Retroperitoneal malignant teratoma. A case report

Retroperitoneal teratomas are rare in adults. These tumours may be benign or malignant and are composed of multiple tissues foreign to the part in which they arise. We report a malignant teratoma of retroperitoneal space. In searching the literature, we have been able to find 39 cases reported since 1937. Of the forty cases reported (including this case), only ten (25%) were malignant.     

Pharyngeal teratoma

A 30-week newborn patient presented with acute respiratory obstruction due to a large pharyngeal teratoma. At laryngoscopy no view of the larynx was obtained, and a tracheal tube was unintentionally passed blindly into the oesophagus. This relieved the obstruction by anterior displacement of the mass.     

Retroperitoneal venous hemangioma

Retroperitoneal venous hemangioma is a very rare condition. Only two cases have been reported in the English literature. We report the case of a 28-yr-old man with a retroperitoneal venous hemangioma who underwent surgical resection. Preoperative magnetic resonance imaging revealed a retroperitoneal tumor with low signal intensity on the T1-weighted image and high signal intensity on the T2-weighted image, typical of hemangiomas. In addition, it showed a partial interruption of the muscle layer surrounding the tumor. Intraoperative findings showed a large, reddish brown retroperitoneal mass with an ill defined capsule firmly attached to the muscular tissue surrounding the tumor. Retroperitoneal hemangioma is rare and is almost always of the cavernous type. Although accurate pre- and intraoperative diagnosis of retroperitoneal venous hemangiomas is difficult, magnetic resonance imaging and the presence of a firm attachment to the muscles may be helpful for the important diagnostic findings of this disease.     

Neuroblastoma arising in testicular teratoma

One case of neuroblastoma arising in an adult immature testicular teratoma is described, with multiple systemic metastases, a partial response to intensive chemotherapy and a swift recurrence leading to death. Such instances of prevailing neuroblastoma with systemic metastases, have only seldomly been reported hitherto. Because of the teratoma and the focal presence of intratubular germ cell neoplasia of unclassified type, we think this tumor must be indeed of germ cell derivation.     

Two cases of intrapulmonary teratoma

We encountered two unusual cases of intrapulmonary teratoma, one in a 31-year-old female and the other in a 15-year-old female. The chief complaint of both patients was fever, and in both a consolidation was detected in the left upper lobe using routine radiography. We performed left upper lobectomy for the former patient and segmentectomy of the left lingual segment for the latter. Neither tumor communicated with the mediastinum. Histological examination revealed a pulmonary teratoma containing no thymic tissue in both. Intrapulmonary teratoma has been reported to be extremely rare, and only 27 cases including these two have been reported in the literature.     

An unusual congenital nasopharyngeal teratoma

A supine technique for reducing posterior dislocations of the hip is presented. We believe this technique provides more controlled traction than do other maneuvers and have found it to be a safe and effective method to reduce the posteriorly dislocated hip.     

Retroperitoneal laparoscopic nephrectomy in children

We present two cases of obstructive uropathy nefrectomy through a retroperitoneal approach was performed. Renal differential function by means of a 2,3 dimercapto-succinic acid renal scan showed less than 10% on the ipsilateral kidney to the diagnosis pathology. The size of the kidneys meant no hindrance during its nefrectomy. Morcellation within the organ bag was required for its removal without needing to broaden the 10 mm port opening. The patients were discharged home 48 hours after surgery and they returned to school within the first postoperative week.     

Retroperitoneal fibrosis: unusual localization

Six cases of retroperitoneal fibrosis, each with a different pathogenesis and unusual localization were observed from 1980 to 1996. Four patients had had previous surgery for a neoplasm, one patient had idiopathic retroperitoneal fibrosis, and the last patient was hardly classifiable due to the complexity of the clinical pattern. The mean survival in 3 patients with malignant retroperitoneal fibrosis was 7 months. Two patients treated with medical therapy are still alive and in good clinical condition. The aspecificity of the symptoms makes early diagnosis difficult. CT and NMR are essential procedures for differential diagnosis of abdominal masses. Histology differentiates benign from malignant retroperitoneal fibrosis. The choice between medical or surgical therapy depends on the general condition of each patient.     

Retroperitoneal tumors: personal experience

The Authors experience in five retroperitoneal tumors with symptoms and histopathological characteristics not different from those described in the Literature, is here reported. Topographic findings, classification, and incidence of retroperitoneal tumors as referred by various Authors are discussed. Two aspects are particularly pointed out: the histological type and the surgical strategy for their removal. Concerning the first aspect, the Authors underline that benign lesion may have an optimal outcome and a long survival, unlike the malignant ones, which have always unfavourable prognosis, despite adjuvant and complementary therapy (radiotherapy, chemotherapy). As for the second aspect, surgery is the treatment of choice even when other organs different from those exclusively retroperitoneal, may be involved in the demolition.     

Malignant gastric teratoma: case report

Gastric teratomas are rare and usually benign. A 4 month old boy presented with an abdominal mass and computed tomographic and ultrasound examination demonstrated a large multi-loculated tumour which was totally excised. The pathological diagnosis was of a malignant gastric teratoma and 12-month follow-up was uneventful.     

The antenatal diagnosis of sacrococcygeal teratoma

The teratomas are rarely met with the newborn and the sacrococcygeal teratomas are the most often among them. A private case is detailedly described, correctly diagnosed antenatally by the ultrasound method, the clinical session and the outcome of the pregnancy. In the discussion the theories of their origin are shown, the anomalies connected with them and the delivery. The opinions of other authors on this matter have been quoted.     

Ovarian teratoma (case report)

Case-history of an accidentally detected teratoma, during X-ray examination because of back pain in a 44-year-old female patient. The teratoma contained a premolar and hair.     

Primary intrathoracic lymphangioma masquerading as teratoma

Two cases of cystic hygroma arising as a primary lesion in the chest are presented. Because of calcifications discovered on CT and because of the anterior location of the mass in both cases, teratoma was the first diagnostic consideration. However, after surgical removal, histologic study determined that both lesions were cystic hygromas with areas of scattered calcification probably secondary to hemorrhage. These cases are presented because of the remarkable similarity of their imaging features to those of teratoma.     

Retroperitoneal fibrosis and chronic peri-aortitis--new hypothesis

Retroperitoneal fibrosis is characterised by the development of fibrotic mass surrounding the abdominal aorta and its branches. In the one third of cases, the causes of this disease include ergot-derivative drugs, retoperitoneal haemorrhage or urine extravasation and desmoplastic response to a variety of tumours. Retroperitoneal fibrosis is idiopathic in two thirds of cases and is found most commonly as an isolated fibrotic plague centered over the lumbar spine and entrapping one or both ureters. It has been postulated that fibrosis in idiopathic cases is caused by a chronic inflammatory or autoimmune response to antigens leaking into retroperitoneum from atheromatous plagues in the aorta or common iliac arteries. Many findings indicate the active nature of aortic adventitial chronic inflammation associated with human advanced atherosclerosis ("chronic periaortitis") and show its possible progressive potential to the clinically important disease termed "idiopathic retroperitoneal fibrosis" and "inflammatory aneurysm". A definitive differential diagnosis requires not only CT and NMR but also histologic confirmation. Treatment may be surgical or medical, with the best outcome observed in patient receiving both.