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Gastric teratoma: The sixth reported case in a female infant
Gastric Teratoma: The Sixth Reported Case in a Female Infant By Jon S. Gengler, Keith W. Ashcraft, and Patrick Slattery Kansas City, Missouri • Teratomas are derived from tissues of all three germ layers. Gastric teratomas are rare and represent 1 % of all teratomas in boys. This report describes the sixth occurrence of gastric teratoma in a girl.
Copyright © 1995by W.B. Saunders Company INDEX WORDS: Teratoma, gastric; tumor, germ cell.
ASTRIC T E R A T O M A is an extremely rare tumor. It is almost exclusively found in men and boys. This is the sixth case of a teratoma arising from the stomach of a girl. Therapy consists of local excision, and the tumors are always benign.
G
CASE REPORT
A 1-month-old white female infant presented to Children's Mercy Hospital with a 4-day history of fever, irritability, and increased abdominal distension. She was the product of a full-term uncomplicated vaginal delivery. Her history was notable for significant reflux symptoms that prompted an upper gastrointestinal (UGI) examination at another institution and that was reported as negative. On the day of presentation, the infant was experiencing nonbilious emesis and had normal stools. Physical examination showed a pale, mottled, and moderately dehydrated infant. The abdomen was markedly distended, tender, and firm to palpation with no masses appreciated. A barium enema study from an outside institution was suggestive for midgut volvulus. An exploratory laparotomy showed a retrogastric mass in the area of the antrum with a 1.5-cm perforation of the posterior duodenum with cloudy peritoneal fluid. The tumor was adherent to the posterior wall of the stomach and distinct from the mesentery. This exogastric mass was then dissected in toto from the stomach, and the duodenal perforation closed primarily.
Fig 1. Gross photograph of the tumor showing irregular, nodular surface with solid and cystic areas and focal hemorrhage. Journal of Pediatric Surgery, Vo130, No 6 (June), 1995: pp 889-890
Fig 2. Histology of teratoma. Note predominance of neuroectoderreal tissue, including immature brain, respiratory epithelium, and fibroconnective tissue.
Pathological examination showed a nodular, grayish-white mass that measured 9.0 x 8.5 x 7.5 cm and weighed 500 g. Cut section showed cystic and solid areas. Microscopically, all three germ layers were present, with neuroectodermal components predominating, including immature and mature brain, retina, and choroid plexus. There were no malignant cells present (Figs I and 2). The infant recovered and was discharged uneventfully. DISCUSSION
The stomach is a rare site of origin for teratomas. The first gastric teratoma was described in 1922 by Eusterman and Sentry I in a 31-year-old male patient. Gastric teratomas account for < 1% of all childhood teratomas. There is a marked male preponderance, with only five reported cases occurring in female patients before this. 2 There has been no report of malignant gastric teratoma. 3 This is interesting in that teratomas in other sites occur predominately in female patients (68%), and that these other sites carry a 20% overall rate of malignancy.4-5 Gastric teratomas most commonly present with abdominal distension and a palpable mass 3 and can be a cause for upper gastrointestinal hemorrhage. 6 They can arise from any portion of the stomach, and are usually exogastric in nature. The teratomas that present with hemorrhage usually show a large intramural component. In our case, the exophytic tumor From the Department of Surgery, The Children's Mercy Hospital, Kansas City, MO. Address reprint requests to Keith IV..Ashcrafi, MD, Department of Surgery, The Children's Mercy Hospital, Kansas City, MO 64108. Copyright © 1995 by W.B. Saunders Company 0022-3468/95/3006-0030503.00/0 889
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had eroded through the posterior duodenum, and there was a 2.5-cm portion that protruded intraluminally. The histological pattern of this tumor consisted of immature neural elements that, according to one author, are exceedingly rare. 7 The treatment is complete local surgical excision.
A partial gastrectomy, or rarely, a total gastrectomy, is required depending on the degree of intramural growth. Follow-up consists of observation, although some surgeons recommend serial ot-fetoprotein measurements to monitor for malignant degeneration.
REFERENCES 1. Eusterman GB, Sentry EG: Benign tumors of the stomach: Report of twenty-seven cases. Surg Gynecol Obstet 34:372-378, 1922 2. Gangopadhyay AN, Pandit SK, Sinha A, et al: Gastric teratoma--Review of the literature. Indian J Pediatr 59:541-544, 1992 3. Matias IC, Huang YC: Gastric teratoma in infancy--Report of a case and review of the world literature. Ann Surg 178:631-636, 1973 4. Grosfeld JL, Ballantine TV, Lowe D, et al: Benign and
malignant teratomas in children: Analysis of 85 patients. Surgery 80:297-305, 1976 5. Haley T, Dimler M, Hollier P: Gastric teratoma with gastrointestinal bleeding. J Pediatr Surg 21:949-950, 1986 6. Cairo MS, Grosfeld JL, Wheetman RM: Gastric teratoma: Unusual case for bleeding of the upper gastrointestinal tract in the newborn. Pediatrics 67:721-724, 1981 7. Ravikumar VR, Ramkumar R, Lakshemana D, et al: Gastric teratoma in an infant. J Pediatr Surg 21:948, 1986
Copyright © 1995by W.B. Saunders Company INDEX WORDS: Teratoma, gastric; tumor, germ cell.
ASTRIC T E R A T O M A is an extremely rare tumor. It is almost exclusively found in men and boys. This is the sixth case of a teratoma arising from the stomach of a girl. Therapy consists of local excision, and the tumors are always benign.
G
CASE REPORT
A 1-month-old white female infant presented to Children's Mercy Hospital with a 4-day history of fever, irritability, and increased abdominal distension. She was the product of a full-term uncomplicated vaginal delivery. Her history was notable for significant reflux symptoms that prompted an upper gastrointestinal (UGI) examination at another institution and that was reported as negative. On the day of presentation, the infant was experiencing nonbilious emesis and had normal stools. Physical examination showed a pale, mottled, and moderately dehydrated infant. The abdomen was markedly distended, tender, and firm to palpation with no masses appreciated. A barium enema study from an outside institution was suggestive for midgut volvulus. An exploratory laparotomy showed a retrogastric mass in the area of the antrum with a 1.5-cm perforation of the posterior duodenum with cloudy peritoneal fluid. The tumor was adherent to the posterior wall of the stomach and distinct from the mesentery. This exogastric mass was then dissected in toto from the stomach, and the duodenal perforation closed primarily.
Fig 1. Gross photograph of the tumor showing irregular, nodular surface with solid and cystic areas and focal hemorrhage. Journal of Pediatric Surgery, Vo130, No 6 (June), 1995: pp 889-890
Fig 2. Histology of teratoma. Note predominance of neuroectoderreal tissue, including immature brain, respiratory epithelium, and fibroconnective tissue.
Pathological examination showed a nodular, grayish-white mass that measured 9.0 x 8.5 x 7.5 cm and weighed 500 g. Cut section showed cystic and solid areas. Microscopically, all three germ layers were present, with neuroectodermal components predominating, including immature and mature brain, retina, and choroid plexus. There were no malignant cells present (Figs I and 2). The infant recovered and was discharged uneventfully. DISCUSSION
The stomach is a rare site of origin for teratomas. The first gastric teratoma was described in 1922 by Eusterman and Sentry I in a 31-year-old male patient. Gastric teratomas account for < 1% of all childhood teratomas. There is a marked male preponderance, with only five reported cases occurring in female patients before this. 2 There has been no report of malignant gastric teratoma. 3 This is interesting in that teratomas in other sites occur predominately in female patients (68%), and that these other sites carry a 20% overall rate of malignancy.4-5 Gastric teratomas most commonly present with abdominal distension and a palpable mass 3 and can be a cause for upper gastrointestinal hemorrhage. 6 They can arise from any portion of the stomach, and are usually exogastric in nature. The teratomas that present with hemorrhage usually show a large intramural component. In our case, the exophytic tumor From the Department of Surgery, The Children's Mercy Hospital, Kansas City, MO. Address reprint requests to Keith IV..Ashcrafi, MD, Department of Surgery, The Children's Mercy Hospital, Kansas City, MO 64108. Copyright © 1995 by W.B. Saunders Company 0022-3468/95/3006-0030503.00/0 889
GENGLER, ASHCRAFT, AND SLATrERY
890
had eroded through the posterior duodenum, and there was a 2.5-cm portion that protruded intraluminally. The histological pattern of this tumor consisted of immature neural elements that, according to one author, are exceedingly rare. 7 The treatment is complete local surgical excision.
A partial gastrectomy, or rarely, a total gastrectomy, is required depending on the degree of intramural growth. Follow-up consists of observation, although some surgeons recommend serial ot-fetoprotein measurements to monitor for malignant degeneration.
REFERENCES 1. Eusterman GB, Sentry EG: Benign tumors of the stomach: Report of twenty-seven cases. Surg Gynecol Obstet 34:372-378, 1922 2. Gangopadhyay AN, Pandit SK, Sinha A, et al: Gastric teratoma--Review of the literature. Indian J Pediatr 59:541-544, 1992 3. Matias IC, Huang YC: Gastric teratoma in infancy--Report of a case and review of the world literature. Ann Surg 178:631-636, 1973 4. Grosfeld JL, Ballantine TV, Lowe D, et al: Benign and
malignant teratomas in children: Analysis of 85 patients. Surgery 80:297-305, 1976 5. Haley T, Dimler M, Hollier P: Gastric teratoma with gastrointestinal bleeding. J Pediatr Surg 21:949-950, 1986 6. Cairo MS, Grosfeld JL, Wheetman RM: Gastric teratoma: Unusual case for bleeding of the upper gastrointestinal tract in the newborn. Pediatrics 67:721-724, 1981 7. Ravikumar VR, Ramkumar R, Lakshemana D, et al: Gastric teratoma in an infant. J Pediatr Surg 21:948, 1986