Intracranial immature teratoma invading the nasal cavity mimicking olfactory neuroblastoma

Abstract

Rationale:Primary intracranial immature teratoma accounts for majority of congenital central nervous system germ-cell tumors, but it is extremely rare in patients older than 15 years.Patient concerns:A 27-year-old woman was referred to our hospital for headache, nasal congestion, and decreased olfactory sensation. Imaging showed a mass measuring approximately 5 cm × 4 cm in the right frontal lobe, which also filled the right nasal cavity. Histopathologically, the intracranial tumor tissues were composed of both mature tissues, including glands and squamous epithelial cells and immature neuroectodermal components. However, the tumor tissues in the nasal cavity were mainly immature neuroectodermal components that mimicked olfactory neuroblastoma. The cells stained positively for neuron-specific enolase, Alpha Thalassemia/Mental Retardation Syndrome X-Linked, and Oligodendrocyte transcription factor on immunostaining, proving a neuroectodermal differentiation.Diagnoses:According to these findings, the tumor was diagnosed as a primary intracranial immature teratoma that also involved the nasal cavity after excluding the metastatic tumors.Interventions:The patient underwent 2 surgeries. The first surgery was via the subfrontal approach, followed by a second endoscopic sinus surgery performed 22 days later.Outcomes:The patient had no recurrence within a 6-month follow-up after the last surgery.Lessons:When an intracranial immature teratoma involves the nasal cavity, the lesions in the nasal cavity may mimic other tumors including olfactory neuroblastoma. We suggest that thorough examination of tumor tissues and identification of variable components are critical for the appropriate diagnosis of intracranial immature teratoma, a rare tumor.

Olfactory Neuroblastoma of the Sinonasal Tract with Prominent Orbital Protrusion: A Case Report and Literature Review

“…Furthermore, magnetic resonance diffusion kurtosis imaging (DKI) and dynamic contrast enhanced MRI (DCE-MRI) are helpful in distinguishing ONB from nasal squamous cell carcinoma for significantly higher K values and lower V e values in ONB [ 1 ]. In particular, ONB can be differentiated from intracranial immature teratoma for the absence of some increased substances including AFP, b-HCG, and PLAP in serum and cerebrospinal fluid [ 14 ]. The diagnosis of ONB can be established after a careful evaluation of radiological study, histopathological examination, immunohistochemistry, and cytogenetic analysis [ 11 ].…”

Imaging of supratentorial intraventricular masses in children: a pictorial review—part 2

“…Immature teratomas, on the other hand, are characterized by the presence of even small tissue components that have incompletely differentiated, resembling fetal structures. These tumors may contain cysts, calcifications, and chondroid material, but they generally have soft, fleshy components reflecting the high cellularity of immature elements [ 80 ]. Teratomas with somatic-type malignancy can mirror mature or immature teratomas but are more likely to exhibit regional necrosis and possible overgrowth by sarcomatous components [ 81 ].…”