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CASE REPORT Table of Contents   
Year : 2009  |  Volume : 52  |  Issue : 2  |  Page : 234-236
Primary malignant teratoma of the thyroid in a child with nodal metastases


Department of Pathology, Cancer Institute (Wia) 38, Sardar Patel Road, Chennai-600 036, India

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   Abstract 

Malignant teratomas of the thyroid are rare tumors. We report a case of primary malignant teratoma of the thyroid in a child with lymph node metastases. Fine needle aspiration biopsy was suggestive of malignancy. Near-total thyroidectomy with right side neck dissection revealed a malignant teratoma of the thyroid with metastases in the lymph nodes. The patient is alive and in complete remission 4 years after the initial diagnosis.

Keywords: Immunohistochemistry, primitive neuroepithelium, thyroid teratoma

How to cite this article:
Majhi U. Primary malignant teratoma of the thyroid in a child with nodal metastases. Indian J Pathol Microbiol 2009;52:234-6

How to cite this URL:
Majhi U. Primary malignant teratoma of the thyroid in a child with nodal metastases. Indian J Pathol Microbiol [serial online] 2009 [cited 2020 Apr 9];52:234-6. Available from: http://www.ijpmonline.org/text.asp?2009/52/2/234/48929



   Introduction Top


Teratomas are tumors comprised of tissues derived from all the three germ cell layers: ectoderm, endoderm and mesoderm. They have been described in various sites both in adults and in children. They are more common in the ovaries, testes, sacrococcygeal region, mediastinum, pineal region, retroperitonium, central nervous system, liver, nasal sinuses, thyroid and cervical area. [1] The degree of immaturity of the tissue determines the malignant potential of the tumor. Grading criteria for ovarian tumor were accepted. [2],[3]


   Case Report Top


A 13-year-old girl presented in February 2003 with swelling in front of the lower neck of 3 months duration. On examination, an obliquely placed oval swelling was noticed in the lower neck on the anterior aspect with a smooth outer surface. It was a firm mass and moved with deglutition. It had well-defined borders. The swelling measured 4.2cm × 2cm × 3cm. No nodes were palpable.

Investigations revealed a normal chest X-ray. Thyroid studies revealed normal T3 and T4. The patient had normal serum calcium and other biochemical parameters. X-ray of the skull was normal. Ultrasonograms of the abdomen and pelvis were normal. The fine needle aspiration biopsy was reported as a malignant tumor.

A near-total thyroidectomy with right level II, III and IV nodal dissection was performed along with right pre- and paratracheal clearance. The specimen measured 7cm × 5.5cm × 3.5cm. The right lobe measured 5.5cm × 3.5cm × 3.5cm and was almost completely replaced by the tumor with a grayish white nodular cut surface. The isthmus measured 2.5cm × 0.8cm and was replaced by the tumor. The left lobe measured 3.5cm × 2cm × 1.5cm and appeared unremarkable. The lymph nodes were small and total nodes at various levels dissected were 28.

The microsections showed thyroid tissue almost replaced by a tumor except a thin rim at the periphery [Figure 1]. Certain areas showed thyroid tissue intermingled with teratoma [Figure 2]. Derivatives of all the three germ cell layers were seen with a predominantly primitive neuroepithelial component forming neuroepithelial rosettes and tubules lined by crowded basophilic cells with numerous mitoses [Figure 3]. Rosettes of the Homer-Wright type, ependymal type and ependymoblastomatous type were seen. Sheets of immature neuroblastemal elements comprising of small- to medium-sized rounded cells with dense hyperchromatic nuclei with many mitoses were seen separated by loose myxoid to fibrous immature mesenchymal stroma. Areas showed sheets of undifferentiated round cells with central necrosis. Few squamoid islands, glands of various types, mature and immature cartilage, glial tissue and immature muscle bundles were also seen.

Some of the lymph nodes showed metastatic immature teratoma [Figure 4]. One level III lymph node, one right paratracheal lymph node and four pretracheal lymph nodes showed metastatic immature teratoma (malignant) with many neuroepithelial rosettes. The level II and level V lymph nodes did not show any metastases. The total number of lymph nodes showing metastases were six out of 28 nodes.

Immunoreactivity for epithelial, neural and mesenchymal markers showed a positive reaction for the corresponding tissue types. Ependymal rosettes showed a positive reaction for keratin. Many immature elements reacted with S-100 protein, neuron-specific enolase and synaptophysin. Mature and immature cartilage showed positivity for S-100 protein. Desmin and muscle actin showed early skeletal muscle differentiation with cross striations.

As the patient had nodal metastases, she was offered adjuvant chemotherapy. The patient is alive and in complete remission for 4 years after initial diagnosis.


   Discussion Top


Teratomas are germ cell tumors comprising of all the three primitive germ cell layers. They are more frequent in the gonads, sacrococcygeal region, mediastinum, etc. and rare in the thyroid. [1],[4],[5],[7] Thyroid teratomas occur almost exclusively in children and comprise the most common extragonadal germ cell tumors. Most of them occur in infants aged less than 1 year. [8],[9] Malignant thyroid teratoma is an aggressive tumor. The outcome is dependent largely on the age of the patient, [6],[8],[10] the size of the tumor at the time of initial presentation and the proportion of immaturity. Surgical treatment is the treatment of choice. This present case is a case of immature teratoma grade III (malignant) arising from the thyroid. Six out of 28lymph nodes at various levels showed metastatic immature teratoma with numerous primitive neuroepithelial rosettes. The patient was offered adjuvant chemotherapy. She is alive and in complete remission after 4 years.

 
   References Top

1.Kingsley DP, Elton A, Bennett M. Malignant teratoma of the thyroid: Case report and review of literature. Br J Cancer 1968;22:7-11.   Back to cited text no. 1    
2. Valdiserri RO, Yunis EJ. Sacrococcygeal teratoma: A review of 68 cases. Cancer 1981;48:217-21.  Back to cited text no. 2    
3.Noris HJ, Zirkin HJ, Benson WL. Immature (malignant) teratoma of the ovary: A clinical and pathologic study of 58 cases. Cancer 1976;37:2359-72.  Back to cited text no. 3    
4.Kimler SC, Muth WF. Primary malignant teratoma of the thyroid: Case report and literature review of cervical teratomas in adults. Cancer 1978;42:311-7.  Back to cited text no. 4  [PUBMED]  
5.Thompson LD, Rosai J, Heffes CS. Primary thyroid teratoma: A clinico pathological study of 30 cases. Cancer 2000;88:1149-58.  Back to cited text no. 5    
6.Riedlinger WF, Lack EE, Robson CD, Rahbar R, Nose V. Primary thyroid teratoma in children: A report of 11 cases with a proposal of criteria for their diagnosis. Am J Surg Pathol 2005;29:700-6.  Back to cited text no. 6    
7.Kim E, Bae TS, Kwon Y, Kim TH, Chung KW, Kim SW, et al . Primary malignant teratoma with a primitive neuroectodermal component in thyroid gland: A case report. J Korean Med Sci 2007;22:568-71.   Back to cited text no. 7  [PUBMED]  [FULLTEXT]
8. Martins T, Carioho F, Gomes L, Mesquita C, MartinsMJ, Cavalheiro M. Malignant teratoma of the thyroid: Case report. Thyroid 2006;16:11-3.  Back to cited text no. 8    
9.Branzelli MC, Vanlemmens L, Lecomte-Houcke M, Demaille MC. Malignant germinal tumors of thyroid: Two cases involving immunohistochemical and ultrastructural studies. Ann Pathol 1992;12:9.  Back to cited text no. 9    
10.Craver RD, Lipscomb JT, Suskind D, Veltz MC. Malignant teratoma of the thyroid with primitive neuroepithelial and mesenchymal sarcomatous components. Ann Diagn Pathol 2001;5:285-92.  Back to cited text no. 10    

Top
Correspondence Address:
Urmila Majhi
No. 5(Old No. 3), 2nd Street, Armuganagar, Narayanpuram, P. O. - Pallikarnai, Chennai - 601 302
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.48929

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

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    Abstract
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