DEAR DR. ROACH: I had a CT scan due to broken ribs from a very recent fall. The scan revealed a large teratoma near my heart. I am 69 and was previously unaware of this formation. No suggestion has been given to me regarding further investigation or treatment of the teratoma. I am assuming it may have been present at birth and does not cause any problem. But now I am wondering if it should be monitored. Can a teratoma grow or migrate in the body? Any information on teratoma will be appreciated. — S.S.
ANSWER: A teratoma is a type of tumor of germ cells — the cells that become eggs or sperm. They can occur within the testis or ovary, but also can occur outside the gonads. When they do, they usually are found in the midline of the body. A frequent place is the anterior superior mediastinum, in between the lungs and below the breastbone. Teratomas usually are benign tumors, but some types can act like cancers.
Your tumor is unlikely to have been there since birth. Nobody knows whether the germ cell that became a teratoma properly went into the gonads during development, or whether the cell left the gonad and then became a tumor. It is clear, however, that men with teratoma outside the gonads are at higher risk for developing testicular cancer later on.
Teratomas, being derived from germ cells, are capable of creating any tissue. Teeth and hair are sometimes found inside teratomas.
I am very surprised you haven’t been recommended for surgical removal. Surgery is usually successful at curing teratoma. They certainly can grow, and occasionally become very large. I would certainly recommend seeing an oncologist (cancer specialist). Thoracic (chest) surgeons operate on this area. It may be that the position is difficult, but a surgeon should still evaluate you, in my opinion.
DEAR DR. ROACH: How it that, at age 67, I’d never heard about the abomination called scabies? Last year, I was rubbing cream onto my aged mother’s rash, and now I have this disgusting infestation on my body! Why haven’t people been advised of this scourge! — Anon.
ANSWER: Scabies, sometimes just called, “the itch,” is caused by the mite Sarcoptes scabiei, and is very common, with an estimated 300 million people infected worldwide. It is transmitted person-to-per- son by direct contact.
The major symptom of scabies is itching, often very severe and usually much worse at night. Itching begins about six weeks after the first infection, sooner if you have been infected before.
Often, the hardest part is figuring out the diagnosis, because a lot of people don’t know about this condition. When the rash is classic in distribution (belt line, under the arms, wrists, genitals and especially in the finger web spaces), most regular doctors and any dermatologist can figure it out.
Permethrin 5 percent cream (Elimite and others) over the entire body for eight to 14 hours is the standard treatment. Many physicians recommend a second treatment in one to two weeks. There is an oral medication as well. Clothing and bedding need to be disinfected, too.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@ med.cornell.edu. To view and order health pamphlets, visit www.rbmamall.com, or write to Good Health, 628 Virginia Drive Orlando, FL 32803.