Fetal Presentation of Mediastinal Immature Teratoma: Ultrasound, Autopsy and Cytogenetic Findings

Abstract

Teratomas are the most common congenital tumors, occurring along the midline or paraxial sites, or uncommonly, the mediastinum. Teratomas are classified as mature, containing only differentiated tissues from the three germinal layers; and immature, which also present with neuroectodermal elements, ependymal rosettes, and immature mesenchyme. Herein, we describe a new case of fetal mediastinal immature teratoma detected at 21 weeks of gestational age (wga) + 1 day with thorough cytogenetic analysis. Ultrasound (US) showed a solid and cystic mass located in the anterior mediastinum, measuring 1.8 × 1.3 cm with no signs of hydrops. At 22 wga, US showed a mass of 2.4 cm in diameter and moderate pericardial effusions. Although the prenatal risks and available therapeutic strategies were explained to the parents, they opted for termination of pregnancy. Histology showed an immature teratoma, Norris grade 2. Karyotype on the fetus and tumor exhibited a chromosomal asset of 46,XX. The fetal outcome in the case of mediastinal teratoma relies on the development of hydrops due to mass compression of vessels and heart failure. Prenatal US diagnosis and close fetal monitoring are paramount in planning adequate treatment, such as in utero surgery, ex utero intrapartum therapy (EXIT) procedure, and surgical excision after birth.

New Findings in the Multidisciplinary Management of a Fetal Intrapericardial Teratoma: A Case Report

“…Intrapericardial teratoma was first described by Joel et al [12] in 1890, after which it has been rarely reported. Pilu et al [1] reported 16 cases of intrapericardial teratoma diagnosed by antenatal ultrasound up to 2021, 12 of which complicated by NIFH. Only four cases were diagnosed before 22 weeks (gestational age ranged from 20 to 38 weeks, median 28 weeks), with survival in two (C-section performed at 25 weeks in one case and at 33 weeks in the other), and EXIT was performed in 1/16 cases.…”

“…Intrapericardial teratoma is a rare, potentially fatal tumor derived from endodermal, mesodermal, and ectodermal cell lines and usually diagnosed in the perinatal period [1, 2]. Most are of vascular origin and arise from the aorta or pulmonary artery [3], where they may impair thoracic blood and lymphatic circulation and cause non-immune fetal hydrops (NIFH).…”

“…To the best of our knowledge, no antenatal medical therapy to treat teratomas and their consequences has been described to date [1]. Furthermore, published data on this rare tumor are scant.…”

What Do We Have to Know about PD-L1 Expression in Prostate Cancer? A Systematic Literature Review (Part 6): Correlation of PD-L1 Expression with the Status of Mismatch Repair System, BRCA, PTEN, and Other Genes

“…Systematic literature reviews and metanalyses (SLRs) conducted according to the PRISMA guidelines (including an evidence-based minimum set of items for reporting) ( , accessed on 8 May 2021) are increasingly important in health care, keeping medical doctors up to date, and also representing the background for developing clinical guidelines/trials, as well as the justification for financial supports of research projects. Usually conducted by multidisciplinary teams, SLRs performed according to these guidelines could be applicable in various topics/contexts, improving the research quality not only of pure meta-analyses but also of SLRs applied to case report/series [ 215 , 216 , 217 , 218 , 219 , 220 , 221 , 222 , 223 , 224 , 225 , 226 , 227 , 228 , 229 , 230 , 231 , 232 , 233 , 234 , 235 , 236 , 237 , 238 , 239 , 240 , 241 , 242 , 243 , 244 , 245 , 246 , 247 , 248 , 249 , 250 , 251 , 252 , 253 , 254 , 255 , 256 , …”

What Do We Have to Know about PD-L1 Expression in Prostate Cancer? A Systematic Literature Review. Part 3: PD-L1, Intracellular Signaling Pathways and Tumor Microenvironment

“…They highlight various subtopics, including: PD-L1 immunohistochemical expression in PC cases, with discussion of pre-analytical and interpretation variables; correlations of PD-L1 expression with clinic-pathological features in PC patients; genetic and epigenetic regulation of PD-L1; data of pre-clinical studies (cell lines, mouse models) about the effects of experimental treatments on PD-L1 expression in PC cells; investigated correlations of PD-L1 expression with the status of mismatch repair system, BRCA, PTEN and other main genes in PC; PD-L1 expression in liquid biopsy samples; information of clinical trials, etc. We address the Readers to the other papers for further details on these subtopics [259][260][261][262][263][264][265][266][267][268][269][270][271][272][273][274][275][276].…”