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Case Reports
. 2011:2011:450743.
doi: 10.1155/2011/450743. Epub 2011 Jun 9.

Teratoma with malignant transformation: a case report with pathological, cytogenetic, and immunohistochemistry analysis

Jue Wang  1 , Syed A Jaffar Kazmi
Affiliations
Case Reports

Teratoma with malignant transformation: a case report with pathological, cytogenetic, and immunohistochemistry analysis

Jue Wang et al. Sarcoma. 2011.

Abstract

Background. Teratoma with malignant transformation (TMT) is rare and most commonly encountered in adult patient with germ cell tumor (GCT). Method. We report a rare case of testicular teratoma with metastatic TMT/embryonal rhabdomyosarcoma (ERMS). A 44-year-old man underwent right orchiectomy which revealed a malignant teratoma, he subsequently had right pneumonectomy with two pulmonary masses containing a high-grade embryonal rhabdomyosarcoma. The patient developed liver metastasis three months after initial diagnosis. He was treated with a chemotherapy regimen with vincristine, dactinomycin, and cyclophosphamide (VAC) alternating with vincristine and irinotecan (VI) with complete resolution of his liver lesion. The tumors were examined with a battery of cytogenetic, immunohistochemical, and molecular assays. Results. The malignant cells were immunohistochemically positive for desmin, myogenin, and MyoD1. Molecular cytogenetics of embryonal rhabdomyosarcoma tissue revealed the presence of i(12p). The tumor expressed high level of TOPO2A, TOPO1, MRP1, MGMT, BCRP, ERCC1, RRM1, and TS. Conclusion. The activity of topoisomerase inhibitors and the potential usefulness of topoisomerase expression as biomarkers should be further tested in aprospective study.

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Figures

Figure 1
Figure 1
Chest computed tomography (CT) showed large right lung masses; the right upper lobe mass measured 6.8 cm, a large right lower lobe measured 10.5 cm.
Figure 2
Figure 2
18F-FDG coincidence scintigraphy showed increased FDG uptake in right lung masses.
Figure 3
Figure 3
Histopathological findings of the pulmonary tumor. H & E stained section of pulmonary tumor demonstrating rhabdomyosarcoma showing rhabdoid cells (a) and chondrosarcoma with hyaline cartilage differentiation (b). Rhabdomyoblasts are positive for desmin (c) and myogenin (d).
Figure 4
Figure 4
Immunohistochemistry findings of the pulmonary tumor. (a) Rhabdomyoblasts with Topo 2a, (b) Topo I.
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