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To receive news and publication updates for Case Reports in Neurological Medicine, enter your email address Mature no 640 the box below. This is an open access article distributed under the Creative Commons Attribution Licensewhich permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Intracranial germ cell tumors are uncommon and account for only 0. Teratomas are a subset of these neoplasms, and their finding in brain structures is exceptionally rare, and occurrence within the skull base is quite novel.

Imaging revealed a large Mature no 640 mass with suprasellar extension, involvement of the ventricular system, and marked hydrocephalus with the enlargement of the lateral and third ventricles. Postoperative histological examination of the resected mass was confirmatory for a mature cystic teratoma.

This was followed by radiotherapy, stereotactic radiosurgery, and adjuvant radiotherapy. At the most recent followup, approximately 4 years later, the patient is doing well with improved vision since the operation.

This report highlights our experience with a teratoma in a very unusual location, and we review the relevant literature. Intracranial germ cell tumors of the central nervous system are rare and usually occur in the midline of the brain, particularly at the pineal region and neurohypophysis [ 12 ].

While mixed Mature no 640 are common, multiple types have been described with varying malignant behavior. Specifically, teratomas have been designated as benign tumors that contain representative components of all three germinal layers [ 3 ]. Teratomas comprise only 0. One study found the age range for central nervous teratomas to be from 16 to 45 years, with the mean age being Common presenting symptoms of intracranial teratomas may include signs of raised intracranial Mature no 640, visual disturbance, polydipsia, and polyuria [ 24 ].

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Treatment protocols for malignant intracranial mature nongerminomatous germ cell tumor in adults have been adapted from strategies used in the pediatric population [ 5 ]. When imaging studies and CSF analysis are inconclusive, stereotactic or incisional biopsies provide Mature no 640 diagnosis by providing a histopathological sample [ 5 ].

Gross total resection may confer a survival benefit and prevent the development of more serious clinical complications [ 5 ], with the intracranial location of the tumor deciding the surgical approach [ 4 ]. We report on a rare case of a skull-base teratoma with suprasellar extension.

The patient is a year-old man who presented in July with decreased vision bilaterally, left sided facial weakness, ataxia, and short-term memory loss. The patient had also presented previously with a history of seizures, most recently a few months prior to the current presentation. A craniopharyngioma or another parasellar mass was suspected, and an ophthalmology consult was obtained. MRI showed a large intrasellar mass with considerable suprasellar extension and chiasmatic compression with the displacement of Mature no 640 inferior frontal lobe.

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There was also hydrocephalus with gross enlargement of the lateral and third Mature no 640 Figure 1. CSF analysis identified no malignant cells. The patient was determined to be an excellent candidate for surgery, the only other comorbidity being glaucoma treated with Lumigon.

After placement of a ventriculostomy catheter, the major part of the craniotomy followed.

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The first line of incision was made in a curvilinear fashion Mature no 640 began at the area 1 centimeter anterior to the tragus of the ear near the root of the zygoma. It curved superiorly up around the temporal bone and parietal bone and then extended toward the midline frontal bone.

Dissection proceeded to expose the appropriate amount of cranial anatomy. The tumor was eventually exposed by opening up the sylvian fissure to separate the frontal lobe from the temporal lobe. The tumor was noted to have both cystic and solid components.

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Fluid aspirated from the cystic component was thick and yellow, with the appearance of oil or cholesterol. There were odd appearing components to the tumor, including what appeared to be yellow clumps of hair embedded within fatty deposits. There were Mature no 640 several firm calcified structures that appeared to be compressing the left optic nerve.

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The optic nerve itself appeared Mature no 640 be blanched in color without a very good blood supply. There were several firm calcified deposits of tumor that were tightly adhered to the optic chiasm, right carotid artery, and cranial nerve III complex. Though these were tightly adhered and it was decided to be too dangerous to completely resect, the high quality of decompression performed made Mature no 640 so that it was not felt that complete removal of these structures was clinically indicated.

Specimens taken during the operation were sent to pathology and revealed portions of skin with skin appendages, innumerable hairs, and keratinous debris Figure 2.

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Fluid from the cystic component demonstrated a homogenous, yellow gelatinous appearance no gross identifiable solid tissue.

Another component of the specimen obtained was a tan-brown, granular appearing tissue with mixtures of curd-like material. No immature tissue component was identified.

The mass was identified to be the most consistent with a suprasellar mature cystic teratoma. Upon closure of the procedure, there appeared to be no complications, and postoperative condition was deemed stable. Due to incomplete resection of tumor and risk of recurrence, external beam radiotherapy and eventually stereotactic radiosurgery were used as well as postoperative adjuvant therapy.

The patient had a seemingly uncomplicated subsequent recovery and was discharged home. Though over the next month he had a slowly progressive decline in mental status and was admitted for observation. He was discharged soon after following close monitoring and recovery of his status.

Since then, he has been watched carefully with frequent clinic appointments and imaging studies. At the most recent followup, approximately 4 years later, he is doing well with significantly improved neurological status and vision.

Mature no 640 teratomas are well-differentiated tumors that are usually lobulated and often firmly adhere to neighboring structures [ 2 ]. They contain fully mature tissues of ectodermal, mesodermal, and endodermal origins [ 2 ]. Microscopically, Mature no 640 tend to consist of solid and cystic components of squamous epithelium with keratin debris [ 2 ]. Components of mature teratomas reported in previous case reports are diverse and include immature mesenchymal tissue, cuboidal and columnar epithelium with goblet cells, islands of immature cartilage, bands of striated and nonstriated muscles, glioneuronal tissue, retinal tissue, and adipose tissue [ 2 ].

CT and MRI are helpful Mature no 640 estimate the nature of the lesion and may show Mature no 640 of mixed density that include fat and soft tissue, cartilage, and calcified tissues such as bone and teeth [ 2 ].

Here, the authors report the case of a year-old male patient with a skull-base teratoma who had presented with vision changes, incontinence, Mature no 640, and altered mental status. While CT showed hydrocephalus without other changes from prior films, MRI revealed a large intrasellar mass with suprasellar extension, involvement of the ventricular system, and marked hydrocephalus with the enlargement of the lateral and third ventricles.

Postoperative examination of the resected mass revealed a mature cystic teratoma, or dermoid cyst. Intracranial germ cell tumors are rare comprising about 0.

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Mature no 640 The prevalence is much higher in the earlier decades of life [ 6 ], with one peak in the neonatal and infancy period and another peak in children ages of 5—14 [ 7 ]. Overall, these tumors appear to be more common in men, with a finding of However, despite a clear preponderance of the more common pineal region tumors for male patients, suprasellar neurohypophysis region tumors may be more common in women [ 7 ].

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While germ cell tumors are often mixed in type, five distinct types have been Mature no 640 The majority of adult germ cell tumors are germinomas of the testes [ 811 ]. Teratomas are a type of germ cell tumors containing tissue elements of each of the three germ cell layers: They have been further classified as mature, immature, or malignant [ 411 ]. Cranio-spinal axis teratomas are uncommon, and they have been Mature no 640 only in case reports and a rare case series [ 413 ].

Most intracranial germ cell tumors arise from midline structures, with the pineal gland being the most common, followed by the suprasellar compartment [ 1 ]. Germinomas are the most common germ cell tumors in these locations, and it has been suggested that the primary site of suprasellar germinomas is the neurohypophysis [ 114 ].

Thus, Mature no 640 find a teratoma in the intra- and suprasellar region of a year-old male to be particularly rare. Clinical and radiographic findings can make it difficult to distinguish a mature teratoma from a craniopharyngioma [ 6 ]. In this case, craniopharyngioma was suspected prior to histological examination of the Mature no 640 tumor due to the age of the patient, presenting symptoms, and imaging studies.

They often occur in the hypothalamic-pituitary region, and while they are especially common in the first two decades of life, they do have a second prevalence peak in the seventh and eighth decades [ 615 ]. Craniopharyngiomas typically show calcification on CT; however, mature teratomas can differentiate into a cartilaginous tissue, which is hyperdense and can mimic calcification. Therefore, our case highlights the importance of obtaining a histological diagnosis to differentiate teratomas from other lesions.

The typical treatment for mature teratomas is surgical resection, which was successfully done in this case. The deterioration of the patient after a period of improvement in mental status and ambulation may be due to hydrocephalus or due to chemical encephalitis from by-products of the tumor.

However, a phenomenon of tumor recurrence has been reported, referred Mature no 640 as the growing teratoma syndrome [ 512 ].

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This refers to a relapse following a partial response to therapy with a tumor that is often cystic and has elements of a mature teratoma, [ 516 ]. In this syndrome, the recurrent tumor is presumed to be refractory to chemotherapy or radiation [ 5 ]. This syndrome, however, generally refers to those who had a previous malignant tumor. Suprasellar mature teratomas Mature no 640 exceptionally rare. However, because they mimic many other lesions, it is important to recognize this entity in the differential diagnosis and to obtain a thorough histological diagnosis.

A multimodal approach for treatment is recommended with complete Mature no 640 resection, radiotherapy, and chemotherapy. Future reports on this rare location for a teratoma can help ascertain long-term outcomes.

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Abstract Intracranial germ cell tumors are uncommon and account for only 0. Introduction Intracranial germ cell tumors of the central nervous system are rare and usually occur in the midline of the brain, particularly at the pineal region and neurohypophysis [ 12 ].

History The patient is a year-old man who presented in July with decreased vision bilaterally, left sided facial weakness, ataxia, and short-term memory loss. Imaging and Laboratory Studies MRI showed a large intrasellar mass with considerable suprasellar extension and chiasmatic compression with the displacement of the inferior Mature no 640 lobe.

Nov-Dec;2(6) doi: /wsbm The mammalian blood system, containing more than 10 distinct mature cell types, stands on one specific cell type Self-renewal is the ability to give rise to Mature no 640 itself without differentiation.

The main causes of failure in a mature hemodialysis AV fistula are vascular stenotic lesions. In addition, it is not surprising that AV fistulas requiring intervention prior to maturation are more. Ann Vasc Surg ; Grown-ups may still have immature brains.


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