J Korean Neurosurg Soc.  2021 Nov;64(6):975-982. 10.3340/jkns.2020.0343.

Posterior Fossa Teratomas in Adults : A Systematic Review

• Shin DW
• Kim JH
• Song SW
• Kim YH
• Cho YH
• Hong SH
• Nam SJ

• KMID: 2521988
• DOI: http://doi.org/10.3340/jkns.2020.0343

Abstract

Objective
: The occurrence of posterior fossa teratomas in adulthood is extremely rare. In this study, we aimed to report our experience with two cases of posterior fossa mature teratoma in adults who underwent surgical resection. We also performed a systematic review of published papers available to date.
Methods
: We retrospectively reviewed the electronic medical records of patients who had onset of posterior fossa teratomas in adulthood at our institute between 1995 and 2020. We evaluated the clinical, radiographic, and pathological features of mature teratomas at the posterior fossa in adulthood. Furthermore, we searched the PubMed, EMBASE, and Web of Science database and reviewed published articles.
Results
: We found 507 articles on database review; of them, 102 were duplicates and 389 were excluded based on the inclusion criteria. Finally, 16 cases of posterior fossa from the web search and related articles. Subsequently, we added two cases that underwent surgery at our institute. We analyzed a total of 18 cases of mature teratomas. Headache was the most common (55.6%) symptom. The teratomas showed heterogeneous signals on magnetic resonance imaging. Thirteen patients (72.2%) had lesion at midline, five patients (27.8%) had calcification. Surgical resection was performed in all patients. No studies reported recurrence after resection.
Conclusion
: The occurrence of posterior fossa teratomas in adulthood is difficult to diagnose at the initial stage. Radiographic diagnosis alone can lead to misdiagnosis. Pathological confirmation is essential. Surgical resection is a curative option for posterior fossa teratomas in adulthood.

Keyword

Teratoma; Neoplasms; Cerebellum; Brain stem

Figure

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  Fig. 1. Flow chart of the literature review process.

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  Fig. 2. A : Initial radiographic image showing an oval mass with a heterogeneous signal on T1- and T2-weighted imaging at quadrigeminal cistern. Computed tomography showing focal calcification and lipid component. B : After a 16-year follow-up period, the mass had increased in size and nodular strong enhancement appeared. Gd : gadolinium, CT : computed tomography.

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  Fig. 3. A : Microscopic view through the occipital transtentorial approach. The tentorium was coagulated and cut. The mass was soft, fragile, and capsulated. B : Severe adhesion was noted between the quadrigeminal plate (black arrows) and the mass (arrowheads). Numerous small vessels were surrounding the mass.

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  Fig. 4. Image of the mass located at the posterior cerebellum (midline). The image shows heterogeneous signal intensity without peritumoral edema.

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  Fig. 5. A : The ciliated columnar epithelium (black arrows), adipose tissue (asterisk), and salivary gland tissue (white and black arrowheads) are observed. The salivary gland tissue shows serous acini (black arrowheads) and mucinous acini (white arrowheads) (H&E stain, ×100). B : A tumor with fully differentiated three germ-layer derivates—the hair follicle (white arrows), adipose tissue, and skin appendages (H&E stain, ×100).

Reference

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