Giant mature adrenal cystic teratoma in an infant

Mature Teratoma of Posterior Mediastinum in a Newborn: A Case Report

Teratomas are germ cell tumors that can appear in different parts of the body, most often in the ovaries or testes. Treatment depends on whether the tumor is mature or immature: mature teratomas are usually removed surgically, while immature ones often require chemotherapy as well. Teratomas located in the mediastinum, particularly in the back part (posterior mediastinum), are rare. These tumors are typically discovered by chance during imaging exams, and only a few cases cause noticeable symptoms. In this report, we describe a rare case involving a 9-day-old female newborn with no prior medical issues, who was brought to the pediatric emergency department with acute breathing difficulties. Her condition required admission to the neonatal intensive care unit due to respiratory failure. On examination, she had signs of respiratory distress, including a Silverman score of 6/10, fast breathing, and low oxygen levels. A chest X-ray revealed a mass in the left side of her chest, causing a shift in the mediastinum. A CT scan of the chest confirmed the presence of a large mass with both solid and cystic components in the posterior mediastinum, suggesting a mature teratoma. The baby underwent successful surgery to remove the tumor. Pathology confirmed it was a mature teratoma, showing a mass made up of different tissue types but no glial tissue. Her recovery went smoothly, with no complications during follow-up. This case underscores how unusual it is for newborns to have symptomatic mature teratomas in the mediastinum. It also highlights the importance of considering this diagnosis in infants with breathing problems and shows that early surgical treatment can lead to a good outcome.

Case Report: A rare case of antenatally diagnosed mature adrenal teratoma in an infant: insights and literature review

Teratomas are germ cell tumors that arise from the derivatives of the three germ cell layers. They are categorized into subtypes by the extent of maturation, with mature teratomas being the most common subtype. While they can arise in various extragonadal regions, including the retroperitoneum, their occurrence in the retroperitoneal space is extremely rare. It is even more exceptional for these tumors to be located within the adrenal gland. In this report, we describe an 18-day-old female infant who presented with a left suprarenal mass. The mass was detected during prenatal screening via ultrasound at 30 weeks of pregnancy. Evaluation after birth, including a chest and abdomen computed tomography (CT) scan, revealed a large, well-defined left suprarenal mass. The mass was surgically resected and found to measure 9 cm × 7 cm × 5 cm. Histopathological examination confirmed a cystic mature teratoma containing a variety of well-differentiated tissues. The patient has shown excellent progress over the 1-year follow-up, with no evidence of recurrence. Only a few cases of mature adrenal teratoma have been reported, highlighting the importance of this case report.

Primary adrenal teratoma in an infant: A case report and literature review

INTRODUCTION

Teratomas are germ cell neoplasms arising from the totipotent stem cells. Retroperitoneal teratomas are very rare, accounting for about 5 % of all teratomas of those, primary adrenal ones are exceedingly rare, with few cases reported in the English literature in pediatric age group.

CASE PRESENTATION

A nine-month-old female presented with a two-month history of gradually increasing abdominal distention, her physical examination revealed a palpable large abdominal mass. Abdominal CT imaging showed a right suprarenal heterogeneous mass. Oncological resection was performed, and histopathology confirmed a primary mature adrenal teratoma.

DISCUSSION

The diagnosis of primary adrenal teratoma is usually challenging and relies predominantly on imaging studies, and histopathological finding.

CONCLUSION

Primary adrenal teratoma is extremely rare in pediatric age group, and present a significant diagnostic challenge, as a result it should be considered in the differential diagnosis of pediatric patients with adrenal masses.

A giant teratoma in the anterior mediastinum found prenatally: A case report

Prenatal anterior mediastinal teratomas are rare. Anterior mediastinal teratomas can cause edema during the perinatal period. Color Doppler ultrasonography and chest computed tomography (CT) are of great value in diagnosing neonatal anterior mediastinal teratomas. Here, we report a case of prenatally diagnosed neonatal anterior mediastinal teratoma. After birth, transthoracic echocardiography and chest enhanced CT showed a large solid mass in the pericardial cavity. Owing to compression of the heart, the tumor was completely removed 1 day after birth, and cardiopulmonary bypass was performed. Pathology results indicated an immature teratoma (Grade I). At 9-month follow-up, the patient remained in good overall condition without observed recurrences.

Teratoma involving adrenal gland - A case report and review of literature

Teratomas are germ cell tumors which are mainly gonadal in origin. Other common extra-gonadal sites are mediastinal, sacro-coccygeal and pineal regions. Adrenal teratomas are extremely rare and primary adrenal teratomas are even rarer. We reported a case of primary adrenal teratoma in a 60-year-old male. We reviewed literature from 2000 to till date, and found 29 adult cases and 6 paediatric cases of adrenal teratoma. Usually, they are asymptomatic and identified as an incidental finding. Imaging modality such as USG, CT and MRI are useful in diagnosis. Though these tumors are mostly benign, malignant transformation may occur. Treatment includes surgical removal.

Primary adrenal teratoma: An unusual tumor - Challenges in diagnosis and surgical management

We report a rare case of a 25-year-old lady who presented with right hypochondriac pain associated with weakness for 3 months. Her hormonal evaluation was normal. Computed tomography scan revealed an adrenal mass for which a right open transperitoneal adrenalectomy was performed, and the lesion was diagnosed as mature teratoma on histopathological examination. Teratoma is an unusual neoplasm which arises from one or all the three germ layers. Extragonadal teratomas are rare in adults as compared to children and are mostly retroperitoneal in location, constituting only 4% of all primary teratomas. Primary adrenal teratomas are even rarer and to the best of our knowledge, only eight cases have been reported in adults in the past 10 years. Adrenal teratoma can pose a diagnostic challenge because radiologically it mimics myelolipoma, angiomyolipoma, liposarcoma, or pheochromocytoma. Mature teratomas are usually benign but may possess malignant potential, the chances of which are greater in adults as compared to children, making it an important entity requiring a proper diagnosis and management.

Primary adrenal teratoma: A case series and review of the literature

Primary adrenal teratoma is a rare type of cancer. Of the 338 patients who underwent adrenalectomy during this study, only 2 (aged 69 and 29 years) were diagnosed with adrenal teratoma and underwent laparoscopic retroperitoneal adrenalectomy. For the purposes of the present study, the term 'adrenal teratoma' was searched in the PubMed database, and 237 articles published between June 1952 and March 2017 were retrieved. However, we were only able to identify 10 relevant studies. In total, these studies reported a series of 18 cases of primary adrenal teratoma in patients aged >16 years, another 8 cases of adult adrenal retroperitoneal teratoma, and 7 cases of adrenal teratoma in children aged <16 years. In the 18 cases aged >16 years, the age range was 17-61 years (mean ± standard deviation, 33.06±15.47 years), the median tumor diameter was 8.25 cm and 13 patients (72.22%) were female. Almost all patients underwent laparoscopic surgery between 2006 and 2017 (75%). Among the 7 cases of adrenal teratoma in children under the age of 16 years, 5 cases (71.43%) were male, the median tumor diameter was 10 cm, the oldest patient was aged 8 years, 5 cases (71.43%) were selected for open surgical resection of the tumor, and 5 cases (71.43%) were followed up without recurrence or death. These data indicate that primary adrenal teratomas in children are rarer compared with adults. Although the data are limited, it was observed that the clinical symptoms of primary adrenal teratoma are not typical, the preferred treatment is retroperitoneal laparoscopic surgery, and the prognosis is favorable. The aim of the present study was to elucidate the clinical characteristics associated with primary adrenal teratoma, in order to further raise awareness of this rare disease.

Adrenal Teratoma: a Case Series and Review of the Literature

Adrenal teratomas are rare neoplasms and there is limited data on their surgical outcomes and long-term prognosis. We aimed to review our institutional experience and compare this to the existing literature on adrenal teratomas in adults and children. An institutional pathology database was searched for cases of adrenal teratoma (June 1956-July 2016). Clinical and imaging data were abstracted from the medical records and pathology slides were obtained for review. In addition, a PubMed search for "adrenal teratoma" from June 1952 to July 2016 was performed to identify reports of primary adrenal teratoma in patients of all ages. Of 7706 patients who underwent adrenalectomy during the study period at our institution, three patients were identified with adrenal teratoma. Patients were 24, 26, and 29 years of age, respectively. Two patients presented with abdominal pain and two of the three underwent a laparoscopic adrenalectomy. A pathologic examination revealed mature cystic teratomas that frequently displayed well-differentiated respiratory, digestive, and squamous epithelia. Eighteen case reports in the literature were identified in patients 17-61 years of age. Patients presented most frequently with abdominal or flank pain (63.6%). Median tumor diameter was 9.0 cm and tumors were frequently left-sided (81.8%), cystic (63.6%), and calcified (72.7%) on either radiologic or pathologic examination. Primary adrenal teratomas are rare neoplasms that typically present as large, left-sided nodules with cystic and calcified components seen radiographically. Although the data are limited, they are generally amenable to laparoscopic resection and have a very favorable prognosis.

A Rare Adrenal Mass in a 3-Month-Old: A Case Report and Literature Review

A three-month-old female infant presented with abdominal distention for 2 months. A large palpable mass in right upper quadrant was noted on physical exam. Abdominal ultrasound revealed a large heterogeneous mass with multiple cystic components. Mass was surgically excised and pathology was consistent with mature adrenal teratoma. Teratoma is a germ cell tumor mainly found in gonadal tissues. Occurrence of adrenal gland teratoma in children is very rare with less than 10 pediatric case reports in English literature. We present a rare case of primary adrenal tumor in an infant and a review of the literature.

Lipomatous tumours in adrenal gland: WHO updates and clinical implications

Adrenal lipomatous tumour is a group of adrenal tumours with a significant component of adipose tissue. According to the current World Health Organization (WHO) classification of tumours of endocrine organs, adrenal myelolipoma is the only entity amongst the group of tumours being described. In the literature, other more recently documented adrenal lipomatous tumours included 24 lipomas, 32 teratomas and 16 angiomyolipomas. Rare fatty tumours of the adrenal gland comprised liposarcoma, hibernoma, adrenocortical tumours with fat component and rare adrenal tumours with fat component. Myelolipoma comprises approximately 3% of primary adrenal tumour. It is noted more commonly in females and in the right adrenal gland. Approximately 40 bilateral myelolipomas were reported. The tumour is most frequently recorded in patients between fifth and seventh decades of life. Adrenal lipomas are often seen in males and in the right adrenal gland. They were commonly noted in patients in the sixth decade of life. The diagnosis could only be possible on examination of the surgically removed specimen. Adrenal teratomas were more common in females and with a bimodal age distribution. Slightly over 60% of the patients with adrenal teratoma are symptomatic. Adrenal angiomyolipomas were often symptomatic, more common in females and in the fifth decades of life. To conclude, adrenal lipomatous tumour is uncommon. They are often benign and non-functional. It is important to recognize the features of this group of lipomatous tumours in the adrenal gland as they are being detected on increasing incidence as a result of the wide-spread use of modern imaging modalities.

Giant adrenal germ cell tumour in a 59-year-old woman

Adrenal germ cell tumour is very rare. We report a case of a 59-year-old woman who presented with right flank discomfort. The laboratory examinations were normal and the chest computed tomography (CT) showed right pleural effusion. The abdominal CT scan revealed a large mass on the right adrenal gland. The patient underwent an adrenalectomy. Histopathologic examination and immunohistochemical findings were consistent with mixed germ cell tumour. Three months later following the operation, the patient was admitted to our hospital again with chest tightness and shortness of breath. The chest CT showed right pleural effusion recurrence and enlargement of mediastinal lymph nodes and right hilar lymph nodes. The patient had right supraclavicular lymphadenectasis on physical examination. Fine needle aspiration cytology from the supraclavicular lymph nodes showed groups of malignant tumour cells. The patient died within 6 months postoperatively. In this case, the lymph node pathway played an important role in the metastatic procedure.

"Looks Can Be Deceiving": Adrenal Teratoma Causing Diagnostic Difficulty

Teratomas are unusual tumours that derived from totipotent cells with their origin from more than one or usually all three germ cells. Here authors are presenting a case of primary retroperitoneal tumour that is a rare clinical entity. A 19-year-old male presented with right lumbar pain and was found to have complex cyst with large calcification in right adrenal gland on imaging. Intraoperatively, he was found to have a solid mass with areas of soft consistency, which was excised en bloc. On gross examination, the cyst contained pieces of bone, few teeth, and hairs entangled in mucinous material. On histological evaluation, it was confirmed to be mature teratoma arising from the right adrenal gland. He made uneventful recovery and was kept well on annual follow-up.