Ryan Nicholas1, Christo Cave2, Tanzilah Barrow3, Melanie Johncilla4, Dilip Dan2. 1. Department of Clinical Surgical Sciences, University of the West Indies, St Augustine, Trinidad and Tobago. Electronic address: rmnicholas17@gmail.com. 2. Department of Clinical Surgical Sciences, University of the West Indies, St Augustine, Trinidad and Tobago. 3. Eric Williams Medical Sciences Complex, Champs Fleurs, Trinidad and Tobago. 4. Global Pathology Solutions, 5 Fitts Street South, Port of Spain, Trinidad and Tobago.
Abstract
INTRODUCTION AND IMPORTANCE: Teratomas typically are benign gonadal neoplasms, arising from more than one embryonic germ layer. Extragonadal teratomas are rare and primary adrenal teratomas more so, with few documented cases. We present one such case, diagnosed via CT, resected via laparoscopic adrenalectomy, and confirmed on histology. To the best of our knowledge, this is the first case documented in the Caribbean. CASE PRESENTATION: A 38-year-old obese female with restrictive lung disease presented with right back/flank pain due to a non-functional 10.5 cm right adrenal mass on CT, likely a giant myelolipoma. Further radiologic review suggested this was instead a mature adrenal teratoma. She underwent a laparoscopic adrenalectomy and histology confirmed a mature adrenal teratoma. CLINICAL DISCUSSION: Most adrenal tumours are incidentalomas and are usually benign adenomas. Primary adrenal teratomas account for 1 % of teratomas and 0.13 % of adrenal tumours. They may be mature or immature; the latter carries a greater risk of malignancy. Benign adrenal teratomas are typically non-functional and commonly mistaken for myelolipomas on imaging. Adrenalectomy is required due to the risk of malignant transformation. The laparoscopic approach depends on size, localized tissue invasion and technical considerations, but offers advantages for the patient if possible. CONCLUSIONS: Though uncommon, preoperative radiologic diagnosis of an adrenal teratoma is possible and should be completely resected after a functional workup. A laparoscopic adrenalectomy is preferred once this can be done safely, even when very large, with surgical and oncologic outcomes equivalent to an open approach combined with the known advantages of laparoscopic surgery.
INTRODUCTION AND IMPORTANCE: Teratomas typically are benign gonadal neoplasms, arising from more than one embryonic germ layer. Extragonadal teratomas are rare and primary adrenal teratomas more so, with few documented cases. We present one such case, diagnosed via CT, resected via laparoscopic adrenalectomy, and confirmed on histology. To the best of our knowledge, this is the first case documented in the Caribbean. CASE PRESENTATION: A 38-year-old obese female with restrictive lung disease presented with right back/flank pain due to a non-functional 10.5 cm right adrenal mass on CT, likely a giant myelolipoma. Further radiologic review suggested this was instead a mature adrenal teratoma. She underwent a laparoscopic adrenalectomy and histology confirmed a mature adrenal teratoma. CLINICAL DISCUSSION: Most adrenal tumours are incidentalomas and are usually benign adenomas. Primary adrenal teratomas account for 1 % of teratomas and 0.13 % of adrenal tumours. They may be mature or immature; the latter carries a greater risk of malignancy. Benign adrenal teratomas are typically non-functional and commonly mistaken for myelolipomas on imaging. Adrenalectomy is required due to the risk of malignant transformation. The laparoscopic approach depends on size, localized tissue invasion and technical considerations, but offers advantages for the patient if possible. CONCLUSIONS: Though uncommon, preoperative radiologic diagnosis of an adrenal teratoma is possible and should be completely resected after a functional workup. A laparoscopic adrenalectomy is preferred once this can be done safely, even when very large, with surgical and oncologic outcomes equivalent to an open approach combined with the known advantages of laparoscopic surgery.
Authors: Eric J Kuo; Anthony E Sisk; Zhiming Yang; Jiaoti Huang; Michael W Yeh; Masha J Livhits Journal: Endocr Pathol Date: 2017-06 Impact factor: 3.943
Authors: Siham El Haddad; Laila Hessissen; Maria El Kababri; Najat Lamalmi; Mounir Kisra; Nazik Allali; Latifa Chat Journal: Pan Afr Med J Date: 2020-09-07