Teratocarcinomas
Teratocarcinomas are a form of malignant testicular cancer that originate from primordial germ cells, specifically spermatozoa precursor cells. These tumors are characterized by a mix of embryonal carcinoma and teratoma cells, which are typically benign tumors composed of tissues derived from all three embryonic layers. Although more commonly observed in prepubescent boys, teratomas can also be found in the ovaries as dermoid cysts. Risk factors for developing teratocarcinomas include undescended testes, anomalies in testicular development, and a family history of testicular cancer.
The exact cause of teratocarcinomas remains unknown, but it's thought that interrupted testicular development may lead to the uncontrolled division of primordial germ cells. Annually, there are approximately 9,760 cases of testicular cancer in the U.S., with teratocarcinomas accounting for 25 to 30 percent of these tumors. Symptoms may include a painless, firm mass in the scrotum, often discovered incidentally. Diagnosis typically involves clinical assessment and imaging techniques such as ultrasound or CT scans. Treatment options include surgical removal of the tumor, chemotherapy, and radiation therapy, with a five-year survival rate of about 93%. However, patients should be aware that infertility may result from treatment.
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Subject Terms
Teratocarcinomas
ALSO KNOWN AS: Teratomas
RELATED CONDITIONS: Germ-cell tumors, nonseminomatous germ-cell tumors (NSGCTs), choriocarcinomas, yolk sac tumors, seminomas, embryonal cell carcinomas, dermoid cysts
DEFINITION: Teratocarcinomas are malignant testicular cancers whose cells are derived from primordial germ cells (spermatozoa precursor cells). They are a mixed tumor composed of an embryonal carcinoma formed from a teratoma's epithelial cells. Teratomas are tumors, typically benign and usually seen in prepubescent boys but also found in the ovary (dermoid cyst), in which cells are derived from all three primitive embryonic tissue layers. Teratocarcinomas contain embryonic stem cells in addition to these cells.
Risk factors: One of the risk factors for developing a teratocarcinoma is undescended testes (cryptorchidism) during infancy. Anomalies in testicular development, such as that found in Klinefelter syndrome, may increase the risk of malignancy. Family history, age of descent or correction, location, single or bilateral undescended testes, premature birth, and previous history of testicular cancer have also been implicated.
Etiology and the disease process: The exact mechanisms by which teratocarcinomas develop remain unknown. Studies suggest that primordial spermatozoa cells (gonocytes) in the seminiferous tubules of the testes retain their embryonic characteristics of being able to differentiate into different mature tissues, as well as divide uncontrollably when testicular development is interrupted.
Incidence: There are about 9,760 cases of testicular cancer reported in the United States per year. Teratocarcinoma make up 25 to 30 percent of testicular tumors.
Symptoms: Symptoms may include an often painless, palpable mass within the scrotal area. The mass may also be firm and, at times, fixed. Discovery of the mass may be incidental, with no other signs of disease present.
Screening and diagnosis: Diagnosis is primarily clinical. If twisting of the testicle or its blood supply is suspected (causing discoloration and pain), Doppler ultrasound is done to assess blood flow as well as visualize the mass. Abdominal computed tomography (CT) or magnetic resonance imaging (MRI) is carried out to look for spread outside the scrotum.
Treatment and therapy: Surgical resection of the entire tumor; chemotherapy with cisplatin, bleomycin, and vinblastine; and irradiation are the treatments of choice. In the mid-2020s, medical researchers began investigating the effectiveness of cellular therapies in treating solid tumors like teratocarcinoma. Additionally, combinations of chemotherapy drugs proved effective in treating teratocarcinoma.
Prognosis, prevention, and outcomes: Prognosis is generally excellent with optimal treatment. The five-year survival rate for patients with teratocarcinomas is 93 percent. However, infertility may occur and should be understood by the patient as a possible side effect of therapy.
Bibliography
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