Immature gastric teratoma in an infant: a case report and review of the literatures

Spontaneous rupture of immature gastric teratoma with hemoperitoneum in a newborn with 3-year follow-up

Among the subtypes of germ cell tumors, teratomas are the most frequent in the pediatric population and commonly occur in the sacrococcygeal region and the gonads. Less than 1% of all teratoma are found in abdominal organs including the stomach, liver, and kidney. Gastric teratomas are very rare tumors predominantly found in infants. Moreover, an immature gastric teratoma is exceptionally rare. Here, we present a case of immature gastric teratoma with spontaneous rupture in a newborn who was preoperatively diagnosed with neuroblastoma. On the first day after birth, the neonate presented with progressive abdominal distension accompanying respiratory distress. A firm mass was detected during a physical examination of the abdomen. An emergency exploratory laparotomy revealed hemoperitoneum resulting from a rupture of the tumor located in the posterior wall of the gastric antrum. Complete resection of the tumor and gastroduodenostomy were performed. The pathology evaluation revealed a grade 3 immature gastric teratoma with no malignant components. The patient was treated with adjuvant chemotherapy to prevent recurrence, since the tumor was ruptured in the abdominal cavity and the level of alpha-fetoprotein was decreased but still remained high above the normal range after surgery. In conclusion, physicians should be aware of the existence of gastric teratoma as the differential diagnosis of a huge abdominal mass in infants, especially neonates. Complete surgical removal of the tumor and long-term follow-up has been adopted as the standard management for immature gastric teratoma, although there has been controversy with adjuvant chemotherapy.

Hydrops fetalis and neonatal abdominal compartment syndrome continuum from immature gastric teratoma: a case report

Background

Hydrops fetalis as well as abdominal compartment syndrome (ACS) are conditions that are associated with high mortality rates. A rare case of immature gastric teratoma causing fetal hydrops and subsequent ACS is presented. The related pathophysiologic mechanisms are discussed, and the importance of timely recognition and appropriate interventions are highlighted.

Case presentation

The male patient was born preterm, weighing 3.9 kg., by Cesarean section. Prior prenatal ultrasounds were normal, but a scan done just before delivery had findings indicating polyhydramnios, fetal ascites, and meconium peritonitis. Upon delivery, the patient had respiratory distress, anasarca and a massively distended abdomen. Resuscitation measures, including ventilatory support, were instituted. Imaging studies showed ascites as well as a large, complex intra-abdominal lesion with calcifications. In the succeeding hours, anuria persisted, anasarca worsened, the abdomen became more distended, and inotrope requirements increased. The occurrence of ACS, from what was presumed to be a retroperitoneal teratoma, was therefore considered. Laparotomy was done on the 28th hour of life, with en bloc excision of a massive tumor and attached section of the greater curvature of the stomach. Passage of urine occurred intra-operatively, and the patient was soon after weaned off inotropes and ventilator support. The histopathologic result was immature gastric teratoma. No chemotherapy was given, and the patient’s serum AFP is at normal levels 15 months following surgery.

Conclusion

The presence of a massive intra-abdominal lesion can result in the pathophysiologic continuum of hydrops fetalis and neonatal ACS. The early recognition of such an association can enable appropriate expectant management of similarly affected neonates, including emergent decompression laparotomy.

Case series: Five pediatric germ cell/sex cord stroma tumors

•

This report consists of five pediatric tumors of ovarian cell lineage.

•

These unusual, interesting tumors challenge both surgeon and oncologist.

•

Some appear malignant, seemingly require chemotherapy, but behave with benignity. Some are easily resected; others demand the utmost skill.

•

Complexity perplexes; elucidation is by selection – ignoring some things, attending to others.

•

Case studies illustrate – for good or ill – the process whereby clinical conundrums are resolved.

Multimodal depiction of a rare immature gastric teratoma from fetus to infant

Immature gastric teratomas are rare gastrointestinal tumors. Presented here are imaging findings of this neoplasm which was first seen via antenatal ultrasound. Subsequent fetal magnetic resonance imaging demonstrated a partially calcified mass that contained areas of diffusion restriction. Meconium pseudocyst was originally entertained as a differential consideration. Follow-up computed tomography and upper gastrointestinal fluoroscopy after delivery revealed a bilobed mass that was at least partially endogastric. Resection was performed, and the diagnosis was uncovered via histologic analysis.