Teratomas in children

What is a teratoma?

Teratomas are germ cell tumors which can consist of several types of tissue. Basically, teratomas are divided into mature and immature tumors, while immature teratomas are usually considered malignant.

What is unique about teratomas is that they can in theory contain any type of tissue in the body - including hair, cartilage or even bone as well as muscle, fat and blood vessels. This is because of the germ cells from which the tumor arises that are normally responsible for the embryological development of the tissue.

In most cases, the symptoms associated with this tumor are more due to the size of the teratoma and the displacement of the surrounding tissue. That means that the tumor itself usually causes damage only due to its size. Rarely, the teratoma may involve thyroid tissue and cause symptoms due to the production of thyroid hormones.

All in all, teratomas are a rare tumor in adults, but they are considered the most common ovarian tumor in children, more often being the mature and benign form of teratoma.

How do teratomas in children develop?

It is not yet fully understood exactly how teratomas develop. During embryonic development in humans, germ cells differentiate into the various tissue types of the body, as mentioned previously.

During this period, however, not all germ cells form tissue, some of them migrate as they are into the gonads and remain there. During the further development of the embryo, they form eggs or sperm - depending on the sex of the child.

A theory about the development of teratomas includes the idea that the germ cells, which should actually migrate to the gonads, do not fully make it to their destination and become "stuck" along the path through the body. This would help explain why teratomas may occur not only in the gonads themselves, but also along the path of this cell movement (medically known as "germ cell migration").

Furthermore, these germ cells do not seem to respond to signals from the body, ultimately leading to their random differentiation into tumor tissue.

How common are teratomas in children?

While the benign, mature form of teratoma is considered a common tumor in newborns, its incidence ranges from 1:20,000 to 1:40,000 in live births, depending on the source. The treatment is usually fairly simple, as the tumors are detected early.

New cases of teratomas in older children are quite rare and malignant, immature teratomas in particular are considered a very rare tumor in children. An additional peak in incidence is the mature teratoma in young women between the age of twenty and forty.

What are the common symptoms?

Symptoms associated with a teratoma depend greatly on the location of the tumor. As mentioned before, the symptoms are rather the result of the mass displacement that comes with the growth of the tumor and affects the surrounding tissues. Usually patients remain without symptoms for a long time and, in some cases, they never experience symptoms.

If a teratoma is found in the gonads of the patient, one of the first symptoms may be a palpable lump or swelling, specifically in the testicles. If it is located in the ovaries, the most serious scenario may be a rupture and associated pain and bleeding.

Another rare site of a teratoma is the chest, where the tumor can impair heart and lung function due to its size. Furthermore, teratomas can appear on the tailbone, where they are either noticed as a visible mass or back pain and gastrointestinal complaints.

How can a specialist diagnose a teratoma?

Often, smaller teratomas are discovered by chance during other clinical examinations. If there is a suspected tumor, a detailed physical examination is necessary first. This involves checking for visible nodules, swellings or other changes.

In most cases, further imaging procedures such as X-ray, MRI or CT scan of the affected area of the body are required to pinpoint the location of the tumor and estimate the size of the tumor.

Afterwards, a special tumor marker can be analyzed as part of a blood test, giving information about the maturity of the tumor.

A biopsy is usually also carried out to determine the exact cell content of the tumor and to confirm the diagnosis of teratoma.

How can teratomas in children be treated?

The treatment of a teratoma depends on its size and location, and on whether the affected child is experiencing symptoms.

In small asymptomatic teratomas, clinical observation is often sufficient to evaluate further growth of the tumor. In this situation, surgery is usually not necessary.

However, if a particularly large teratoma is found compressing the surrounding tissue and leading to symptoms, it usually needs to be surgically removed. Malignant teratomas usually require chemotherapy and radiotherapy to treat the tumor in addition.

How does the disease progress and what is the prognosis?

As previously mentioned, small, benign teratomas can stay completely symptom-free without any need for further medical treatment other than continuous observation. If the size of the tumor remains the same, these patients have a very good prognosis and can live a life free of symptoms.

The prognosis is usually very good also for larger, benign teratomas that have been surgically resected, unless the surrounding structures have been permanently damaged.

The prognosis for malignant teratomas is very variable and depends heavily on the size of the tumor at the time of diagnosis. Because of the few, nonspecific symptoms, such tumors are often very large by the time they are discovered and have generally begun to infiltrate the surrounding tissue. As a rule, the earlier the diagnosis and the smaller the tumor, the better the prognosis.

Which doctors & clinics specialize in teratomas in children?

Teratomas are often suspected by the pediatrician treating the child. They will then initiate further examinations and, if necessary, refer the child to other specialists.

In most cases, the treatment of the teratoma is then coordinated by specialists in pediatric oncology, who can administer chemotherapy and radiotherapy if necessary. Pediatric surgeons are generally responsible for the surgical removal of the tumor.

If you're in need of a doctor, you expect the best medical care possible. So of course patients are curious to find out what clinic to go to. As there is no objective way to answer this question and a legitimate doctor would never claim to be the best, patients must rely on a doctor's experience. Let us help you find an expert for your condition. All listed doctors and clinics have been reviewed by us for their outstanding specialization in the field of teratomas in children and are looking forward to your inquiry or wish for treatment.

Sources

• next.amboss.com/de/article/aO0QIT;

• www.ncbi.nlm.nih.gov/pmc/articles/PMC7528104/

• www.osmosis.org/answers/teratoma

• www.nicklauschildrens.org/conditions/teratoma