Dados do Trabalho

Título

A primary retroperitoneal mature teratoma in an adult

Apresentação do caso

A 25-year-old woman, with a past medical history of refractory right lower back pain, without any specific signs and symptoms, and was referred to the surgical clinic. She denied any associated symptoms including fever, loss of appetite, weight loss, nausea or vomiting. Her physical examination was unremarkable. A previous computed tomography (CT) scan of the abdomen revealed a 7.7cm x 3.7cm x 6.0 cm retroperitoneal heterogeneous mass, extending from the posterior aspect of the pancreas, reaching the aorta and inferior vena cava, composed of calcifications and fatty elements. CEA and CA19–9 were normal. Upon routine follow-up another CT scan was performed and no signs of progression or enlargement of the tumor was detected, but the diagnostic appearance of a liposarcoma was suggested. Therefore, after multidisciplinary discussion, we opted for surgical treatment. The patient underwent laparotomy and on peritoneal cavity inventory there were no signs of metastases or ascites. A complex retroperitoneal mass, roughly shaped as a thyroid gland, was observed closed to the hepatic hilum, reaching the posterior aspect of the stomach. On the right, in intimate contact with the inferior vena cava and close to the right kidney’s vessels, on the left, involving the posterior abdominal wall and left adrenal gland. Connecting the two sides, the tumor’s isthmus sited loosely adhered to the celiac trunk. The tumor was separated from the noble structures and the mass was totally excised and sent to the lab for pathologic evaluations. The postoperative recovery progressed satisfactorily and after four days, she was discharged home.

Discussão

Pathology assessment reported a mature teratoma with no evidence of malignancy. Extragonadal teratomas represent 15% of all cases, and retroperitoneal ones are even more rare. These masses are commonly asymptomatic and incidentally found on routine examinations. Surgical resection is the mainstay treatment and prognosis is excellent after surgical removal. Radiographic evaluations are of great importance due to their diagnostic roles and contribution in planning the surgical treatment.

Comentários Finais

Retroperitoneal teratomas in adults are very rare and to date, only a few cases have been reported. Similar to other true primary retroperitoneal teratomas in adults it was located in above the left kidney, and extending to retrohepatic vena cava. Therefore, we presented a case with a very rare entity.

Palavras-chave

Teratoma, retroperitoneal neoplasms, surgical oncology.