Teratoma (T) originates during the 3rd and 4th weeks of fetal development (2 - 4% of intracranial tumors in children). In spinal location (1:35.000 to 40.000 births) it originates from totipotential cell rests at the caudal/notochord (Hensen node). T is a heterogeneous mass containing calcifications, mixed solid and cystic components, fat-debris levels, bone, hair, teeth, or cartilage. Benign Ts (83%) rarely invade the spinal canal and show varying stages of differentiation; malignant Ts (17%) are more likely to be intrasacral with aggressive behavior. Malignant risk increases with age at diagnosis, higher surgical subtype, male gender, presence of necrosis or hemorrhage. There are high levels of AFP if the tumor contains enteric glandular elements.
CT findings: calcifications (≤ 60%), small punctate foci (well formed teeth, bones), fat (markedly hypodense).
MRI findings: T1WI - heterogeneous mixed signal intensity, fat (hyperintense), soft tissue (isointense) and calcium (markedly hypointense); STIR - depicts lobulated, sharply demarcated tumor margins; T1 + contrast - heterogeneous enhancement of solid portions.
Cytoreduction surgery + radiation. With early diagnosis, resection offers the best chance for cure.
CT findings: calcifications (≤ 60%), small punctate foci (well formed teeth, bones), fat (markedly hypodense).
MRI findings: T1WI - heterogeneous mixed signal intensity, fat (hyperintense), soft tissue (isointense) and calcium (markedly hypointense); STIR - depicts lobulated, sharply demarcated tumor margins; T1 + contrast - heterogeneous enhancement of solid portions.
Cytoreduction surgery + radiation. With early diagnosis, resection offers the best chance for cure.
References
- Ross JS, Brant-Zawadzki M, Moore KR, et al.. Diagnostic Imaging Spine. First edition - Amirsys - Elsevier Saunders - 2004.
- Diagnostic Imaging - Brain - Osborn - First edition;second printing- Amirsys - Elsevier Saunders - 2004.
