|Year : 2017 | Volume
| Issue : 3 | Page : 142-144
Immature gastric teratoma: A rare tumour
Ajay Yadav1, Akash Mathur2, Arpita Jindal3, Hemant Malhotra4
1 Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
2 Department of Medicine, SMS Medical College, Jaipur, Rajasthan, India
3 Department of Pathology, SMS Medical College, Jaipur, Rajasthan, India
4 Department of Medicine, Division of Medical Oncology, SMS Medical College, Jaipur, Rajasthan, India
|Date of Web Publication||15-Sep-2017|
Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi
Source of Support: None, Conflict of Interest: None
Gastric teratoma is a very rare tumour. We reviewed the literature and found that only around 100 cases have been reported. Almost all reported cases of gastric teratoma were of mature variety. Only a few cases were of immature variety. The rarity of the disease makes the diagnosis very difficult most of the cases occurred in infants. The disease is more common in males than in females. Majority of cases have been reported to arise from the greater curvature and posterior wall of the stomach. Histopathological examination confirms the diagnosis. Treatment of choice is surgical excision with close follow up. Following surgical excision prognosis is excellent. Hence, in an infant who presents with abdominal lump gastric teratoma should be kept as one of the differential diagnosis. Here, we are reporting a case of immature teratoma.
Keywords: Abdominal lump, female, gastric teratoma
|How to cite this article:|
Yadav A, Mathur A, Jindal A, Malhotra H. Immature gastric teratoma: A rare tumour. Adv Hum Biol 2017;7:142-4
| Introduction|| |
Immature gastric teratoma is an uncommon germ cell tumor of the stomach. It is a type of germ cell tumour composed of tissues derived from ectoderm, endoderm, and mesoderm and has been described in various locations, including the gonad, intracranium, anterior mediastinum, retroperitoneum, and sacrococcygeal region Gastric teratoma is an extremely rare type of tumor in pediatric age group. It accounts for less than 1 percent of total teratomas diagnosed in the world. Till date only 100 cases have been reported in literature. Herein we report a case of immature gastric teratoma in a 3 month old infant.
| Case Report|| |
A 3-month-old male child presented with palpable abdominal mass. His parents noticed it 1.5 months back. On examination, there was a lump in right lower half of abdomen which was 10 cm × 5 cm in size, smooth, round and mobile. Abdominal ultrasound revealed a large solid cystic lesion with internal classification and fat contents, extending from epigastrium to pelvis. Computed tomography (CT) showed large heterogeneously enhancing soli/cystic mass lesion with dense linear/nodular calcification and streaks of fatty component occupying peritoneal cavity from right sub hepatic space to right lumbar region. All bowel loops displaced towards left. Serum alpha-feto protein level was 2930 ng/ml. Exploratory laprotomy with excision of abdominal mass with adjacent stomach wall with two layer suturing of stomach was done. The gross specimen obtained measured 13 cm × 9 cm × 6 cm. On opening cut surface was solid variegated showing cystic area filled with clear fluid and solid area. Microscopic examination revealed a mass arising from serosal surface showing cysts lined by stratified squamous epithelium, intestinal epithelium, gastric epithelium and retinal pigmented epithelium appendages. Immature elements were seen in the form of blastemma and neuroectodermal tissue. The pathological diagnosis was immature teratoma – Grade 2. Post-operative CT abdomen was advised after 20 days of surgery. There was no significant abnormality. Serum alpha-fetoprotein (AFP) reduced to 110 ng/ml on 20th and to 56 ng/ml on 40th post-operative day [Figure 1],[Figure 2],[Figure 3].
|Figure 1: Radiological findings of immature gastric teratoma in a 3-month-old boy|
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|Figure 2: Immature teratoma in 3-month-old boy with primitive neuroepithelial element (×100)|
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|Figure 3: Immature teratoma showing mature element of three germ layers (×50)|
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| Discussion|| |
Gastric teratoma is a rare neoplasm, which accounts for <1% of all teratomas occurring in infancy and childhood. Only about 100 cases have been reported in literature. First case of gastric teratoma was reported by Eusterman and Sentry in 1922. Majority of reported cases have involved infants or neonates. This is more common in male than female. Gastric teratomas can be mature and immature. Mature gastric teratomas are considered benign, whereas the malignant potential is present in immature gastric teratoma. Almost all reported cases of gastric teratoma are of mature variety. Only few cases of immature teratomas have been published in literature.
Gastric teratoma can arise from various sites, but most of the cases have been reported to arise from the greater curvature and posterior wall of the stomach. Gastric teratomas are exophytic in the majority of cases (>60%) and endophytic growths are present in about 30% of cases, in some cases, mixed exophytic and endophytic growths may present.
Rarity of disease makes the diagnosis very difficult. Sign and symptoms depend on the site of tumour. Abdominal distention and palpable abdominal mass are common presenting complains. Upwards displacement of the diaphragm by tumour can produce respiratory difficulty. Infants with exogastric growth may present with vomiting, haematemesis and malena.
Pre-operative diagnosis of gastric teratomas is very difficult. Important modalities that help in diagnosis are abdominal radiograph, ultrasonography, CT or magnetic resonance imaging and gastrointestinal endoscopy. Radiograph reveals a soft tissue mass with associated calcifications which is found in about 50% of cases. Ultrasonography demonstrates a heterogeneous mass with mixed echogenicity. CT with contrast is the modality of choice which demonstrates a heterogeneous mass containing varying amounts of cystic and solid components with fat and calcification. CT with contrast can detect the origin of gastric teratoma. Gastroscopy barium meal and other modalities has a limited role in the diagnosis of gastric teratoma.,
Differential diagnosis of abdominal mass in this age group includes neuroblastoma, Wilm's tumour, rhabdomyosarcoma, pancreatic cyst, hepatoblastoma, liposarcoma and retroperitoneal teratoma.
Histopathological examination confirms the diagnosis. On histopathological examination (HPE) teratoma can be one of two varieties mature and immature. In immature teratoma, immature neuroectodermal tissue is usually present along with other germinal layer structures. Majority of gastric teratoma are considered as benign.
Treatment of choice is surgical excision with close follow up. Following surgical excision prognosis is excellent with report of one case of recurrence.
AFP and β-human chorionic gonadotropin are helpful in monitoring after surgery. In our case, pre-operative AFP level abruptly reduced twenty times within 1½ months of excision and patient is alive and free of disease at last follow up after 1 year of surgery.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]