Large Immature Intracranial Teratoma in an Infant: A Case Report

Abstract

Intracranial immature teratomas are rare, highly malignant, and fast-growing with a poor prognosis. We report the case of an infant with a large immature teratoma in the intracranial compartment. A two-month-old child presented to the emergency room with drowsiness and seizures. CT and cranial MRI showed hydrocephalus with a large expansive process in the right cerebral hemisphere extending to the infratentorial compartment, compressing the cerebellum and brainstem. It was then decided to partially resect the lesion. Postoperatively, due to the aggressiveness of the residual tumor, the patient developed complications (status epilepticus, hyperthermia, and electrolyte disorders) and died. Histopathological and immunohistochemical studies confirmed an immature teratoma. Teratomas are a subtype of germ cell tumors. Immature teratomas contain a population of cells that retain embryonic characteristics and tissues with more primitive components derived from all or some of the three germ layers (ectoderm, mesoderm, and endoderm). The prognosis of immature teratomas is associated with the degree of tumor differentiation, and those composed of undifferentiated embryonic tissues have a poor prognosis. This case report illustrates the rare and severe occurrence of a bulky immature cerebral teratoma in an infant. Unfortunately, despite undergoing a planned partial resection, the infant ended up having complications and died. Therefore, due to the size of the lesion in an infant, these cases are always complex when deciding on a surgical approach.

Keywords: acute hydrocephalus; immature teratoma; nervous central system; somatic malignancy; tumours.

Figure 1. Magnetic Resonance Imaging

(A and B) Axial T1, large heterogeneous lesion with significant mass effect with brain stem compression (black arrow); (C) Axial T2, massive infiltrative lesion (black arrow); (D and E) Sagittal view with contrast, tumor compressing the brainstem(white arrow); (F) Coronal T2, tumor in the supra and infratentorial compartment (black arrows)

Figure 2. Surgery and histopathological study

(A) Craniotomy with exposure of the brain; (B) Part of the lesion resected; (C and D) Histopathology with mature and immature components (H&E, 100x)