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NEUROIMAGE
Year : 2010  |  Volume : 58  |  Issue : 1  |  Page : 166-167

Spontaneous rupture of an intracranial teratoma


1 Department of Neuroimaging, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
2 Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
3 Department of Neuropathology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

Date of Acceptance23-Oct-2009
Date of Web Publication8-Mar-2010

Correspondence Address:
Dai Jianping
Department of Neuroimaging, Beijing Tiantan Hospital, Capital Medical University, Beijing
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.60391

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How to cite this article:
Xuzhu C, Tao J, Junmei W, Jianping D. Spontaneous rupture of an intracranial teratoma. Neurol India 2010;58:166-7

How to cite this URL:
Xuzhu C, Tao J, Junmei W, Jianping D. Spontaneous rupture of an intracranial teratoma. Neurol India [serial online] 2010 [cited 2023 Jun 9];58:166-7. Available from: https://www.neurologyindia.com/text.asp?2010/58/1/166/60391


Teratoma rupture has been reported in various regions such as the omental sac, [1] mediastinum, [2] pelvic cavity, [3] occipitocervical region, [4] and sacrococcygeal area. [5] To the best of our knowledge, rupture of intracranial teratoma has not been reported to date. We present a case of spontaneous rupture of a large intracranial teratoma.

A 16-year-old female patient presented with six months history of headache and dizziness. Her medical history was unremarkable and she did not have any history of trauma. On examination, the left nasolabial groove was superficial and there was a decrease in the angle on the left side of her lips. The uvula deviated to the right side and there was a loss of pharyngeal reflex on the right side. She also had ataxia. Computed tomography (CT) scanning revealed a large lesion in the posterior fossa and the suprasellar region with a maximum diameter of 9.35 cm. This lesion was mostly composed of fat with attenuation value of -36 HU. The solid part of the lesion was heterogeneous in density with multiple calcifications or ossifications within it. Scattered "oil" was seen in the pontine cistern, bilateral cisterna ambiens, and bilateral ventricles, suggesting rupture of the tumor [Figure 1]. Magnetic resonance imaging (MRI) showed a large lesion in the posterior fossa and the posterior part of the third ventricle. It had linear, dot-like and patchy hyperintensities and irregular hypo intensities. Patchy and dot-like hyperintensities were shown in the bilateral ventricles and cisterns on T1 weighted images (T1WI) [Figure 2]. On fat saturation sequence, there were no high signals in the tumor, cisterns and ventricles [Figure 3]. Intraoperatively, the intracranial tumor was hairy in parts and soft in texture with scant blood supply. The inferior part of the tumor was yellow and white in color and composed of oil and fat. The superior part of the tumor was tenacious in texture and yellow in color with septa and calcifications. The tumor was subtotally resected. Histopathological examination confirmed the diagnosis of teratoma. The patient's recovery was uneventful and she was discharged on the seventh postoperative day.

Teratoma, a type of germ cell tumors, makes up 2-4% of intracranial tumors in children. [6] The etiology and pathogenesis of intracranial teratomas are not wholly understood. Some authors insist that these tumors arise from misplaced primordial germ cells, which are embedded in or near the midline structures in the head. Others think the tumors may not originate from one single type of cell such as the primordial germ cells. [7] Pathophysiologically, the mechanism of teratoma rupture remains unclear. In the mediastinum, proteolytic or digestive enzymes derived from the tumor have been proposed as the cause. [8] In the ovary, rupture of mature cystic teratoma may be the result of primary perforation of the tumor. [9] These mechanisms may or may not explain intracranial teratoma rupture.


 ╗ Acknowledgment Top


We thank Miss Ally Chuan Xiang, from King's College London School of Medicine, 2 nd Floor, Henriette Raphael House, Guy's Campus, London Bridge, London, SE1 1UL, UK, for her English editing.

 
 ╗ References Top

1.Chen SS, Chen CP, Chien SC, Hsu CY. Spontaneous rupture of omental teratoma mimicking a ruptured ovarian teratoma. Taiwan J Obstet Gynecol 2008;47:229-32.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]  
2.Jang SH, Jang KS, Min KW, Paik SS, Chon SH. Ruptured thymic teratoma diagnosed by pleural effusion cytology. Acta Cytol 2008;52:394-6.  Back to cited text no. 2  [PUBMED]    
3.Kimbrell BJ, Emami C, Petrone P, Asensio JA. Ruptured ovarian cystic teratoma secondary to blunt abdominal trauma: a very unusual case. J Trauma 2007;63:E27-9.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]  
4.Dadmehr M, Nejat F, Ansari S, Habibi Z. Ruptured occipitocervical teratoma mimicking an upper cervical myelomeningocele. J Neurosurg 2006;104:360-1.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]  
5.Yamaguchi Y, Tsukimori K, Hojo S, Nakanami N, Nozaki M, Masumoto K, et al. Spontaneous rupture of sacrococcygeal teratoma associated with acute fetal anemia. Ultrasound Obstet Gynecol 2006;28:720-2.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]  
6.Uken P, Sato Y, Smith W. MR findings of malignant intracranial teratoma in a neonate. Pediatr Radiol 1986;16:504-5.  Back to cited text no. 6  [PUBMED]    
7.Sano K. Pathogenesis of intracranial germ cell tumors reconsidered. J Neurosurg 1999;90:258-64.  Back to cited text no. 7  [PUBMED]  [FULLTEXT]  
8.Choi SJ, Lee JS, Song KS, Lim TH. Mediastinal teratoma: CT differentiation of ruptured and unruptured tumors. Am J Roentgenol 1998;171:591-4.  Back to cited text no. 8      
9.Chang YT, Lin JY. Intraperitoneal rupture of mature cystic ovarian teratoma secondary to sit-ups. J Formos Med Assoc 2009;108:173-5.  Back to cited text no. 9  [PUBMED]  [FULLTEXT]  


    Figures

  [Figure 1], [Figure 2], [Figure 3]

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