Retroperitoneal teratoma

Retroperitoneal Teratoma By D. C. Keramidas

P

REOPERATIVE DIAGNOSIS to make, and thus complete plished readily.

and N. G. Voyatzis

of retroperitoneal excision of this tumor

teratoma is difficult is not always accom-

CASE REPORT A 2-yr-old boy was admitted with signs of intestinal obstruction. At operation, an ill-defined cystic mass was found on the left side of the abdomen. It was densely adherent to the small intestine and to the left colon, and caused displacement and obstruction. from it. It was then partly opened and was Some 950 cc of whitish fluid was aspirated found to be lined by apparent intestinal mucosa. No communication could be found leading from the interior. It was marsupialized to the skin. A biopsy of the wall showed epithelium resembling intestinal mucosa. Postoperatively, an intravenous pyelogram was normal. Gastrointestinal x-rays did not show any communication. Contrast material infused in the marsupialized pouch did not reveal any communication with the intestinal tract. (Fig. I) On the 40th day the patient was reexplored. After extensive dissection the mass was excised completely. Its

Fig. 1. Lateral radiogram of the abdomen in upright position following contrast medium infusion into the cystic part of the retroperitoneal teratoma.

From the Department of Surgery, Agfaias Kyriakou Children’s Hospital, Athens, Greece. D. C. Keramidas, M.D.: Surgicnl Registrar, Department of Surgery, Agfuius Kyriukou Children’s Hospital, Athens, Greece. N. G. Voyatzis, M.D.: Consultant, Department of Surgery, Agluius Kyriukou Children’s Hospital, Athens, Greece. 434

Journal

of Pediatric

Surgery,

Vol. 7, No. 4 (August-September),

1972

RETROPERITONEAL

posterior

part

TERATOMA

was

solid,

435

and the cystic

pancreas. He did well postoperatively studies showed a teratoma containing

portion

emerged

from

beneath

the

tail

of the

and has been asymptomatic for 9 mo. Microscope mature elements of all three germ layers.

DISCUSSION

A total of 127 cases have been reported previously,rW3 and it has been found that 610% of these teratomas are malignant. The tumor usually becomes evident clinically during the first year of life, and in most cases the first symptoms are related to the urinary tract. Displacement of gastrointestinal viscera is less common .4 The tumor may remain undetected for many years.5 In our case, resection was achieved in two stages. The initial operation relieved intestinal obstruction and reduced the size of the mass, thereby enabling easier removal at a later date. Furthermore, with the subsidence of the acute obstruction, additional radiological studies could be performed to delineate the size, location, and relationship to the urinary and gastrointestinal tract. REFERENCES

2. Arnheim, E. E.: Retroperitoneal teratomas in infancy and childhood. Pediatrics 8:309, 1951.

Polloch, W. F.: Retroperitoneal tumors. In Mustard, W. T., Ravitch, M. M., Snyder, W. H., Welch, K. J., and Benson, C. D. (Eds.) : Pediatric Surgery. Chicago, Year Book, 1969. 5. Wooley, M. M., Ginsburg, S., DiCesno,

3. Engel, R. P., Elkins, B. D. : Retroperitoneal 22:1068, 1968.

S., Snyder, W., Mirabal, Q. V., and Landing, B. H.: Teratomas in infancy and childhood. Z. Kinderchir. 4 :289, 1967.

1. Palumbo, L. T.: Primary teratomas in the lateral retroperitoneal spaces. Surgery 26:149, 1949.

4. Snyder,

W.

R. C., and Fletcher, teratoma. Cancer

H., Hastings,

T.

B.,

and