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Teratoma
Classification and external resources
ICD-O: 9080
DiseasesDB 3604 12952 12966
eMedicine med/3449 
MeSH D013724

A teratoma is a type of neoplasm. The International Classification of Diseases for Oncology (ICD-O is a domain specific extension of the International Statistical Classification of Diseases and Related Health Problems The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books The word teratoma comes from Greek and means roughly "monstrous tumor". Definitive diagnosis of a teratoma is based on its histology: a teratoma is a tumor with tissue or organ components resembling normal derivatives of all three germ layers. Histology (from the Greek = 'tissue' is the study of the microscopic anatomy of cells and tissues of Plants and Tissue is a cellular organizational level intermediate between cells and a complete organism In Biology, an organ ( Latin: organum, "instrument tool" from Greek όργανον - organon "organ instrument A germ layer is a collection of cells formed during animal Embryogenesis. Rarely, not all three germ layers are identifiable. The tissues of a teratoma, although normal in themselves, may be quite different from surrounding tissues, and may be highly inappropriate, even grotesque (hence the monstrous): teratomas have been reported to contain hair, teeth, bone and very rarely more complex organs such as eyeball, torso, and hand. Hair is a keratinised protein filament that grows through the epidermis from follicles deep within the Dermis. Bones are rigid organs that form part of the Endoskeleton of Vertebrates They function to move support and protect the various organs of the body produce Eyes are organs that detect Light, and send signals along the Optic nerve to the visual areas of the brain Torso is an anatomical term for the central part of the many animal bodies (including that of the human from which extend the neck and limbs The hands ( med / lat: manus pl manūs are the two intricate prehensile multi- Fingered body parts normally located at the end of each arm of a Usually, however, a teratoma will contain no organs but rather one or more tissues normally found in organs such as the brain, thyroid, liver, and lung. The brain is the center of the Nervous system in animals All Vertebrates and the majority of Invertebrates have a brain The thyroid is one of the largest Endocrine glands in the body The liver is a vital organ in the human body and is present in Vertebrates and some other animals lung is the essential Respiration organ in air-breathing Animals including most Tetrapods a few Fish and a few Snails The most primitive

Teratomas are thought to be present at birth, but often they are not diagnosed until much later in life.

Contents

Natural history

Main article: Germ cell tumor

Teratomas belong to a class of tumors known as nonseminomatous germ cell tumor (NSGCT). A germ cell tumor ( GCT) is a Neoplasm derived from Germ cells Germ cells normally occur inside the gonads ( Ovary and Testis) A germ cell tumor ( GCT) is a Neoplasm derived from Germ cells Germ cells normally occur inside the gonads ( Ovary and Testis) A germ cell tumor ( GCT) is a Neoplasm derived from Germ cells Germ cells normally occur inside the gonads ( Ovary and Testis) All tumors of this class are the result of abnormal development of pluripotent cells: germ cells and embryonal cells. Pluripotency in the broad sense refers to "having more than one potential outcome Germ cells are progenitors of the Gametes. These singled out cells move through the gut to the developing Gonads and undergo mitotic proliferation followed An embryo (from Greek:, plural, lit "that which grows" from en- "in" + bryein "to swell be full" is a multicellular Teratomas of embryonal origin are congenital; teratomas of germ cell origin may or may not be congenital (this is not known). A congenital disorder is a disease or disorder that is present at birth The kind of pluripotent cell appears to be unimportant, apart from constraining the location of the teratoma in the body.

Location and incidence

Teratomas derived from germ cells occur in the testes in males and ovaries in females. The testicle (from Latin testiculus, diminutive of testis, meaning "witness" virility plural testes) is the male "Ovaria" redirects here This is also a proposed section and a Synonym of Solanum. Teratomas derived from embryonal cells usually occur on the body midline: in the brain, elsewhere inside the skull, in the nose, in the tongue, under the tongue, and in the neck (cervical teratoma), mediastinum, retroperitoneum, and attached to the coccyx. The neck is the part of the Body on many limbed Vertebrates that distinguishes the head from the Torso or trunk The mediastinum is a non-delineated group of structures in the Thorax (chest surrounded by Loose connective tissue. The retroperitoneum (adj retroperitoneal) is the anatomical space in the Abdominal cavity behind ( retro) the Peritoneum. The coccyx (pronounced kok -siks (Latin os coccygis) commonly referred to as the tailbone, is the final segment of the human vertebral column However, teratomas may also occur elsewhere: very rarely in solid organs (most notably the heart and liver) and hollow organs (such as the stomach and bladder), and more commonly on the skull sutures. This article is about joints in the bones of the cranium There is also an article about sutures as features of a wide range of animals. Embryonal teratomas most commonly occur in the sacrococcygeal region: sacrococcygeal teratoma is the single most common tumor found in newborn babies. See also Teratoma Sacrococcygeal teratoma (SCT is a Teratoma (a kind of tumor located at the base of the Coccyx (tailbone

Of teratomas on the skull sutures, approximately 50% are found in or adjacent to the orbit[1]. In Anatomy, the orbital bone is the cavity or socket of the Skull in which the Eye and its appendages are situated Limbal dermoid is a choristoma, not a teratoma.

Teratoma qualifies as a rare disease, but is not extremely rare. A rare disease (sometimes known as an orphan disease has such a low Prevalence in a population that a doctor in a busy General practice would not Sacrococcygeal teratoma alone is diagnosed at birth in 1 out of 40,000 babies. Given the current world population birth rate, this equals 5 per day or 1800 per year. The world population is the total number of living Humans on Earth at a given time Crude birth rate is the natality or Childbirths per 1000 people per year Add to that number sacrococcygeal teratomas diagnosed later in life, and teratomas in other locations, and the incidence approaches 10,000 new diagnoses of teratoma per year. Incidence is a measure of the risk of developing some new condition within a specified period of time

Hypotheses of origin

Concerning the origin of teratomas, there exist numerous hypotheses. [2] These hypotheses are not to be confused with the unrelated hypothesis that fetus in fetu (see below) is not a teratoma at all but rather a parasitic twin. Fetus in fetu (or fœtus in fœtu) is a Developmental abnormality in which a Fetus gets enveloped inside its Twin and an entire living A parasitic twin (also known as an asymmetrical or unequal conjoined twin) is the result of the processes that produce Vanishing twins and Conjoined

Dermoid cyst

A small (4 cm) dermoid cyst of an ovary, discovered during a C-section
A small (4 cm) dermoid cyst of an ovary, discovered during a C-section

A dermoid cyst is a mature cystic teratoma containing hair (sometimes very abundant) and other structures characteristic of normal skin and other tissues derived from the ectoderm. A Caesarean section (or Cesarean section in American English) also known as C-section, is a form of Childbirth in which a surgical See also Teratoma A dermoid cyst is a Cystic Teratoma that contains developmentally mature Skin complete with Hair follicles The ectoderm is the start of a tissue that covers the body surfaces The term is most often applied to teratoma on the skull sutures and in the ovaries of females.

Fetus in fetu and fetiform teratoma

Fetus in fetu and fetiform teratoma are rare forms of mature teratoma that include one or more components resembling a malformed fetus. Both forms may contain or appear to contain complete organ systems, even major body parts such as torso or limbs. Fetus in fetu differs from fetiform teratoma in having an apparent spine and bilateral symmetry. In Human anatomy, the vertebral column ( backbone or spine) is a column of 34 Vertebrae the Sacrum, Intervertebral "Bilateral symmetry" redirects here For bilateral symmetry in mathematics see Reflection symmetry. [2]

Most authorities agree that fetiform teratomas are highly developed mature teratomas; the natural history of fetus in fetu, however, is controversial. [2] There also may be a cultural difference, with fetiform teratoma being reported more often in ovarian teratomas (by gynecologists) and fetus in fetu being reported more often in retroperitoneal teratomas (by general surgeons). Fetus in fetu has often been interpreted as a fetus growing within its twin. Fetus in fetu (or fœtus in fœtu) is a Developmental abnormality in which a Fetus gets enveloped inside its Twin and an entire living A fetus (or foetus or fœtus) is a developing Mammal or other Viviparous Vertebrate, after the Embryonic stage and Twins are Offspring resulting from the same Pregnancy, either of the same or opposite Sex. As such, this interpretation assumes a special complication of twinning, one of several grouped under the term parasitic twin. Twins are Offspring resulting from the same Pregnancy, either of the same or opposite Sex. A parasitic twin (also known as an asymmetrical or unequal conjoined twin) is the result of the processes that produce Vanishing twins and Conjoined In this regard, it is noteworthy that in many cases the fetus in fetu is reported to occupy a fluid-filled cyst within a mature teratoma. [3][4][5] Cysts within mature teratoma have also been reported to contain a rudimentary beating heart. [6]

Regardless of whether fetus in fetu and fetiform teratoma are one entity or two, they are distinct from and not to be confused with ectopic pregnancy. An ectopic pregnancy is a Complication of pregnancy in which the fertilized Ovum is implanted in any tissue other than the uterine wall

Struma ovarii

A struma ovarii (literally: goitre of the ovary) is a rare form of mature teratoma that contains mostly thyroid tissue. A goitre ( BrE) or goiter ( AmE) ( Latin struma) also called a bronchocele, is a swelling in the neck (just below the The thyroid is one of the largest Endocrine glands in the body Despite its name, struma ovarii is not restricted to the ovary. Only 5% of struma ovarii are malignant.

Pathology classification of individual teratomas

Regardless of location in the body, a teratoma is classified according to a cancer staging system. The stage of a cancer is a descriptor (usually numbers I to IV of how much the Cancer has spread This indicates whether chemotherapy or radiation therapy may be needed in addition to surgery. Chemotherapy, in its most general sense refers to treatment of disease by chemicals that kill cells specifically those of micro-organisms or Cancer. Radiation therapy (or radiotherapy) is the medical use of Ionizing radiation as part of Cancer treatment to control Malignant Teratomas commonly are classified using the Gonzalez-Crussi[2] grading system: 0 or mature (benign); 1 or immature, probably benign; 2 or immature, possibly malignant (cancerous); and 3 or frankly malignant. Malignant (from the Latin roots mal- = "bad" and -genus = "born" is a medical term used to describe a severe and progressively worsening disease Cancer (medical term Malignant Neoplasm) is a class of Diseases in which a group of cells display uncontrolled If frankly malignant, the tumor is a cancer for which additional cancer staging applies. Cancer (medical term Malignant Neoplasm) is a class of Diseases in which a group of cells display uncontrolled The stage of a cancer is a descriptor (usually numbers I to IV of how much the Cancer has spread

Teratomas are also classified by their content: a solid teratoma contains only tissues (perhaps including more complex structures); a cystic teratoma contain only pockets of fluid or semi-fluid such as cerebrospinal fluid, sebum, or fat; a mixed teratoma contains both solid and cystic parts. Cerebrospinal fluid ( CSF) Liquor cerebrospinalis, is a clear Bodily fluid that occupies the Subarachnoid space and the Ventricular system The sebaceous glands are Glands found in the Skin of Mammals Locations and morphology A branched type of Acinar gland, these Cystic teratomas usually are grade 0 and, conversely, grade 0 teratomas usually are cystic.

Grade 0, 1 and 2 pure teratomas have the potential to become malignant (grade 3), and malignant pure teratomas have the potential to metastasize. Metastasis ( Greek: displacement μετά=next + στάσις=placement, plural metastases) sometimes abbreviated mets, These rare forms of teratoma with malignant transformation may contain elements of somatic (non germ cell) malignancy such as leukemia, carcinoma or sarcoma. Leukemia or leukaemia (Greek leukos λευκός, "white" aima αίμα, "blood" is a Cancer of the Blood A carcinoma is any Malignant Cancer that arises from epithelial cells. A sarcoma (from the Greek 'sarx' meaning "flesh" is a Cancer of the connective or supportive tissue ( Bone, Cartilage, Fat [7] A teratoma may contain elements of other germ cell tumors, in which case it is not a pure teratoma but rather is a mixed germ cell tumor and is malignant. A germ cell tumor ( GCT) is a Neoplasm derived from Germ cells Germ cells normally occur inside the gonads ( Ovary and Testis) In infants and young children, these elements usually are endodermal sinus tumor, followed by choriocarcinoma. Endodermal sinus tumor ( EST) also known as Yolk sac tumor ( YST) is a member of the Germ cell tumor group of Cancers Choriocarcinoma is a malignant and aggressive Cancer, usually of the Placenta. Finally, a teratoma can be pure and not malignant yet highly aggressive: this is exemplified by growing teratoma syndrome, in which chemotherapy eliminates the malignant elements of a mixed tumor, leaving pure teratoma which paradoxically begins to grow very rapidly.

"Benign" teratoma may prove to be malignant

A "benign" grade 0 (mature) teratoma nonetheless has a risk of malignancy. Recurrence with malignant endodermal sinus tumor has been reported in cases of formerly benign mature teratoma,[8][9] even in fetiform teratoma and fetus in fetu. Endodermal sinus tumor ( EST) also known as Yolk sac tumor ( YST) is a member of the Germ cell tumor group of Cancers [10][11] A grade 1 immature teratoma that appears to be benign (e. g. , because AFP is not elevated) has a much higher risk of malignancy, and requires adequate follow-up. [12][13][14][15]

Teratoma with malignant transformation

A teratoma with malignant transformation or TMT is a very rare form of teratoma that may contain elements of somatic (non germ cell) malignant tumors such as leukemia, carcinoma or sarcoma. Leukemia or leukaemia (Greek leukos λευκός, "white" aima αίμα, "blood" is a Cancer of the Blood A carcinoma is any Malignant Cancer that arises from epithelial cells. A sarcoma (from the Greek 'sarx' meaning "flesh" is a Cancer of the connective or supportive tissue ( Bone, Cartilage, Fat [7] Of 641 children with pure teratoma, 9 developed TMT[16]: 5 carcinoma, 2 glioma, and 2 embryonal (here, these last are classified among germ cell tumors). A carcinoma is any Malignant Cancer that arises from epithelial cells. A glioma is a type of Cancer that starts in the brain or spine

Extraspinal ependymoma

Extraspinal ependymoma, usually considered to be a glioma (a type of non-germ cell tumor), may be an unusual form of mature teratoma. Ependymoma is a Tumor that arises from the Ependyma, a tissue of the Central nervous system. A glioma is a type of Cancer that starts in the brain or spine [17]

Initial diagnosis

Teratomas are thought to be present since birth, or even before birth, and therefore can be considered congenital tumors. A congenital disorder is a disease or disorder that is present at birth However, many teratomas are not diagnosed until much later in childhood or in adulthood. Large tumors are more likely to be diagnosed early on. Sacrococcygeal and cervical teratomas are often detected by prenatal ultrasound. Not to be confused with Supersonic. Ultrasound is cyclic Sound pressure with a Frequency greater than the upper Additional diagnostic methods may include prenatal MRI. In rare circumstances, the tumor is so large that the fetus may be damaged or die. A fetus (or foetus or fœtus) is a developing Mammal or other Viviparous Vertebrate, after the Embryonic stage and In the case of large sacrococcygeal teratomas, a significant portion of the fetus' blood flow is redirected toward the teratoma (a phenomenon called steal syndrome), causing heart failure, or hydrops, of the fetus. Blood flow is the flow of Blood in the Cardiovascular system. Heart failure is a Cardiac condition that occurs when a problem with the structure or function of the Heart impairs its ability to supply Hydrops fetalis is a condition in the Fetus characterized by an accumulation of fluid or Edema, in at least two fetal compartments including the subcutaneous tissue In certain cases, fetal surgery may be indicated. Open fetal surgery is an invasive form of Fetal intervention in the treatment of Birth defects where the pregnant Uterus is opened up for direct surgery

Beyond the newborn period, symptoms of a teratoma depend on its location and organ of origin. Ovarian teratomas often present with abdominal or pelvic pain, caused by torsion of the ovary or irritation of its ligaments. "Ovaria" redirects here This is also a proposed section and a Synonym of Solanum. Women and chronic pelvic pain Most women at some time in their lives experience pelvic pain The term torsion may refer the following In geometry Torsion of curves Torsion tensor in differential geometry "Ovaria" redirects here This is also a proposed section and a Synonym of Solanum. Testicular teratomas present as a palpable mass in the testis; mediastinal teratomas often cause compression of the lungs or the airways and may present with chest pain and/or respiratory symptoms. The testicle (from Latin testiculus, diminutive of testis, meaning "witness" virility plural testes) is the male The mediastinum is a non-delineated group of structures in the Thorax (chest surrounded by Loose connective tissue. In Medicine, chest pain is a Symptom of a number of serious conditions and is generally considered a Medical emergency.

Some teratomas contain yolk sac elements, which secrete alpha-fetoprotein (AFP). The yolk sac is the first element seen in the Gestational sac during Pregnancy, usually at 5 weeks Gestation. Alpha-fetoprotein ( AFP) is a molecule produced in the developing Embryo Detection of AFP may help to confirm the diagnosis and is often used as a marker for recurrence or treatment efficacy, but is rarely the method of initial diagnosis. (Maternal serum alpha-fetoprotein, or MSAFP, is a useful screening test for other fetal conditions, including Down syndrome, spina bifida and abdominal wall defects such as gastroschisis). Alpha-fetoprotein ( AFP) is a molecule produced in the developing Embryo Screening, in medicine is a strategy used in a Population to detect a Disease in individuals without signs or Symptoms of that disease Down syndrome, Down's syndrome, or trisomy 21 is a Chromosomal disorder caused by the presence of all or part of an extra 21st chromosome. Spina bifida ( Latin: "split spine" is a developmental Birth defect involving the Neural tube: incomplete closure of the Embryonic neural The abdominal wall represents the boundaries of the Abdominal cavity. Gastroschisis (also called paraomphalocele, laparoschisis or abdominoschisis) is a type of inherited Congenital Abdominal wall defect

Time of Presentation

Teratomas of germ cell origin usually are found (i. e. , present) in adult men and women, but they may also be found in children and infants. Teratomas of embryonal origin are most often found in babies at birth, in young children, and, since the advent of ultrasound imaging, in fetuses.

The most commonly diagnosed fetal teratomas are sacrococcygeal teratoma (Altman types I, II, and III) and cervical (neck) teratoma. See also Teratoma Sacrococcygeal teratoma (SCT is a Teratoma (a kind of tumor located at the base of the Coccyx (tailbone Because these teratomas project from the fetal body into the surrounding amniotic fluid, they can be seen during routine prenatal ultrasound exams. The amniotic sac is the sac in which the Fetus develops Some sources consider it to be equivalent to the Amnion. Teratomas within the fetal body are less easily seen with ultrasound; for these, MRI of the pregnant uterus is more informative. [18][19]

Complications

Teratomas are not dangerous for the fetus unless there is either a mass effect or a large amount of blood flow through the tumor (known as vascular steal). In Medicine, a mass effect is the effect of a growing mass (or Tumor in its narrow meaning for example the consequences of a growing Cancer. The mass effect frequently consists of obstruction of normal passage of fluids from surrounding organs. The vascular steal can place a strain on the growing heart of the fetus, even resulting in heart failure, and thus must be monitored by fetal echocardiography. An echocardiogram is a Sonography of the Heart. Also known as a cardiac ultrasound it uses standard ultrasound techniques to image two-dimensional slices of

After surgery, there is a risk of regrowth in place, or in nearby organs. [20]

Treatment

Surgery

The treatment of choice is complete surgical removal (i. e. , complete resection). [21][22] Teratomas normally are well encapsulated and non-invasive of surrounding tissues, hence they are relatively easy to resect from surrounding tissues. Exceptions include teratomas in the brain, and very large, complex teratomas that have pushed into and become interlaced with adjacent muscles and other structures.

Prevention of recurrence does not require en bloc resection of surrounding tissues.

Chemotherapy

For malignant teratomas, usually, surgery is followed by chemotherapy.

Teratomas that are in surgically inaccessible locations, or are very complex, or are likely to be malignant (due to late discovery and/or treatment) sometimes are treated first with chemotherapy.

Clinical trials

As of 2007, there have been two clinical trials in progress that address germ cell tumors, both of which include teratomas. In health care clinical trials are conducted to allow safety and Efficacy data to be collected for new drugs or devices A germ cell tumor ( GCT) is a Neoplasm derived from Germ cells Germ cells normally occur inside the gonads ( Ovary and Testis) [23][24]

Follow-up

Depending on which tissue(s) it contains, a teratoma may secrete a variety of chemicals with systemic effects. Some teratomas secrete the "pregnancy hormone" human chorionic gonadotropin (βhCG), which can be used in clinical practice to monitor the successful treatment or relapse in patients with a known HCG-secreting teratoma. Human chorionic gonadotropin ( hCG) is a Glycoprotein Hormone produced in Pregnancy that is made by the Embryo soon after conception This hormone is not recommended as a diagnostic marker, because most teratomas do not secrete it. Some teratomas secrete thyroxine, in some cases to such a degree that it can lead to clinical hyperthyroidism in the patient. Thyroxine, or 353'5'-tetra­iodothyronine (often abbreviated as T4) a form of Thyroid hormones is the major Hormone secreted by the Hyperthyroidism is the term for overactive tissue within the Thyroid gland resulting in overproduction and thus an excess of circulating free thyroid hormones Thyroxine Of special concern is the secretion of alpha-fetoprotein (AFP); under some circumstances AFP can be used as a diagnostic marker specific for the presence of yolk sac cells within the teratoma. Alpha-fetoprotein ( AFP) is a molecule produced in the developing Embryo The yolk sac is the first element seen in the Gestational sac during Pregnancy, usually at 5 weeks Gestation. These cells can develop into a frankly malignant tumor known as yolk sac tumor or endodermal sinus tumor. Endodermal sinus tumor ( EST) also known as Yolk sac tumor ( YST) is a member of the Germ cell tumor group of Cancers Endodermal sinus tumor ( EST) also known as Yolk sac tumor ( YST) is a member of the Germ cell tumor group of Cancers

Adequate follow-up requires close observation, involving repeated physical examination, scanning (ultrasound, MRI, or CT), and measurement of AFP and/or βhCG. [25][26]

Use in basic research

In light of the ethical issues surrounding the source of human stem cells, teratomas are being looked at as an alternative source for research since they lack the potential to grow into functional human beings. Stem cell controversy is the ethical debate centered on research involving the creation usage and destruction of Human embryonic stem cells Some opponents of the research argue

See also

Tumor pages for locations in which teratoma can occur:

Other conditions that may resemble a teratoma:


References

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  2. ^ a b c d Gonzalez-Crussi, F. A brain tumor is any intracranial Tumor created by abnormal and uncontrolled cell division, normally either in the Brain itself ( Neurons Oral cancer is any cancerous tissue growth located in the Mouth. The term head and neck cancer refers to a group of biologically similar cancers originating from the upper aerodigestive tract including the Lip, Oral cavity ( Masses in the anterior portion of the mediastinum can include Thymoma, Lymphoma, Pheochromocytoma and Germ cell tumors including In Oncology, small intestine cancer, also small bowel cancer and cancer of the small bowel, is a Cancer of the Small intestine. See also Teratoma Sacrococcygeal teratoma (SCT is a Teratoma (a kind of tumor located at the base of the Coccyx (tailbone Ovarian cancer is a cancerous growth arising from an Ovary. The cancer most commonly forms in the lining of the ovary (resulting in epithelial Testicular cancer is Cancer that develops in the Testicles a part of the Male reproductive system A pilonidal cyst, also referred as sacrococcygeal fistula, is a Cyst near the Natal cleft of the buttocks that often contains hair and skin debris Dermoid sinus is a genetic autosomal skin condition in Dogs It is also known (apparently incorrectly as pilonidal sinus because it resembles Pilonidal sinus (1982) Extragonadal Teratomas. Atlas of Tumor Pathology, Second Series, Fascicle 18. Armed Forces Institute of Pathology, Washington D. The Armed Forces Institute of Pathology (AFIP is a US government institution concerned with diagnostic consultation education and research C.
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  23. ^ GCT1P1 Protocol / Clinical Study: Pilot study of Cisplatin, Etoposide, Bleomycin and Escalating Dose Cyclophosphamide Therapy for Children with High-Risk Malignant Germ Cell Tumors
  24. ^ GCT132 Protocol / Clinical Study: A Phase III Study of Reduced Therapy in the Treatment of Children with Low and Intermediate Risk Extracranial Germ Cell Tumors (AGCT0132)
  25. ^ Marina NM, Cushing B, Giller R, Cohen L, Lauer SJ, Ablin A, Weetman R, Cullen J, Rogers P, Vinocur C, Stolar C, Rescorla F, Hawkins E, Heifetz S, Rao PV, Krailo M, Castleberry RP (1999). "Complete surgical excision is effective treatment for children with immature teratomas with or without malignant elements: A Pediatric Oncology Group/Children's Cancer Group Intergroup Study. ". J. Clin. Oncol. 17 (7): 2137-43. PMID 10561269.  
  26. ^ Cushing B, Giller R, Ablin A, Cohen L, Cullen J, Hawkins E, Heifetz SA, Krailo M, Lauer SJ, Marina N, Rao PV, Rescorla F, Vinocur CD, Weetman RM, Castleberry RP (1999). "Surgical resection alone is effective treatment for ovarian immature teratoma in children and adolescents: a report of the pediatric oncology group and the children's cancer group. ". Am. J. Obstet. Gynecol. 181 (2): 353-8. doi:10.1016/S0002-9378(99)70561-2. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 10454682.  

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Technical information

Dictionary

teratoma

-noun

  1. (pathology) A benign or malignant tumour, especially of the gonads, that arises from germ cells and consists of different types of tissue such as skin, hair, or muscle.
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