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Spectrum of Germ Cell Tumors: From Head to Toe¹

Teruko Ueno, MD, Yumiko Oishi Tanaka, MD, Michio Nagata, MD, Hajime Tsunoda, MD, Izumi Anno, MD, Shigemi Ishikawa, MD, Koji Kawai, MD and Yuji Itai, MD

¹ From the Department of Radiology, Tsukuba University Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan (T.U.); and the Departments of Radiology (Y.O.T., I.A., Y.I.), Pathology (M.N.), Obstetrics and Gynecology (H.T.), Thoracic Surgery (S.I.), and Urology (K.K.), University of Tsukuba, Ibaraki, Japan. Presented as an education exhibit at the 2002 RSNA scientific assembly. Received March 27, 2003; revision requested May 30 and received August 18; accepted August 20. All authors have no financial relationships to disclose. Address correspondence to T.U. (e-mail: u-teruko@mua.biglobe.ne.jp).

View larger version (101K): [in a new window]   Figure 1. Development of the primordial gonads. Drawing shows a transverse section of a 5-week embryo. Primordial germ cells migrate from the hindgut to the gonadal ridge. (Adapted and reprinted, with permission, from reference 1.)

View larger version (32K): [in a new window]   Figure 2. Differential pathways of origin for GCTs. Diagram shows the cellular origin of each type of GCT, which is correlated with the differentiation of the primordial germ cells. ITGCN = intratubular germ cell neoplasia.

View larger version (56K): [in a new window]   Figure 3a. Testicular seminoma in a 51-year-old man with a palpable mass in the right testis. (a) Axial T2-weighted MR image shows a solid mass in the right testis. The mass has a lobulated margin and uniform signal intensity. Bandlike structures of low signal intensity (arrows), which represent fibrovascular septa, are seen within the mass. (b) Axial contrast material-enhanced MR image shows that the septa (arrows) enhance more than the tumor tissue. This finding indicates that the septa include a large amount of vascular structures.

View larger version (101K): [in a new window]   Figure 3b. Testicular seminoma in a 51-year-old man with a palpable mass in the right testis. (a) Axial T2-weighted MR image shows a solid mass in the right testis. The mass has a lobulated margin and uniform signal intensity. Bandlike structures of low signal intensity (arrows), which represent fibrovascular septa, are seen within the mass. (b) Axial contrast material-enhanced MR image shows that the septa (arrows) enhance more than the tumor tissue. This finding indicates that the septa include a large amount of vascular structures.

View larger version (115K): [in a new window]   Figure 4a. Dysgerminoma of the ovary in a 31-year-old woman with fever and abdominal pain. (a) Sagittal T2-weighted MR image shows a large, lobulated solid mass in the pelvis and lower abdomen. Fibrovascular septa are seen as low-signal-intensity bands (arrows). (b) Sagittal contrast-enhanced T1-weighted MR image shows clear enhancement of the septa (arrows). (c) Photomicrograph (original magnification, x400; hematoxylin-eosin [H-E] stain) shows that the tumor is composed of large, round cells containing clear cytoplasm and irregularly flattened nuclei. (d) Photomicrograph (original magnification, x40; H-E stain) shows that the clusters of tumor cells are divided by fibrous septa, which include lymphocytes.

View larger version (124K): [in a new window]   Figure 4b. Dysgerminoma of the ovary in a 31-year-old woman with fever and abdominal pain. (a) Sagittal T2-weighted MR image shows a large, lobulated solid mass in the pelvis and lower abdomen. Fibrovascular septa are seen as low-signal-intensity bands (arrows). (b) Sagittal contrast-enhanced T1-weighted MR image shows clear enhancement of the septa (arrows). (c) Photomicrograph (original magnification, x400; hematoxylin-eosin [H-E] stain) shows that the tumor is composed of large, round cells containing clear cytoplasm and irregularly flattened nuclei. (d) Photomicrograph (original magnification, x40; H-E stain) shows that the clusters of tumor cells are divided by fibrous septa, which include lymphocytes.

View larger version (165K): [in a new window]   Figure 4c. Dysgerminoma of the ovary in a 31-year-old woman with fever and abdominal pain. (a) Sagittal T2-weighted MR image shows a large, lobulated solid mass in the pelvis and lower abdomen. Fibrovascular septa are seen as low-signal-intensity bands (arrows). (b) Sagittal contrast-enhanced T1-weighted MR image shows clear enhancement of the septa (arrows). (c) Photomicrograph (original magnification, x400; hematoxylin-eosin [H-E] stain) shows that the tumor is composed of large, round cells containing clear cytoplasm and irregularly flattened nuclei. (d) Photomicrograph (original magnification, x40; H-E stain) shows that the clusters of tumor cells are divided by fibrous septa, which include lymphocytes.

View larger version (175K): [in a new window]   Figure 4d. Dysgerminoma of the ovary in a 31-year-old woman with fever and abdominal pain. (a) Sagittal T2-weighted MR image shows a large, lobulated solid mass in the pelvis and lower abdomen. Fibrovascular septa are seen as low-signal-intensity bands (arrows). (b) Sagittal contrast-enhanced T1-weighted MR image shows clear enhancement of the septa (arrows). (c) Photomicrograph (original magnification, x400; hematoxylin-eosin [H-E] stain) shows that the tumor is composed of large, round cells containing clear cytoplasm and irregularly flattened nuclei. (d) Photomicrograph (original magnification, x40; H-E stain) shows that the clusters of tumor cells are divided by fibrous septa, which include lymphocytes.

View larger version (165K): [in a new window]   Figure 5a. Germinoma of the pineal gland in an 11-month-old boy with sporadic vomiting. Because no abdominal cause was found, the brain was examined. (a) Nonenhanced computed tomographic (CT) scan shows a partly calcified mass in the pineal region (arrow). (b, c) Sagittal T2-weighted (b) and contrast-enhanced T1-weighted (c) MR images show that the mass (black arrows in b) is solid with small cysts and marked enhancement. The tumor extends upward, compressing and displacing the internal cerebral vein (white arrows in b). (d) Photomicrograph (original magnification, x400; H-E stain) shows that the tumor is composed of large, rounded cells with clear cytoplasm.

View larger version (168K): [in a new window]   Figure 5b. Germinoma of the pineal gland in an 11-month-old boy with sporadic vomiting. Because no abdominal cause was found, the brain was examined. (a) Nonenhanced computed tomographic (CT) scan shows a partly calcified mass in the pineal region (arrow). (b, c) Sagittal T2-weighted (b) and contrast-enhanced T1-weighted (c) MR images show that the mass (black arrows in b) is solid with small cysts and marked enhancement. The tumor extends upward, compressing and displacing the internal cerebral vein (white arrows in b). (d) Photomicrograph (original magnification, x400; H-E stain) shows that the tumor is composed of large, rounded cells with clear cytoplasm.

View larger version (152K): [in a new window]   Figure 5c. Germinoma of the pineal gland in an 11-month-old boy with sporadic vomiting. Because no abdominal cause was found, the brain was examined. (a) Nonenhanced computed tomographic (CT) scan shows a partly calcified mass in the pineal region (arrow). (b, c) Sagittal T2-weighted (b) and contrast-enhanced T1-weighted (c) MR images show that the mass (black arrows in b) is solid with small cysts and marked enhancement. The tumor extends upward, compressing and displacing the internal cerebral vein (white arrows in b). (d) Photomicrograph (original magnification, x400; H-E stain) shows that the tumor is composed of large, rounded cells with clear cytoplasm.

View larger version (153K): [in a new window]   Figure 5d. Germinoma of the pineal gland in an 11-month-old boy with sporadic vomiting. Because no abdominal cause was found, the brain was examined. (a) Nonenhanced computed tomographic (CT) scan shows a partly calcified mass in the pineal region (arrow). (b, c) Sagittal T2-weighted (b) and contrast-enhanced T1-weighted (c) MR images show that the mass (black arrows in b) is solid with small cysts and marked enhancement. The tumor extends upward, compressing and displacing the internal cerebral vein (white arrows in b). (d) Photomicrograph (original magnification, x400; H-E stain) shows that the tumor is composed of large, rounded cells with clear cytoplasm.

View larger version (166K): [in a new window]   Figure 6a. Suprasellar germinoma in a 38-year-old woman with amenorrhea. (a, b) Sagittal T2-weighted (a) and contrast-enhanced fat-saturated T1-weighted (b) MR images show a solid mass with a cystic area (arrow in a) and marked enhancement. The pituitary gland is compressed and flattened along the sellar floor (arrows in b). The tumor extends upward toward the infundibular recess. (c) Photomicrograph (original magnification, x400; H-E stain) shows uniformly proliferating tumor cells. In contrast to ovarian dysgerminoma, few fibrous septa are seen.

View larger version (159K): [in a new window]   Figure 6b. Suprasellar germinoma in a 38-year-old woman with amenorrhea. (a, b) Sagittal T2-weighted (a) and contrast-enhanced fat-saturated T1-weighted (b) MR images show a solid mass with a cystic area (arrow in a) and marked enhancement. The pituitary gland is compressed and flattened along the sellar floor (arrows in b). The tumor extends upward toward the infundibular recess. (c) Photomicrograph (original magnification, x400; H-E stain) shows uniformly proliferating tumor cells. In contrast to ovarian dysgerminoma, few fibrous septa are seen.

View larger version (185K): [in a new window]   Figure 6c. Suprasellar germinoma in a 38-year-old woman with amenorrhea. (a, b) Sagittal T2-weighted (a) and contrast-enhanced fat-saturated T1-weighted (b) MR images show a solid mass with a cystic area (arrow in a) and marked enhancement. The pituitary gland is compressed and flattened along the sellar floor (arrows in b). The tumor extends upward toward the infundibular recess. (c) Photomicrograph (original magnification, x400; H-E stain) shows uniformly proliferating tumor cells. In contrast to ovarian dysgerminoma, few fibrous septa are seen.

View larger version (111K): [in a new window]   Figure 7a. Seminoma of the mediastinum in a 37-year-old man with edema and swelling of the face and neck but no other symptoms. Chest radiography indicated a tumor of the upper mediastinum. (a) Axial T2-weighted MR image shows a large lobulated mass with several fibrovascular septa (arrows). (b) Axial contrast-enhanced T1-weighted MR image shows marked enhancement of the septa (arrows). (c) Photomicrograph (original magnification, x400; H-E stain) shows that the tumor is composed of large, rounded, clear cells.

View larger version (127K): [in a new window]   Figure 7b. Seminoma of the mediastinum in a 37-year-old man with edema and swelling of the face and neck but no other symptoms. Chest radiography indicated a tumor of the upper mediastinum. (a) Axial T2-weighted MR image shows a large lobulated mass with several fibrovascular septa (arrows). (b) Axial contrast-enhanced T1-weighted MR image shows marked enhancement of the septa (arrows). (c) Photomicrograph (original magnification, x400; H-E stain) shows that the tumor is composed of large, rounded, clear cells.

View larger version (159K): [in a new window]   Figure 7c. Seminoma of the mediastinum in a 37-year-old man with edema and swelling of the face and neck but no other symptoms. Chest radiography indicated a tumor of the upper mediastinum. (a) Axial T2-weighted MR image shows a large lobulated mass with several fibrovascular septa (arrows). (b) Axial contrast-enhanced T1-weighted MR image shows marked enhancement of the septa (arrows). (c) Photomicrograph (original magnification, x400; H-E stain) shows that the tumor is composed of large, rounded, clear cells.

View larger version (130K): [in a new window]   Figure 8a. Pure testicular seminoma in a 30-year-old man. (a) Ultrasonographic (US) scan shows a multinodular tumor in the right testis. The tumor is divided by fibrous septa, which appear as hypoechoic bands (arrow). No cystic component is seen. (b) Color Doppler image shows that the septa are richly vascularized (arrowhead).

View larger version (85K): [in a new window]   Figure 8b. Pure testicular seminoma in a 30-year-old man. (a) Ultrasonographic (US) scan shows a multinodular tumor in the right testis. The tumor is divided by fibrous septa, which appear as hypoechoic bands (arrow). No cystic component is seen. (b) Color Doppler image shows that the septa are richly vascularized (arrowhead).

View larger version (128K): [in a new window]   Figure 9. Testicular microlithiasis in a patient with a nonseminomatous GCT of the mediastinum. US scan shows diffusely scattered, tiny, echogenic foci within the testis.

View larger version (132K): [in a new window]   Figure 10a. Mixed GCT of the anterior mediastinum in a 22-year-old man with dyspnea. Chest radiography indicated that the left thorax was filled with tumor tissue. (a) Coronal T2-weighted MR image shows a large, heterogeneous mediastinal mass that invades the left pleural cavity. The heart, great vessels, and left lung are markedly compressed (arrows). (b) Contrast-enhanced CT scan shows that most of the tumor appears solid, although a relatively large cystic component is seen (arrow). Surgical exploration was followed by chemotherapy. (c) Photomicrograph (original magnification, x400; H-E stain) shows a small amount of immature neural tissue. In addition, serum levels of human chorionic gonadotropin and -fetoprotein were very high at admission. The tumor was diagnosed as a mixed GCT that included an immature teratoma.

View larger version (136K): [in a new window]   Figure 10b. Mixed GCT of the anterior mediastinum in a 22-year-old man with dyspnea. Chest radiography indicated that the left thorax was filled with tumor tissue. (a) Coronal T2-weighted MR image shows a large, heterogeneous mediastinal mass that invades the left pleural cavity. The heart, great vessels, and left lung are markedly compressed (arrows). (b) Contrast-enhanced CT scan shows that most of the tumor appears solid, although a relatively large cystic component is seen (arrow). Surgical exploration was followed by chemotherapy. (c) Photomicrograph (original magnification, x400; H-E stain) shows a small amount of immature neural tissue. In addition, serum levels of human chorionic gonadotropin and -fetoprotein were very high at admission. The tumor was diagnosed as a mixed GCT that included an immature teratoma.

View larger version (178K): [in a new window]   Figure 10c. Mixed GCT of the anterior mediastinum in a 22-year-old man with dyspnea. Chest radiography indicated that the left thorax was filled with tumor tissue. (a) Coronal T2-weighted MR image shows a large, heterogeneous mediastinal mass that invades the left pleural cavity. The heart, great vessels, and left lung are markedly compressed (arrows). (b) Contrast-enhanced CT scan shows that most of the tumor appears solid, although a relatively large cystic component is seen (arrow). Surgical exploration was followed by chemotherapy. (c) Photomicrograph (original magnification, x400; H-E stain) shows a small amount of immature neural tissue. In addition, serum levels of human chorionic gonadotropin and -fetoprotein were very high at admission. The tumor was diagnosed as a mixed GCT that included an immature teratoma.

View larger version (94K): [in a new window]   Figure 11a. Embryonal carcinoma of the pineal gland in a 32-year-old man with double vision. The brain was examined with MR imaging. (a) Axial T2-weighted MR image shows a tumor with heterogeneous signal intensity in the pineal gland (arrows). (b) Axial contrast-enhanced T1-weighted MR image shows some enhancing foci within the tumor (arrows). (c) Photomicrograph (original magnification, x200; H-E stain) shows embryonal cells with an epithelial appearance growing in a tubular pattern. Glandular, papillary, and solid reticular patterns are also present.

View larger version (91K): [in a new window]   Figure 11b. Embryonal carcinoma of the pineal gland in a 32-year-old man with double vision. The brain was examined with MR imaging. (a) Axial T2-weighted MR image shows a tumor with heterogeneous signal intensity in the pineal gland (arrows). (b) Axial contrast-enhanced T1-weighted MR image shows some enhancing foci within the tumor (arrows). (c) Photomicrograph (original magnification, x200; H-E stain) shows embryonal cells with an epithelial appearance growing in a tubular pattern. Glandular, papillary, and solid reticular patterns are also present.

View larger version (137K): [in a new window]   Figure 11c. Embryonal carcinoma of the pineal gland in a 32-year-old man with double vision. The brain was examined with MR imaging. (a) Axial T2-weighted MR image shows a tumor with heterogeneous signal intensity in the pineal gland (arrows). (b) Axial contrast-enhanced T1-weighted MR image shows some enhancing foci within the tumor (arrows). (c) Photomicrograph (original magnification, x200; H-E stain) shows embryonal cells with an epithelial appearance growing in a tubular pattern. Glandular, papillary, and solid reticular patterns are also present.

View larger version (80K): [in a new window]   Figure 12a. Mixed GCT (combined seminoma and choriocarcinoma) of the testis in a 31-year-old man with an enlarged testis containing a palpable mass. (a) Coronal T2-weighted MR image shows a smoothly marginated, rounded tumor. Although the upper part of the tumor appears homogeneously solid, the lower part is cystic. (b) Coronal contrast-enhanced T1-weighted MR image shows some fibrovascular septa (arrow), which are indicative of a seminoma. At pathologic analysis of the resected specimen, the upper part of the tumor was diagnosed as a seminoma. (c) Photomicrograph (original magnification, x400; H-E stain) of the lower part of the tumor shows both syncytiotrophoblasts (black arrow) and cytotrophoblasts (white arrow) with hemorrhage.

View larger version (67K): [in a new window]   Figure 12b. Mixed GCT (combined seminoma and choriocarcinoma) of the testis in a 31-year-old man with an enlarged testis containing a palpable mass. (a) Coronal T2-weighted MR image shows a smoothly marginated, rounded tumor. Although the upper part of the tumor appears homogeneously solid, the lower part is cystic. (b) Coronal contrast-enhanced T1-weighted MR image shows some fibrovascular septa (arrow), which are indicative of a seminoma. At pathologic analysis of the resected specimen, the upper part of the tumor was diagnosed as a seminoma. (c) Photomicrograph (original magnification, x400; H-E stain) of the lower part of the tumor shows both syncytiotrophoblasts (black arrow) and cytotrophoblasts (white arrow) with hemorrhage.

View larger version (142K): [in a new window]   Figure 12c. Mixed GCT (combined seminoma and choriocarcinoma) of the testis in a 31-year-old man with an enlarged testis containing a palpable mass. (a) Coronal T2-weighted MR image shows a smoothly marginated, rounded tumor. Although the upper part of the tumor appears homogeneously solid, the lower part is cystic. (b) Coronal contrast-enhanced T1-weighted MR image shows some fibrovascular septa (arrow), which are indicative of a seminoma. At pathologic analysis of the resected specimen, the upper part of the tumor was diagnosed as a seminoma. (c) Photomicrograph (original magnification, x400; H-E stain) of the lower part of the tumor shows both syncytiotrophoblasts (black arrow) and cytotrophoblasts (white arrow) with hemorrhage.

View larger version (116K): [in a new window]   Figure 13a. Yolk sac tumor of the sacrococcygeal region in a 7-month-old girl. A cystic teratoma of the sacrococcygeal region was found at birth. After surgical resection, the tumor grew again. (a, b) Sagittal T1-weighted (a) and T2-weighted (b) MR images show a heterogeneous sacrococcygeal mass with high signal intensity (white arrows). The dorsal part of the tumor appears cystic, and fatty tissue is not evident. The tumor margin is ill defined with infiltration of adjacent tissue (black arrow). (c) Photomicrograph (original magnification, x200; H-E stain) shows a reticular pattern, which is characterized by a loose meshwork of communicating spaces lined by primitive tumor cells. The neoplastic cells have hyperchromatic, irregular nuclei with unusual shapes. A glomeruloid body is seen (arrows), which is a characteristic feature of yolk sac tumors. (d) Photomicrograph (original magnification, x400; -fetoprotein immunohistochemical stain) shows that the tumor contains yolk sac epithelium.

View larger version (127K): [in a new window]   Figure 13b. Yolk sac tumor of the sacrococcygeal region in a 7-month-old girl. A cystic teratoma of the sacrococcygeal region was found at birth. After surgical resection, the tumor grew again. (a, b) Sagittal T1-weighted (a) and T2-weighted (b) MR images show a heterogeneous sacrococcygeal mass with high signal intensity (white arrows). The dorsal part of the tumor appears cystic, and fatty tissue is not evident. The tumor margin is ill defined with infiltration of adjacent tissue (black arrow). (c) Photomicrograph (original magnification, x200; H-E stain) shows a reticular pattern, which is characterized by a loose meshwork of communicating spaces lined by primitive tumor cells. The neoplastic cells have hyperchromatic, irregular nuclei with unusual shapes. A glomeruloid body is seen (arrows), which is a characteristic feature of yolk sac tumors. (d) Photomicrograph (original magnification, x400; -fetoprotein immunohistochemical stain) shows that the tumor contains yolk sac epithelium.

View larger version (164K): [in a new window]   Figure 13c. Yolk sac tumor of the sacrococcygeal region in a 7-month-old girl. A cystic teratoma of the sacrococcygeal region was found at birth. After surgical resection, the tumor grew again. (a, b) Sagittal T1-weighted (a) and T2-weighted (b) MR images show a heterogeneous sacrococcygeal mass with high signal intensity (white arrows). The dorsal part of the tumor appears cystic, and fatty tissue is not evident. The tumor margin is ill defined with infiltration of adjacent tissue (black arrow). (c) Photomicrograph (original magnification, x200; H-E stain) shows a reticular pattern, which is characterized by a loose meshwork of communicating spaces lined by primitive tumor cells. The neoplastic cells have hyperchromatic, irregular nuclei with unusual shapes. A glomeruloid body is seen (arrows), which is a characteristic feature of yolk sac tumors. (d) Photomicrograph (original magnification, x400; -fetoprotein immunohistochemical stain) shows that the tumor contains yolk sac epithelium.

View larger version (154K): [in a new window]   Figure 13d. Yolk sac tumor of the sacrococcygeal region in a 7-month-old girl. A cystic teratoma of the sacrococcygeal region was found at birth. After surgical resection, the tumor grew again. (a, b) Sagittal T1-weighted (a) and T2-weighted (b) MR images show a heterogeneous sacrococcygeal mass with high signal intensity (white arrows). The dorsal part of the tumor appears cystic, and fatty tissue is not evident. The tumor margin is ill defined with infiltration of adjacent tissue (black arrow). (c) Photomicrograph (original magnification, x200; H-E stain) shows a reticular pattern, which is characterized by a loose meshwork of communicating spaces lined by primitive tumor cells. The neoplastic cells have hyperchromatic, irregular nuclei with unusual shapes. A glomeruloid body is seen (arrows), which is a characteristic feature of yolk sac tumors. (d) Photomicrograph (original magnification, x400; -fetoprotein immunohistochemical stain) shows that the tumor contains yolk sac epithelium.

View larger version (164K): [in a new window]   Figure 14a. Mature cystic teratoma of the ovary in a 46-year-old woman. A tumor of the lower abdomen was discovered during a medical checkup. The tumor had caused no complications. (a, b) Axial T1-weighted (a) and T2-weighted (b) MR images show a rounded cystic mass that includes fat and a solid component (arrow) with a palm tree-like appearance. (c) Axial fat-saturated T1-weighted MR image shows decreased signal intensity of the cystic component (arrows). (d) CT scan shows coarse calcifications (arrow).

View larger version (135K): [in a new window]   Figure 14b. Mature cystic teratoma of the ovary in a 46-year-old woman. A tumor of the lower abdomen was discovered during a medical checkup. The tumor had caused no complications. (a, b) Axial T1-weighted (a) and T2-weighted (b) MR images show a rounded cystic mass that includes fat and a solid component (arrow) with a palm tree-like appearance. (c) Axial fat-saturated T1-weighted MR image shows decreased signal intensity of the cystic component (arrows). (d) CT scan shows coarse calcifications (arrow).

View larger version (138K): [in a new window]   Figure 14c. Mature cystic teratoma of the ovary in a 46-year-old woman. A tumor of the lower abdomen was discovered during a medical checkup. The tumor had caused no complications. (a, b) Axial T1-weighted (a) and T2-weighted (b) MR images show a rounded cystic mass that includes fat and a solid component (arrow) with a palm tree-like appearance. (c) Axial fat-saturated T1-weighted MR image shows decreased signal intensity of the cystic component (arrows). (d) CT scan shows coarse calcifications (arrow).

View larger version (135K): [in a new window]   Figure 14d. Mature cystic teratoma of the ovary in a 46-year-old woman. A tumor of the lower abdomen was discovered during a medical checkup. The tumor had caused no complications. (a, b) Axial T1-weighted (a) and T2-weighted (b) MR images show a rounded cystic mass that includes fat and a solid component (arrow) with a palm tree-like appearance. (c) Axial fat-saturated T1-weighted MR image shows decreased signal intensity of the cystic component (arrows). (d) CT scan shows coarse calcifications (arrow).

View larger version (88K): [in a new window]   Figure 15a. Mature teratoma of the anterior mediastinum in a 29-year-old woman with no symptoms. A mediastinal mass was found at chest radiography. (a, b) Contrast-enhanced CT scans (a obtained cephalad to b) show a huge anterior mediastinal mass protruding into an interlobular fissure of the left lung. No calcification is seen in this case. (c) Photomicrograph (original magnification, x200; H-E stain) shows that the tumor contains a liquid-like pancreatic juice produced by mature pancreatic glands within the tumor.

View larger version (100K): [in a new window]   Figure 15b. Mature teratoma of the anterior mediastinum in a 29-year-old woman with no symptoms. A mediastinal mass was found at chest radiography. (a, b) Contrast-enhanced CT scans (a obtained cephalad to b) show a huge anterior mediastinal mass protruding into an interlobular fissure of the left lung. No calcification is seen in this case. (c) Photomicrograph (original magnification, x200; H-E stain) shows that the tumor contains a liquid-like pancreatic juice produced by mature pancreatic glands within the tumor.

View larger version (158K): [in a new window]   Figure 15c. Mature teratoma of the anterior mediastinum in a 29-year-old woman with no symptoms. A mediastinal mass was found at chest radiography. (a, b) Contrast-enhanced CT scans (a obtained cephalad to b) show a huge anterior mediastinal mass protruding into an interlobular fissure of the left lung. No calcification is seen in this case. (c) Photomicrograph (original magnification, x200; H-E stain) shows that the tumor contains a liquid-like pancreatic juice produced by mature pancreatic glands within the tumor.

View larger version (116K): [in a new window]   Figure 16a. Immature teratoma of the ovary in a 2-year-old girl with abdominal swelling and abdominal pain during defecation. (a, b) Axial T2-weighted (a) and T1-weighted (b) MR images show a huge solid mass with scattered fat and calcification in the supravesical inframesocolic space. (c) Axial fat-saturated T1-weighted MR image shows intense enhancement of the solid component. (d) Photomicrograph (original magnification, x400; H-E stain) of the resected specimen shows that the solid component is composed of immature neuroectodermal tissue, which forms primitive intraepithelial rosettes and tubules. Scattered fat, which has been reported to be a sign of immature elements and consists of well-differentiated fatty tissue, was visible at microscopy.

View larger version (123K): [in a new window]   Figure 16b. Immature teratoma of the ovary in a 2-year-old girl with abdominal swelling and abdominal pain during defecation. (a, b) Axial T2-weighted (a) and T1-weighted (b) MR images show a huge solid mass with scattered fat and calcification in the supravesical inframesocolic space. (c) Axial fat-saturated T1-weighted MR image shows intense enhancement of the solid component. (d) Photomicrograph (original magnification, x400; H-E stain) of the resected specimen shows that the solid component is composed of immature neuroectodermal tissue, which forms primitive intraepithelial rosettes and tubules. Scattered fat, which has been reported to be a sign of immature elements and consists of well-differentiated fatty tissue, was visible at microscopy.

View larger version (117K): [in a new window]   Figure 16c. Immature teratoma of the ovary in a 2-year-old girl with abdominal swelling and abdominal pain during defecation. (a, b) Axial T2-weighted (a) and T1-weighted (b) MR images show a huge solid mass with scattered fat and calcification in the supravesical inframesocolic space. (c) Axial fat-saturated T1-weighted MR image shows intense enhancement of the solid component. (d) Photomicrograph (original magnification, x400; H-E stain) of the resected specimen shows that the solid component is composed of immature neuroectodermal tissue, which forms primitive intraepithelial rosettes and tubules. Scattered fat, which has been reported to be a sign of immature elements and consists of well-differentiated fatty tissue, was visible at microscopy.

View larger version (169K): [in a new window]   Figure 16d. Immature teratoma of the ovary in a 2-year-old girl with abdominal swelling and abdominal pain during defecation. (a, b) Axial T2-weighted (a) and T1-weighted (b) MR images show a huge solid mass with scattered fat and calcification in the supravesical inframesocolic space. (c) Axial fat-saturated T1-weighted MR image shows intense enhancement of the solid component. (d) Photomicrograph (original magnification, x400; H-E stain) of the resected specimen shows that the solid component is composed of immature neuroectodermal tissue, which forms primitive intraepithelial rosettes and tubules. Scattered fat, which has been reported to be a sign of immature elements and consists of well-differentiated fatty tissue, was visible at microscopy.

View larger version (118K): [in a new window]   Figure 17a. Immature teratoma of the mediastinum in an 11-year-old boy with a persistent cough and fever. Chest radiograph (a) and contrast-enhanced CT scan (b) show a huge mass with a clear margin that extends into both sides of the mediastinum. (Compare the mature teratoma with unilateral protrusion in Fig 15.) On the CT scan (b), some fatty components (black arrows) and linear calcifications (white arrow) are scattered throughout the solid component, which is heterogeneously enhanced.

View larger version (122K): [in a new window]   Figure 17b. Immature teratoma of the mediastinum in an 11-year-old boy with a persistent cough and fever. Chest radiograph (a) and contrast-enhanced CT scan (b) show a huge mass with a clear margin that extends into both sides of the mediastinum. (Compare the mature teratoma with unilateral protrusion in Fig 15.) On the CT scan (b), some fatty components (black arrows) and linear calcifications (white arrow) are scattered throughout the solid component, which is heterogeneously enhanced.

View larger version (151K): [in a new window]   Figure 18a. Immature teratoma of the sacrococcygeal region in a female neonate. The tumor was discovered at birth. (a, b) Sagittal T2-weighted (a) and T1-weighted (b) MR images show a heterogeneous multiloculated mass with a clear margin. There are some cystic components, which include serous fluid. In the anterior part of the tumor, small amounts of fatty tissue are evident (arrow). No calcification or solid component is seen in this case. (c) Photomicrograph (original magnification, x200; H-E stain) of the resected specimen shows a small amount of immature neural tissue.

View larger version (134K): [in a new window]   Figure 18b. Immature teratoma of the sacrococcygeal region in a female neonate. The tumor was discovered at birth. (a, b) Sagittal T2-weighted (a) and T1-weighted (b) MR images show a heterogeneous multiloculated mass with a clear margin. There are some cystic components, which include serous fluid. In the anterior part of the tumor, small amounts of fatty tissue are evident (arrow). No calcification or solid component is seen in this case. (c) Photomicrograph (original magnification, x200; H-E stain) of the resected specimen shows a small amount of immature neural tissue.

View larger version (166K): [in a new window]   Figure 18c. Immature teratoma of the sacrococcygeal region in a female neonate. The tumor was discovered at birth. (a, b) Sagittal T2-weighted (a) and T1-weighted (b) MR images show a heterogeneous multiloculated mass with a clear margin. There are some cystic components, which include serous fluid. In the anterior part of the tumor, small amounts of fatty tissue are evident (arrow). No calcification or solid component is seen in this case. (c) Photomicrograph (original magnification, x200; H-E stain) of the resected specimen shows a small amount of immature neural tissue.