TERATOMA: A RARE TYPE OF TUMOUR

Diya Adhikary, Amity University Kolkata

“Teratomas arise from primordial germ cells” – Stevens in 1961. 

In the year 1964, embryologist Barry Pierce discovered that within each tumor, only one cell continued to divide and give rise to more cells while the rest of the cells differentiated and died. Clay tablets from 600-900 BC were believed to deal with the different ways of predicting the future stated that the prosperity of a woman giving birth to a three-legged child would follow. This is considered as the earliest source mentioning benign teratomas.

The term “Teratoma” has been derived from the Greek word “teratos” which translates to “monstrous tumor”. It is called so as it can contain fully developed hair, eyes, teeth, neurons, and bone (tissues and organs). Teratomas are commonly found in newborns and children yet it is a rare type of tumor (1 in every 35000-40000).

Location

• Ovary: Ovarian Teratomas (Ovarian dermoid cyst) is the most common group of ovarian germ cell tumors. They have three sub-types:- mature ovarian teratoma, immature ovarian teratoma, and specialized teratoma.
• Testis: Testicular teratoma (Teratoma of the testicle) is a part of testicular mixed germ cell tumors.
• Mediastinum: The most common extra-gonadal germ cell tumors are located in the anterior mediastinum.
• Intracranial: Uncommon intracranial neoplasms have a wide variety of components and a broad range of appearances.
• Sacrococcygeal region: The teratoma arises in the sacrococcygeal region.

These tumors form due to complications in the body’s growth process (cell differentiation and specialization). They arise in the germ cells, which generate during the development of a fetus. Few primitive germ cells give rise to sperm or egg-producing cells, tailbone, and mediastinum. 

Types

1. Mature teratomas: They are non-cancerous but may grow again even after being surgically removed. These are further divided into cystic (fluid containing sac), solid (made of tissue), and mixed (both solid and cystic). Mature cystic teratomas grow at a slow rate (growth rate of 1.8mm/year). Some have a rapid growth rate.
2. Immature teratomas: They contain anaplastic immature elements and give rise to cancer which is malignant in nature. 

The Parasitic Twin Theory

A rare type of teratoma is known as ‘fetus-in-fetu’ (FIF), which means a fetus within another fetus. This can occur in 1 in every 500000 and is detected in infancy. It bears the appearance of a malformed (undeveloped) fetus made up of living tissue. Unlike a normal fetus, it does not have a placenta and amniotic sac. Some theories say that the fetus in-fetu is a result of the remains of a twin that could not develop in the womb and had been encompassed by the other child, or it may be a developed form of dermoid cyst.

The teratoma assay

Symptoms

The following are some of the most common symptoms which indicate the potential occurrence of teratoma(s):

1. Painful swelling and bleeding.
2. A mild increase in the levels of AFP (Alpha-FeroProtein), which is a marker for tumors.
3. A mild increase in the levels of BhCG (Beta-human Chorionic Gonadotropin) hormone.
4. Constipation
5. Urinary Incontinence 
6. Leg weakness

Cure 

For determining the severity and a potential cure, medical consultation from an appropriate physician is deemed extremely important in this regard. Few of the possible classifications based on the type of teratoma that is occurring may lead to these course-of-actions:

1. If the teratoma is cancerous, it is recommended that the teratoma be surgically removed.
2. When cancer is a mixture of multiple different tissues from the region that is affected, in that case, surgery may not be a feasible option, in which case chemotherapy is generally the preferred way to go. 
3. When the teratoma is determined to be malignant, chemotherapy along with surgery is deemed to be the most suitable option to be carried out.

Although it is not guaranteed that these measures will lead to a 100% recovery rate, but early diagnosis at stage 1 of the condition ensures a 90-95% survival rate in the first five years. Surgical and chemotherapeutic measures indeed help in preventing the situation to get out of hand in most cases, thereby prolonging the patients’ lifespan as much as possible by increasing chances of recovery through gradual healing.

Also read: Protein Kinase CK2 : The drug target for diverse human disorders

REFERENCE:-

1. Raup C. (2010) “Teratomas”. Embryo Project Encyclopedia. ISSN: 1940-5030 http://embryo.asu.edu/handle/10776/1961 
2. Saber M. and Gaillard F. Teratoma. Radiopaedia. https://radiopaedia.org/articles/teratoma 
3. Wetherell, D. (2014). Mature and immature teratoma: A review of pathological characteristics and treatment options. Medical & Surgical Urology, 03(01). https://doi.org/10.4172/2168-9857.1000124
4. Teratoma: Symptoms and causes. childrenshospital.org/conditions-and-treatments/conditions/t/teratoma/symptoms-and-causes
5. Narayanasamy, J. N., Nallusamy, M. A., & Baharuddin, N. D. (2014). Fetus-in-fetu: A pediatric rarity. Journal of Surgical Case Reports, 2014(2). https://doi.org/10.1093/jscr/rju001
6. Wesselschmidt, R. L., & Schwartz, P. H. (2011). The stem cell laboratory: Design, equipment, and oversight. In P. H. Schwartz & R. L. Wesselschmidt (Eds.), Human Pluripotent Stem Cells (Vol. 767, pp. 3–13). Humana Press. https://doi.org/10.1007/978-1-61779-201-4_1

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