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Large Immature Intracranial Teratoma in an Infant: A Case Report
Ajf Da Silva1,2, Carolina Martins Lessa Barreto3, Laís Lopes Melo Kummer3
1Pediatric Neurosurgery Division, Santa Mônica Maternity School, Alagoas State University of Health Sciences, Maceió, BRA.
Insights
This case report details a rare, aggressive intracranial immature teratoma in an infant. Despite surgical intervention, the infant experienced complications and succumbed to the rapidly growing tumor.
Area of Science:
- Neuro-oncology
- Pediatric Pathology
- Developmental Biology
Background:
- Intracranial immature teratomas are rare, aggressive germ cell tumors with poor prognoses.
- These tumors exhibit rapid growth and malignant potential, particularly in infants.
- Understanding their embryological origins is crucial for diagnosis and treatment.
Observation:
- A two-month-old infant presented with drowsiness and seizures, indicative of a neurological emergency.
- CT and MRI revealed a large, expansive intracranial mass causing hydrocephalus and brainstem compression.
- Histopathological and immunohistochemical analyses confirmed the diagnosis of immature teratoma.
Findings:
- The infant's tumor was characterized by undifferentiated embryonic tissues, correlating with a poor prognosis.
- Post-operative complications, including status epilepticus and metabolic derangements, arose due to tumor aggressiveness.
- The infant unfortunately died following partial tumor resection.
Implications:
- This case highlights the challenges in managing bulky intracranial immature teratomas in infants.
- Surgical approach decisions are complex due to tumor size and location.
- Early diagnosis and aggressive management strategies are critical for improving outcomes in pediatric germ cell tumors.
Abstract:
Intracranial immature teratomas are rare, highly malignant, and fast-growing with a poor prognosis. We report the case of an infant with a large immature teratoma in the intracranial compartment. A two-month-old child presented to the emergency room with drowsiness and seizures. CT and cranial MRI showed hydrocephalus with a large expansive process in the right cerebral hemisphere extending to the infratentorial compartment, compressing the cerebellum and brainstem. It was then decided to partially resect the lesion. Postoperatively, due to the aggressiveness of the residual tumor, the patient developed complications (status epilepticus, hyperthermia, and electrolyte disorders) and died. Histopathological and immunohistochemical studies confirmed an immature teratoma. Teratomas are a subtype of germ cell tumors. Immature teratomas contain a population of cells that retain embryonic characteristics and tissues with more primitive components derived from all or some of the three germ layers (ectoderm, mesoderm, and endoderm). The prognosis of immature teratomas is associated with the degree of tumor differentiation, and those composed of undifferentiated embryonic tissues have a poor prognosis. This case report illustrates the rare and severe occurrence of a bulky immature cerebral teratoma in an infant. Unfortunately, despite undergoing a planned partial resection, the infant ended up having complications and died. Therefore, due to the size of the lesion in an infant, these cases are always complex when deciding on a surgical approach.
