Teratomas are embryonal neoplasms arising from totipotential cells that contain tissue from at least BALNK germ cell layers (endoderm, mesoderm, ectoderm)?

1.   ?    At least one
2.   ?    At least 2
3.   ?    At least 3

Totipotential cells are usually found near what in the early embryo?

1.   ?    Neural crest
2.   ?    Hensen's node
3.   ?    Foregut

An excessive rate of what (10 percent), is noted in families with sacrococcygeal teratoma?

1.   ?    Soft tissue sarcoma
2.   ?    Twins
3.   ?    Vertebral anomalies
4.   ?    Crossed fused renal ectopia

Where do gonadal germ cell tumors derive from?

1.   ?    Hensen's node
2.   ?    Kultichinsky cells
3.   ?    Urogential ridge

Ovarian teratomas invariably have female markers, while male testicular tumors may have BLANK markers?

1.   ?    Male
2.   ?    Female
3.   ?    Either
4.   ?    Neither

Teratomas tend to occur in the midline; what percent are benign verusus malignant?

1.   ?    20 percent benign
2.   ?    40 percent benign
3.   ?    60 percent benign
4.   ?    80 percent benign

Teratoma in younger patients or in infants are usually what?

1.   ?    Gonadal
2.   ?    Extragonadal

Teratoma is predominately in females: what is the percentage?

1.   ?    60 percent female
2.   ?    80 percent female
3.   ?    90 percent female

T or F: More histologically immature teratomas tend to be larger, more aggressive, and with a higher risk of recurrence and malignant changes?

1.   ?    True
2.   ?    False

Yolk sac tumors (endodermal sinus tumors) have the appearance of extraembryonic tissues (chorion, amnion, allantois) and are lined by a glomerula - like structures - BLANK bodies?

1.   ?    Howell-Jolley
2.   ?    Hurthle
3.   ?    Schiller-Duval
4.   ?    Mesangiomas

What tumor type contains intracellular droplets that are PAS-Schiff positive and composed of alpha-fetoprotein?

1.   ?    Yolk sac (endodermal sinus tumors)
2.   ?    Teratomas
3.   ?    Choriocarcinomas
4.   ?    Seminomas

True or false: extrarenal Wilm’s tumors may arise from the renal elements within a teratoma?

1.   ?    True
2.   ?    False

What is the most common site of childhood teratoma?

1.   ?    Retroperitoneal
2.   ?    Sacrococcygeal
3.   ?    Mediastinal
4.   ?    Ovary

T or F: germ cells may form tumors composed of both teratomas and dygerminomatous elements?

1.   ?    True
2.   ?    False

What does alpha-fetoprotein come from?

1.   ?    Fetal intestine
2.   ?    Fetal liver
3.   ?    Yolk sac
4.   ?    All of the above

Alpha-fetoprotein levels are elevated in normal healthy newborns and fall to normal by what age?

1.   ?    1 motnh
2.   ?    3 months
3.   ?    6 months
4.   ?    9 months

How soon after teratoma resection does the alpha-fetoprotein return to normal?

1.   ?    24 - 48 hrs
2.   ?    4 - 5 days
3.   ?    2 - 3 weeks
4.   ?    3 - 4 months

What is the site of HCG production?

1.   ?    Yolk sac
2.   ?    Placenta
3.   ?    Fetal liver
4.   ?    Bone marrow

What lesions produce elevated beta HCG?

1.   ?    Testicular tumors
2.   ?    Gestational trophoblastic tumors
3.   ?    Hepatoma
4.   ?    Hepatoblastoma
5.   ?    Germinoma of the pineal gland
6.   ?    All the above

The risk of fetal hydrops or high output congestive heart failure is increased with large sacrococcygeal teratomas, particularly those larger than how many centimeters?

1.   ?    More than 5 cm
2.   ?    More than 7 cm
3.   ?    More than 10 cm

What percentage of sacrococcygeal teratomas have other associated anomalies?

1.   ?    10 - 15%
2.   ?    20 - 25%
3.   ?    50%
4.   ?    75%

Patients with associated neural tract or anal anomalies along with a sacrococcygeal teratoma often have what genetics?

1.   ?    CHOICE1
2.   ?    CHOICE1
3.   ?    CHOICE1
4.   ?    CHOICE1

Which is NOT in the differential diagnosis of sacrococcygeal teratoma?

1.   ?    Lipoma
2.   ?    Epidermoid cyst
3.   ?    Rectal duplication
4.   ?    Wandering spleen

Within the classification system for sacrococcygeal teratoma, what is the most common type?

1.   ?    Entirely presacral
2.   ?    Mostly internal
3.   ?    External/internal
4.   ?    External

Failure to remove the coccyx is associated with what percent increased incidence of recurrence in a sacrococcygeal teratoma?

1.   ?    10 percent recurence
2.   ?    20 percent recurrence
3.   ?    35 percent recurrence
4.   ?    55 percent recurrence

What percent of sacrococcygeal teratomas in newborns are benign?

1.   ?    More than 95 percent
2.   ?    More than 75 percent
3.   ?    More than 50 percent
4.   ?    More than 25 percent

What type of malignancy is seen with sacrococcygeal teratoma?

1.   ?    Choriocarcinoma
2.   ?    Germ cell
3.   ?    Embryonal carcinoma
4.   ?    Yolk sac tumors
5.   ?    All of the above

If primary malignant sacrococcygeal teratoma is initially unresectable, complete resection after chemotherapy is rarely possible: true or false?

1.   ?    True
2.   ?    False

Five-year survival from nongonadal malignant germ cell tumors is what?

1.   ?    90 percent
2.   ?    75 percent
3.   ?    50 percent
4.   ?    25 percent

Mediastinal teratoma accounts for what percent of all mediastinal tumors in children?

1.   ?    5 percent
2.   ?    10 percent
3.   ?    20 percent
4.   ?    50 percent

Some mediastinal tumors in boys make HCG. This is associated with precocious puberty and what else?

1.   ?    Chr 5 to 12 translocation
2.   ?    Klinefelters syndrome
3.   ?    Sertoli-Leydig tumors
4.   ?    Meig's syndrome

The presence of what in an anterior mediastinal tumor means teratoma until proven otherwise?

1.   ?    Embryonal rests
2.   ?    Calcification
3.   ?    Chief cells
4.   ?    Hassles corpuscles

What percent of mediastinal teratomas are malignant?

1.   ?    5 - 10 percent
2.   ?    15 - 20 percent
3.   ?    45 - 50 percent
4.   ?    60 - 75 percent

How are most anterior mediastinal teratomas removed?

1.   ?    Left thoracotmy
2.   ?    Right Thoracotomy
3.   ?    Median Sternotomy

The presence of immature cellular elements in a mediastinal teratoma in infants has what significance?

1.   ?    It is not significant
2.   ?    Better outcome
3.   ?    Worse outcome

The same findings in teenagers and young adults indicates what?

1.   ?    It is not significant
2.   ?    Better outcome
3.   ?    Worse outcome

What percentage of primary intrapericardial tumors (teratomas) arise in newborns?

1.   ?    10 percent
2.   ?    25 percent
3.   ?    35 percent
4.   ?    55 percent

When do intrapericardial teratomas arise from?

1.   ?    AV valves
2.   ?    Papillary muscle
3.   ?    Base of the descending aorta
4.   ?    Pericardial sinus

Cardiac teratomas are found exclusively in?

1.   ?    Boys
2.   ?    Girls

Retroperitoneal teratoma accounts for what percent of teratomas?

1.   ?    Less than 1 percent
2.   ?    About 5 percent
3.   ?    10 percent

What age do retroperitoneal teratoma usually occur?

1.   ?    Most under age 6 months
2.   ?    Most under 1 year
3.   ?    Most under 2 years
4.   ?    Most under 5 years

True or false: Retroperitoneal teratomas are usually small?

1.   ?    True
2.   ?    False

The presence of WHAT differentiates the fetus in fetu from a teratoma?

1.   ?    Axial skeleton
2.   ?    True organogenesis
3.   ?    Both
4.   ?    Neither

What percentage of retroperitoneal teratomas are malignant at the time of diagnosis?

1.   ?    5 percent
2.   ?    10 percent
3.   ?    20 percent
4.   ?    50 percent

Intracranial teratomas account for what percentage of brain tumors in the first two months of life?

1.   ?    5 percent
2.   ?    10 percent
3.   ?    25 percent
4.   ?    50 percent

The majority of intracranial teratomas in older children and young adults are malignant or benign?

1.   ?    Mostly benign
2.   ?    Mostly malignant

T or F: The most common symptoms of an intracranial teratoma in an infant are due to increased intracranial pressure due to obstructive hydrocephalus?

1.   ?    True
2.   ?    False

T or F: Overall survival with an intracranial teratoma is quite good.

1.   ?    True
2.   ?    False

Which is TRUE regarding teratomas of the oropharynx?

1.   ?    Mostly occurs in older children
2.   ?    May involve the tongue or palate
3.   ?    Mostly malignanat
4.   ?    Recurremce is common

Cervical teratomas (1.5 percent of all teratomas) have an increased incidence of all EXCEPT what?

1.   ?    Teratomas elsewhere
2.   ?    Airway problems at birth
3.   ?    Maternal polyhydramnios
4.   ?    Prematurity and stillbirth

True or false: cervical teratoma is almost always benign in infants?

1.   ?    True
2.   ?    False

What fraction of cervical teratomas contain thyroid tissue?

1.   ?    one-half
2.   ?    one-fourth
3.   ?    one-third
4.   ?    one-tenth

What is the incidence of malignancy in adult cervical teratoma?

1.   ?    About 10%
2.   ?    About 25%
3.   ?    More than 60%
4.   ?    About 90%

Gastric teratoma is more common in boys or girls?

1.   ?    Boys
2.   ?    Girls

Gastric teratomas are usually (small or large) and often multicystic?

1.   ?    Small
2.   ?    Large

Vaginal teratoma is rare and usually presents at what age?

1.   ?    Neonatal period
2.   ?    Infancy
3.   ?    5 to 10 years of age
4.   ?    Adolescence

The most common ovarian tumor in childhood is what?

1.   ?    Fibroid
2.   ?    Teratoma
3.   ?    Cystadenoma
4.   ?    Dysgerminoma

What is the most common symptom of ovarian teratoma?

1.   ?    Torsion
2.   ?    Abdominal pain
3.   ?    Fever and vomiting
4.   ?    Irregular menses

What is the treatment of ovarian teratoma?

1.   ?    Bilateral salpingoopherectomy
2.   ?    Wedge resection
3.   ?    Enucleation and bivavle contralateral ovary
4.   ?    Unilateral salpingoopherectomy

Immature teratomas have malignant potential-what types need chemotherapy?

1.   ?    Grade 1
2.   ?    Grade 2 and above
3.   ?    Grade 3 and above

Most girls with ovarian teratoma and extraovarian glial implants have what type of clinical course?

1.   ?    Rapidly progressive
2.   ?    Benign clinical course

What is the overall survival for malignant germ cell tumors of the ovary?

1.   ?    10 percent
2.   ?    25 percent
3.   ?    45 percent
4.   ?    70 percent

What is the most common pediatric testicular tumor?

1.   ?    Yolk sac tumor
2.   ?    Seminoma
3.   ?    Teratoma
4.   ?    Embryonal cell

T or F: There are 2 peak ages for testicular teratoma - less than 2 years and adolescent / young adults?

1.   ?    True
2.   ?    False

Which is NOT a common symptom of testicular teratoma?

1.   ?    Weight loss
2.   ?    Hydrocele
3.   ?    Painless mass

What is the treatment of stage 1 testicular teratoma?

1.   ?    Radical orchiectomy only
2.   ?    Radical orchiectomy plus retroperitoneal lymph node dissection
3.   ?    Radical orchiectomy and chemotherapy

Most malignant tumors in the testicle of infants are of what type?

1.   ?    Teratoma
2.   ?    Yolk sac tumors
3.   ?    Seminoma

T or F: If tumor markers (alpha-fetoprotein and HCG) do not go back to normal after orchiectomy, it implies Stage B or C?

1.   ?    True
2.   ?    False

True or false: a unilateral retroperitoneal lymph node dissection is not as good as a bilateral dissection?

1.   ?    True
2.   ?    False