Gagnon Marie-helene,  Parikh Ashish,  Taylor Susan,  Derenoncourt Paul-robert,  Ponisio Maria,  Khanna Geetika

Final Pr. ID: Poster #: EDU-050

Germ cell tumors of childhood are most often gonadal in origin. Extragonadal germ cell tumors are located characteristically in the midline arising intracranially, in the mediastinum, pelvis or retroperitoneum. These tumors are generally easily diagnosed due to typical sites of origin and characteristic imaging findings.

However, germ cell tumors can be associated with unusual clinical syndromes or imaging features that can perplex the clinician/radiologist.

We will review and illustrate atypical imaging/clinical manifestations and complications of germ cell tumors in childhood, based on our experience at two large children’s hospitals.

These atypical findings include:
Atypical metastatic disease: a) Burned out tumor – Testicular primary not typically evident with viable metastatic disease in retroperitoneal lymph nodes distant viscera, b) Growing teratoma syndrome (increasing size of tumor/pseudoprogression despite appropriate therapy), c) gliomatosis peritonei (maturation into glial tissue during therapy with pseudoprogression on FDG-PET), d) ossified pulmonary metastasis mimicking granulomas

Antibody mediated paraneoplastic syndromes: a) anti–N-methyl-D-aspartate (NMDA)– receptor antibody–mediated encephalitis associated with ovarian teratomas, b) anti-Ma2 antibody-mediated encephalitis associated with testicular germ cell tumors
Endocrine manifestations: a) Precocious puberty/gynecomastia due to hormonal (hCG) production, b) hyperthyroidism (TSH stimulation and struma ovarii)

Local complications: a) ovarian torsion (common), b) ruptured teratoma or dermoid cyst (uncommon)

Unusual primary tumors: a) Multifocal primary (e.g. pineal and suprasellar germinoma), b) Currarino triad, c) fetus-in-fetu, d) malignant transformation Read More

Authors:  Gagnon Marie-helene , Parikh Ashish , Taylor Susan , Derenoncourt Paul-robert , Ponisio Maria , Khanna Geetika

Keywords:  growing teratoma, gliomatosis peritonei, NMDA encephalitis

Gadde Judith,  Rebsamen Susan,  Kennedy Tabassum

Final Pr. ID: Poster #: EDU-040

1. To briefly review the embryology and anatomy of the pituitary gland.
2. To illustrate the imaging spectrum of duplication of the pituitary gland through an example, to include often associated anomalies such as thickening of the hypothalamus and a palatal teratoma.
3. To review the theories of pathogenesis leading to duplication of the pituitary gland. Read More

Authors:  Gadde Judith , Rebsamen Susan , Kennedy Tabassum

Keywords:  Duplication, pituitary, Embryology, Teratoma

Markovitz Michael,  Hemmrich Megan,  Francis Christopher

Final Pr. ID: Poster #: CR-017

Cystic teratoma and lymphatic malformation (LM) are two generally benign differential considerations for congenital masses which demonstrate overlapping clinical and imaging findings. It is important to distinguish between these etiologies as cystic teratomas may require surgical excision whereas lymphatic malformations may be treated with minimally invasive sclerotherapy. We present two contrasting cases: a cervical neck teratoma mimicking a LM and an abdominal LM resembling a cystic teratoma.

Case 1: A 9-month-old female presented with a right craniofacial neck mass discovered on prenatal screening. Postnatal ultrasound demonstrated a complex multiloculated cystic lesion with peripheral vascularity. MRI confirmed a predominantly cystic, mixed soft tissue and cystic right anterolateral neck mass, most consistent with mixed type lymphatic malformation. Despite two rounds of percutaneous sclerotherapy with doxycycline, the lesion continued to enlarge on repeat MRI, crossing the midline and causing mass effect on the trachea with associated airway compromise. Respiratory distress was exacerbated by COVID-19 infection requiring intubation and eventual tracheostomy. She was started on sirolimus and underwent a third sclerotherapy treatment with doxycycline and STS without improvement. Surgical debulking was performed with pathology returning as mature multicystic teratoma composed of endodermal, neuroglial and mesodermal elements with minimal fat.

Case 2: A 13-year-old male with no significant past medical history presented with three weeks of right-sided abdominal pain and constipation. CT showed a right abdominal multiseptated cystic lesion. MRI confirmed a 27 cm multicystic abdominal mass with small soft tissue component and calcification with mass effect on the small bowel and right ureter causing partial small bowel obstruction and hydronephrosis, most consistent with a large cystic teratoma. However, following surgical excision pathology demonstrated a multicystic mass containing vascular structures with lymphocytic aggregates and nodules consistent with LM.

Expanding on these cases, this exhibit will also review the clinical presentations and management of cystic teratoma and LM with an emphasis on imaging workup and radiology-pathology correlation. It is important for radiologists and their interdisciplinary colleagues to be cognizant of the overlapping features of these conditions to avoid errors in diagnosis and management as their treatments differ. Read More

Authors:  Markovitz Michael , Hemmrich Megan , Francis Christopher

Keywords:  Lymphatic Malformation, Teratoma, Cystic

Wang Megan,  Snyder Elizabeth,  Schulman Marta,  Luo Yu

Final Pr. ID: Poster #: CR-012

Gastric teratomas are exceedingly rare tumors derived from one or more germ layers. These tumors predominantly occur in sacrococcygeal-gonadal locations but can occasionally manifest in midline regions such as the mediastinum, retroperitoneum, and the head/neck.

Case Presentation: A 1-day-old male infant, born at 36 weeks and 4 days via a cesarean section due to multiple fetal anomalies, including large for gestational age (LGA), new-onset polyhydramnios and significant bilateral hydroceles, presented with a significantly distended and firm abdomen. The initial X-ray revealed extensive amorphous calcifications throughout the abdomen, suggestive of meconium peritonitis. However, a subsequent ultrasound examination revealed a large heterogeneous mass in the upper and mid abdomen, characterized by calcifications, cysts, and soft tissue components. In retrospect, the large mass was detected on the prenatal sonographic exam but misinterpreted as echogenic bowel loops. A subsequent CT scan unveiled a 13.4 x 7.6 x 9.9 cm mass originating from the gastric wall, extending into the gastric lumen as well as the peritoneal cavity.
Interestingly, endoscopy revealed a normal mucosa covering the mass. The tumor was resected, including partial gastrectomy, and histology confirmed the presence of native gastric mucosa and an underlying mass composed of endodermal, ectodermal, and mesodermal tissues, consistent with mature teratomas.

This case report presents a large mature teratoma within the gastric wall, exhibiting exophytic and endoluminal growth, which led to polyhydramnios, abdominal distention, and the development of large hydroceles in the newborn, feeding difficulty. Additionally, it emphasizes the importance of thorough prenatal and postnatal imaging evaluations for timely diagnosis and management. Read More

Authors:  Wang Megan , Snyder Elizabeth , Schulman Marta , Luo Yu

Keywords:  Gastric teratoma, computed tomography

Aviado Randy,  Vorona Gregory,  Tye Gary,  Ritter Ann,  Wang Zhihong,  Mahdi Eman,  Mishra Chakradhar,  Jones Kathryn,  Urbine Jacqueline

Final Pr. ID: Poster #: EDU-067

The spectrum of imaging findings associated with intracranial germ cell tumors extends well beyond the typical suprasellar and/or pineal region masses. It is imperative that radiologists who interpret pediatric neuroimaging studies be familiar with the range of imaging findings associated with intracranial germ cell tumors, particularly as the appropriate suggestion of germ cell tumor as a diagnosis can have a significant impact on the initial surgical plan. In our case series we will review the typical imaging (CT and MRI) findings of both germinoma and nongerminomatous germ cell tumors, including metastasis and local invasion/extension. We will also review how intracranial germ cell tumors can be multifocal and how they can involve unusual areas such as the basal ganglia, cerebellum, and septal leaflets. MR spectroscopic findings associated with pediatric intracranial germ cell tumors will also be reviewed, including how these findings can be very helpful to differentiate from other similar-appearing pathologies. Finally, we will briefly discuss the treatment and prognosis of intracranial germ cell tumors. Read More

Authors:  Aviado Randy , Vorona Gregory , Tye Gary , Ritter Ann , Wang Zhihong , Mahdi Eman , Mishra Chakradhar , Jones Kathryn , Urbine Jacqueline

Keywords:  Germ cell tumor, germinoma, teratoma

Acevedo Silvia,  Ritze Kimberly

Final Pr. ID: Poster #: CR-001 (T)

To provide MRI staff education on MRI fetal exams for sacrococcygeal teratomas. Sacrococcygeal teratoma (SCT) is a congenital germ cell tumor located at the base of the tailbone in newborns. This birth defect is generally not malignant. A SCT is most often diagnosed prenatally using routine obstetric ultrasonography, and further anatomical evaluation may require MRI. A SCT can grow during pregnancy and develop large blood vessels requiring more work for the fetal heart. SCT are more common in females than in males and occur in about 1 in 35,000 live births. Read More

Authors:  Acevedo Silvia , Ritze Kimberly

Keywords:  MRI, sacrococcygeal, teratomas

Pfeifer Cory,  Beavers Angela

Final Pr. ID: Poster #: CR-002

Teratomas uncommonly manifest in the gastrointestinal system, and most international literature cites the total number of gastric teratomas reported to be approximately 120. Of these, only 12-30 are of the immature variety. Reports of immature gastric teratoma in the United States are scant. Presented here are images from what appears to be the first known fetal MRI to demonstrate a gastric immature teratoma with follow-up radiographic, fluoroscopic, and CT imaging of the infant. Read More

Authors:  Pfeifer Cory , Beavers Angela

Keywords:  Fetal MRI, Gastric Teratoma

Prosova Blanka

Final Pr. ID: Poster #: CR-021

We present a case of expansion in the oral cavity, referred from routine antenatal ultrasound screening to fetal MRI in 24^th gestational week for extension of diagnostic information concerning predominantly the character of tissue and relationship to adjacent structures. The aim of the presentation, which includes two fetal MRI and one MR performed immediately postnatal, is to specify which details could be obtain by evaluating the fetal MRI in such type of diagnoses and what is their practical application for influencing the outcome of the baby. Orofaryngeal teratomas are exceedingly rare and despite their usual benign histopathology they are potentially lethal due to airway obstruction. Complete surgical resection is the guiding principle of usually urgent postnatal management. The role of imaging method and MRI, with its tissue contrast, is the best method of the choice , is to establish the level of the airway compression, to specify the extent of the lesion for facilitating the postnatal planning , including the approach for resection . We emphasized some question the radiologist could be asked by involved surgeon, especially concerning the tongue involvement, as this factor definitely influenced the quality of life. Read More

Authors:  Prosova Blanka

Keywords:  oral cavity teratoma

Leake David

Final Pr. ID: Poster #: CR-067

The purpose of this case report is to describe a rare case of epignathus (oral teratoma) with lateral skull base and intracranial extension. A 29-year-old G4P1122 female was referred to our institutuion after third trimester ultrasound and fetal MRI revealed a 34 week fetus with oral mass. There was extension intracranially through the lateral skull base. The complex mass showed cystic, solid, and fatty components. Polyhydramnios was also demonstrated. The prenatal imaging was crucial in planning the delivery of the fetus using EXIT procedure. Postnatal MRI Head and Neck, CT Head and Neck, CTA Head and Neck were helpful in guiding surgical resection of the oral, skull base, and intracranial mass. Emphasis will be made on the value of imaging to guide the management of this extremely difficult and rare case. Read More

Authors:  Leake David

Keywords:  epignathus, teratoma, Fetal MRI, Skull Base

Aslan Mine,  Arioz Habibi Hatice,  Kalyoncu Ucar Ayse,  Namdar Yesim,  Adaletli Ibrahim,  Kurugoglu Sebuh

Final Pr. ID: Poster #: CR-026

Sacrococcygeal teratoma (SCT) is one of the most common tumors of the newborn. SCT is seen frequently in the presacral region and in forms of solid or mixed solid and cystic masses. Only 10-15 % of all sacrococcygeal teratomas are in pure cystic form. Here, in this case, we aimed to present sonographic and magnetic resonance images (MRI) of a newborn with pelvic cystic mass and bilateral hydronephrosis that were seen on prenatal ultrasonography.
An operation was planned for two days of age girl patient for cystic pelvic mass and bilateral hydronephrosis detected by prenatal sonography during the third trimester. On her abdominal X-ray radiography, there was no bowel gas at the midline pelvis. The patient was referred to the sonography unit with the suspicion of a duplication cyst. Abdominal sonography revealed bilateral hydroureteronephrosis, bladder wall thickening, and a 75x55x32 mm pure cystic mass located between the rectum and bladder. The mass had a fine septa at the inferior site. Abdominal MRI showed that the mass had no connection with the spinal canal or solid component. The patient was operated and the diagnosis of purely cystic sacrococcygeal teratoma was confirmed histopathologically.
Anterior meningocele, tail gut cyst, rectal duplication cyst, and cystic sacrococcygeal teratomas are common lesions of the presacral region diagnosed in the prenatal or antenatal period. Sacrococcygeal teratoma should be kept in mind in patients with presacral cystic mass in the neoatal period and radiologic methods are helpful for displaying the extent and content of a cystic mass. Read More

Authors:  Aslan Mine , Arioz Habibi Hatice , Kalyoncu Ucar Ayse , Namdar Yesim , Adaletli Ibrahim , Kurugoglu Sebuh

Keywords:  Sacrococcygeal teratoma, Sonography, Magnetic resonance imaging, Neonatal

Laifer-narin Sherelle,  Patel Sejal,  Ayyala Rama,  Bentley-hibbert Stuart,  Hecht Elizabeth,  Newhouse Jeffrey

Final Pr. ID: Poster #: EDU-066

Teratoma is one of the most common fetal tumors that is diagnosed on prenatal imaging. Various sites and organs can be involved, and therefore it is important to be aware of the imaging findings on fetal MRI. Imaging not only aids in prompt diagnosis, but also directs obstetrical care and provides vital information for counseling. The purpose of this exhibit is to review key anatomic, pathologic, and imaging characteristics of fetal teratomas. Read More

Authors:  Laifer-narin Sherelle , Patel Sejal , Ayyala Rama , Bentley-hibbert Stuart , Hecht Elizabeth , Newhouse Jeffrey

Keywords:  Fetal, Teratoma, MRI