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: Last summer, I went to a podiatrist, who did an ultrasound on both of my feet. He concluded that I have Morton’s neuroma in both feet. He recommended three options: Cut the nerve and have a possible stump grow back, which didn’t sound very appealing; freeze, then shoot alcohol once a week for seven weeks; or do a ligament release, which seems to be the best option.

I cannot get a single doctor to provide me a referral of one person with a successful ligament release. They all cite privacy issues.

My question is, Since my situation is getting worse — feet numbing, etc. (I do not have diabetes) — would you have a surgery without any validation of its success from someone who had that surgery? — L.

ANSWER: An interdigital, or Morton’s, neuroma is a localized swelling, usually between the third and fourth toes, which causes pain or numbness. It is thought to be due to nerve damage at the nerve ending. It usually is diagnosed by ultrasound.

In my opinion, conservative management is best for Morton’s neuroma, unless surgery is absolutely necessary. Reducing pressure on the area by using an orthotic, metatarsal support or padded shoe insert usually relieves symptoms. Sometimes foot exercises are recommended also.

If conservative management doesn’t relieve pain, most authorities recommend a single injection of steroid and topical anesthetic. Most people get relief from the injection.

If all else fails, both ligament release and removal of the damaged nerve area have been shown to be very effective. I personally wouldn’t insist on a reference from a patient. My concern is that you might not have had a sufficient trial of conservative treatment to avoid surgery.

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 or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

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