intracranial teratoma
Introduction
Introduction to intracranial teratoma Intracranial teratoma is a congenital ectopic tumor composed of more than one embryonic tissue. It is rare. basic knowledge The proportion of illness: 0.0002% - 0.0009% Susceptible people: no special people Mode of infection: non-infectious Complications: swelling, cerebrospinal fluid leakage, meningitis, subarachnoid hemorrhage, epilepsy
Cause
Causes of intracranial teratoma
Causes
Teratoma is composed of two or three kinds of germ layers, which are classified into benign and malignant according to the degree of tumor cell differentiation, but also those with high differentiation. Malignant teratomas refer to all malignant teratomas, that is, all The tissue composition of the undifferentiated fetal development period, sometimes the occurrence of teratoma malignant transformation refers to the presence of focal sarcoma or cancer components in the teratoma.
According to modern classification, WHO (1993, 2000) divides tumors into three subtypes:
Maturity (20%):
Benign teratoma has a clear boundary, nodular, complete envelope, round, elliptical or lobulated, smooth surface, easy to peel off from surrounding brain tissue, only partially adhered to brain tissue, to the brain The tissue is mainly oppressed, rarely infiltrated, and the tumor is hard and tough. The cut surface can have different sizes of cysts. The color and hardness of the solid part vary from tissue to tissue. There may be watery mucus or lipid in the capsule. Samples (like epithelioid cyst tissue), sometimes the mass of oil has broken into the ventricle, due to the specific gravity, free movement in the ventricle, which is also an indicator of preoperative diagnosis, the solid part can be embedded with bones, teeth and Cartilage, often mixed with hair, sometimes due to old bleeding, the capsule may contain coffee-like liquid.
Immature (20%):
Under light microscopy, the tumor is characterized by differentiation of three germ layer tissues. If it is differentiated into adult-like tissue, it is called mature teratoma. If there is embryonic or fetal-like immature tissue, it is called immature teratoma. The endoderm structure in the tumor may contain digestive tract and respiratory tissues and various glands secreting mucus, mesoderm structures such as bone, cartilage and muscle tissue, ectodermal structures are usually squamous epithelium and nerve tissue, visible glia Cells, various differentiated neurons, glial, neural tube and choroid plexus, etc. The appearance of immature tissue in teratoma does not mean malignant transformation of tumors. On the contrary, mature tissue components also have malignant tumors. Ingredients, the mature neuroepithelium in the teratoma sometimes metastasizes, and the malignant teratoma depends on the presence or absence of germ cell tumors in the tumor, and even the choriocarcinoma component. Therefore, it takes more points to do the tumor pathology because of the organization of different regions. Different ingredients, such as too little material, can miss the malignant ingredients.
Teratoma malignant (5%):
Immature or malignant teratoma, it is difficult to identify bone and cartilage, and the capsule often has a brownish liquid due to hemorrhage, and some of the capsule is incomplete, indicating that it will infiltrate into the surrounding area.
Prevention
Intracranial teratoma prevention
1. Avoid harmful substances (promoting factors)
It is able to help us avoid or minimize exposure to harmful substances. Some related factors of tumorigenesis are prevented before onset. Many cancers are preventable before they are formed. Most malignant tumors are caused by environmental factors. Environmental factors and lifestyle refer to the air we breathe, the water we drink, the food we choose to make, the habits of activities, and social relationships.
2. Improve the body's immunity against tumors
Can help to strengthen and strengthen the body's immune system and cancer. The focus of our current cancer prevention efforts should first focus on and improve those factors that are closely related to our lives, such as smoking cessation, proper diet, regular exercise, and weight loss. Anyone who follows these simple and reasonable lifestyles can reduce their chances of developing cancer.
Promote the body's immunity against cancer: The most important thing to improve the function of the immune system is: diet, exercise and control troubles, healthy lifestyle choices can help us stay away from cancer. Maintaining a good emotional state and proper physical exercise can keep your body's immune system at its best, and it is also good for preventing tumors and preventing other diseases.
Complication
Intracranial teratoma complications Complications, swelling, cerebrospinal fluid, meningitis, subarachnoid hemorrhage, epilepsy
Complications in the saddle area for surgical treatment include intra-saddle complications, including internal carotid artery injury, postoperative large vasospasm, occlusion, and cranial nerve injury, especially for nerve injury, concurrent with saddle operation Symptoms, including hypothalamus, pituitary stalk, pituitary injury; optic nerve, optic chiasm and peripheral blood vessels damage leading to vision loss or blindness, the latter can also be caused by residual tumor hemorrhage, swelling, excessive stuffing in the saddle; Arachnoid fluid rupture occurs cerebrospinal fluid leakage, can cause air cranial, meningitis; other subarachnoid hemorrhage, double epidural hematoma, epilepsy and so on.
Symptom
Intracranial teratoma symptoms Common symptoms Intracranial hypertension Increased intracranial pressure Hydrocephalus growth Slow paralysis Deafness Ataxia Dysfunction Drowsiness positioning signs
Except for malignant teratoma, most of the growth is slow, and its course is related to the site of occurrence. It is located in the pineal region or the third and fourth ventricles. It is easy to obstruct the cerebrospinal fluid circulation pathway and cause hydrocephalus. The disease course is shorter and more About half a year, other parts have a longer course.
Because the tumor is often located in the midline, there are often no obvious signs of brain localization. Most patients have increased intracranial pressure as the first symptom. Teratomas located in the pineal region may have both upper eyesight, ataxia, precocious puberty, and cranial nerves. Paralysis, etc., people in the saddle area may have diabetes insipidus, lethargy, visual field of vision and water, fat metabolism disorders, etc., cranial fossa may have cerebellar dysfunction and neck stiffness, etc., intraventricular can appear corresponding symptoms and signs, bridge Cerebral horns may have headache, vomiting, diplopia, ataxia, deafness, nystagmus, cranial nerve injury and intracranial hypertension.
Examine
Examination of intracranial teratoma
Most patients underwent lumbar puncture pressure measurement with different degrees of pressure increase, cerebrospinal fluid protein content is generally not high, a few have mild to moderate increase.
1. Brain X-ray film
It is helpful for diagnosis. Most of them show signs of increased intracranial pressure. If there are teeth, small bones, and calcified images, it is more helpful for qualitative diagnosis.
2. CT scan
CT plain scan showed irregular shape, nodular shape and obvious lobulated and uneven density of space-occupying lesions, usually with solid components (high density), cystic (low density) and calcification and ossification. Polycystics are more common, all patients can see fat components, intratumoral hemorrhage is rare, in a few cases, the intraventricular fluid-like fluid can swim with changes in body position (caused by teratoma rupture into the ventricle), teratoma It is difficult to distinguish from malignant teratoma in plain scan CT, but the latter has cystic components, calcification and fat are relatively small, and the parenchyma is more, while peritumoral edema often occurs. The benign tumor is often grown. For many years, the masses are usually found to be large. In the pineal region, almost all of the supratentorial ventricles are enlarged. After the injection, the solid part is obviously strengthened, the density is extremely uneven, and the wall strengthening can be multiple rings. Shadow.
3.MRI
Teratomas consist of multiple components, so the signals appearing in T1 and T2 are also very mixed, but the boundaries are clear, nodular or lobulated, and the benign teratoma borders are edema (T2 shows a clear high signal) ), if there is peripheral edema, suggesting that the tumor is a malignant component or a malignant teratoma, the tumor wall and the parenchyma are obviously strengthened after the injection.
Diagnosis
Diagnosis and diagnosis of intracranial teratoma
diagnosis
In children with progressive intracranial hypertension or hydrocephalus, accompanied by the above symptoms and signs, the possibility of teratoma should be considered, and an auxiliary examination should be performed in time to confirm the diagnosis.
Differential diagnosis
Craniopharyngioma
Most occur in children, can be located in the saddle, on the saddle and the saddle, most of them can protrude into the third ventricle and obstruct the interventricular space. CT is cystic, solid and mixed, often with large sac, irregular shape, The vertical upward growth can exceed the interventricular space; sometimes it grows laterally, reaching the forehead forward, and reaching the cerebral cerebral horn at the outside, the inner side can penetrate the sacral leaf, and the back can fill the pool between the feet, so that the brain stem moves backward. Position, CT is characterized by calcification (calcification rate is greater than 90%), which is surrounded by eggshells, and can also be plaque-like calcification. MRI shows high and low signals in T1 image, although cystic and solid components are in T2. Like the high signal, but the cystic change of cholesterol components is higher than the solid component signal, craniopharyngioma is congenital, many children with pituitary dysfunction, short stature and sexual development are not developed, the symptoms are not like saddles Teratoma is the first symptom of urinary collapse. The first symptom of craniopharyngioma is visual field vision and increased intracranial pressure. The incidence of diabetes insipidus is low (about 30%) and often occurs in the late stage of the tumor.
2. Hypothalamic and optic glioma
It is the second common tumor in the sellar region, most of which are hair cell astrocytomas. The hypothalamic astrocytoma is mostly solid, CT is equal or slightly lower density, and MRI is equal or slightly lower in T1. The T2 image is a high signal, and the texture is uniform or uneven. After injection, it can be mildly strengthened to obviously strengthen. When imaging is difficult to identify, it is mainly based on clinical symptoms, that is, germ cell tumors often cause diabetes insipidus on the saddle. There are few diabetes insipidus in astrocytes.
3. Pituitary adenoma
Children are rare, accounting for 2% to 3% of children's intracranial tumors, mostly larger adenomas, can be seen in the coronal scan, the saddle is obviously enlarged, there may be intratumoral hemorrhage, and the density and signal can be displayed on CT and MRT. Uneven, with low endocrine function, often showing centripetal obesity.
4. Dermoid cysts and epithelioid cysts
The saddle epithelioid cyst or epithelioid cyst CT is low density (CT value is -20 ~ 40Hu), T1 is high signal, T2 is low signal to uneven high signal, and sometimes the brain can be floated with oil.
