoma

Intracranial teratomas mainly occur in midline areas such as the suprasellar region and pineal region. Their imaging features are distinctive and can be used to make a preliminary diagnosis.

(1) Lumbar puncture pressure measurement shows varying degrees of increased pressure in the vast majority of patients, and the cerebrospinal fluid protein content is generally not high.

(2) Most cranial X-rays show signs of increased intracranial pressure. If teeth, small bone fragments, or calcifications are found, this will be more helpful for qualitative diagnosis.

(3) CT scan CT scan shows irregular tumors, nodules, obvious lobes and uneven density. They usually have solid components (high density), cysts (low density) and calcification and ossification. Multicysts are more common. Fat components can be seen in all patients, and intratumoral bleeding is rare. In a few cases, oily fluid in the ventricles can be seen to flow with changes in body position (caused by rupture of teratomas into the ventricles). It is difficult to distinguish between teratomas and malignant teratomas on plain CT scans, but the latter has relatively less cystic components, calcification and fat, and more solid parts. Benign teratomas have often grown for many years and are usually larger when discovered. Those in the pineal region almost all have varying degrees of supratentorial ventricular enlargement. After injection, the solid part is significantly enhanced, the density is extremely uneven, and the cyst wall enhancement may present multiple ring-shaped shadows.

(4) The signals of T1 and T2 images in MRI examination are extremely mixed, but the boundaries are clear, nodular or lobed. There is no edema at the border of benign teratoma (T2 image shows clear high signal). If there is peripheral edema, it indicates that the tumor is a malignant component or a malignant teratoma. The tumor wall and solid part are significantly enhanced after injection.

(5) The tumor marker CEA may be slightly or moderately elevated. AFP is significantly elevated in patients with immature teratomas and mixed GCT containing this component.

2. Gastric teratoma

(1) X-ray examination ① Abdominal plain film shows uneven density shadows in the upper middle abdomen or the whole abdomen. The border may be unclear, and the intestine is squeezed to the right front and lower side. Strip-like bone-like or dot-like sand-like calcification shadows can be seen in the shadow of the mass ② Barium meal fluoroscopy shows that the stomach body is compressed and deformed, and the small intestine is displaced downward; filling defects can be seen in the stomach, and it can also be expanded, with air-liquid levels and a large amount of effusion; or the contrast agent in the stomach is distributed along the mass, and can also accumulate between the lobules of the mass. ③ Barium enema shows that the transverse colon, descending colon and sigmoid colon are compressed and displaced downward, and a huge dense shadow is shown in the upper abdomen. ④ Renal pyelography shows that the left renal pelvis is displaced downward, and pressure marks may appear on the upper edge of the bladder.

(2) Ultrasound examination shows various acoustic phases. A transverse scan of the left upper abdomen shows that the tumor is located between the spleen and kidney, and the boundary can be clearly displayed or unclear. The tumor can be multi-locular and lobed, and its internal acoustic phase can be solid, multi-cystic, or mixed, and calcification foci may also be displayed.

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

(4) Gastroscopy is rarely used and can only observe the size of lesions in the gastric cavity and the condition of their surface, such as bleeding, erosion, and superficial ulcers. Its advantage is that it can perform biopsy under direct vision, but it is not very helpful for the diagnosis of gastric teratoma.

3. Testicular teratoma

Ultrasound has important clinical value in determining the nature, size, location, proportion of testicular tissue occupied by the testicular tumor, and even selecting treatment methods. The ultrasound manifestations of testicular teratoma are clear mass boundaries, cystic solidity, cartilage, immature bone tissue or calcification in the mass. The serum alpha-fetoprotein (AFP) level of adult testicular teratoma patients 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 within 6 months varies greatly. Therefore, there is no clear clinical significance for the high or low AFP level of infants within 6 months.

4. Ovarian teratoma

(1) Serum alpha-fetoprotein (AFP) The serum AFP of patients is lower than that of ovarian yolk sac tumor. This may be because the endoderm tissue of immature teratoma can also secrete a small amount of AFP. Another possibility is that many germ cell malignancies are mixed types. Immature teratoma may contain a small amount of yolk sac tumor components, which can synthesize trace amounts of AFP.

(2) Nerve cell specific enolase (NSE): Ovarian immature teratoma contains mature or immature nerve cells. Sometimes NSE can be detected in the serum, which is of reference value for the diagnosis of this disease.

(3) Other examinations including B-ultrasound, CT, MRI, laparoscopy, and histopathology.

5. Sacrococcygeal malformation

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

(2) Other auxiliary examinations: X-rays may show bone and tooth shadows in the tumor. Lateral images may show a tumor shadow in the sacrum and coccyx. Barium enema may show that the rectum is bent forward. Intravenous pyelography helps to determine the extent and location of the tumor and whether it has metastasized. Chest and bone X-ray examinations are required.