Department of Diagnostic Pathology, Kobe University Hospital, Kobe, Japan.
Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Pathol Int. 2021 Nov;71(11):771-776. doi: 10.1111/pin.13156. Epub 2021 Sep 2.
We herein report three cases of mature teratomas with pineal gland differentiation, which is a less recognized phenomenon. Case 1 was a 6-year-old male with a neck mass, Case 2 was a 23-year-old female with a retroperitoneal mass, and Case 3 was a 45-year-old female with a retroperitoneal mass. Each case showed the typical macroscopic and histological findings of mature teratoma, such as solid and cystic lesions mainly lined with a mature squamous epithelium. All cases also showed glial differentiation. Small foci of lobulated cell nests were detected in the center of or adjacent to mature glial tissue. Cells had a clear to pale eosinophilic cytoplasm with small round nuclei. Immunohistochemically, cells were positive for synaptophysin, neurofilament protein with a perivascular "club-shaped swelling" pattern, and cone-rod homeobox protein. To the best of our knowledge, this is the first report of pineal gland differentiation arising in mature teratoma, which may be easily overlooked or misdiagnosed as somatic-type tumors, particularly neuroendocrine tumors. To avoid overtreatment, pathologists need to be aware that pineal gland differentiation may occur in mature teratomas.
我们在此报告三例具有松果体分化的成熟畸胎瘤病例，这是一种不太被认识的现象。病例 1 为 6 岁男性，颈部有一肿块；病例 2 为 23 岁女性，腹膜后有一肿块；病例 3 为 45 岁女性，腹膜后有一肿块。每个病例均表现出成熟畸胎瘤的典型大体和组织学特征，如主要由成熟鳞状上皮衬覆的实性和囊性病变。所有病例均显示出神经胶质分化的特征。在成熟神经胶质组织的中心或附近检测到小灶状分叶状细胞巢。细胞具有清晰到淡嗜酸性细胞质和小圆形核。免疫组织化学染色显示，细胞突触素、神经丝蛋白呈血管周围“棒状肿胀”模式阳性，以及 cone-rod homeobox protein 阳性。据我们所知，这是首例报告在成熟畸胎瘤中出现的松果体分化，这种情况可能容易被忽视或误诊为体节样肿瘤，特别是神经内分泌肿瘤。为避免过度治疗，病理学家需要意识到松果体分化可能发生在成熟畸胎瘤中。
