Indian Journal of Radiology Indian Journal of Radiology  

   Login   | Users online: 2042

Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size     

 

GASTROINTESTINAL Table of Contents   
Year : 2006  |  Volume : 16  |  Issue : 4  |  Page : 567-570
Two cases of immature mesenteric teratoma


Department of Radiology & Imaging, Shri Krishna Hospital, Pramukh Swami Medical College, HM Patel Centre for Medical Care & Education, Gokal Nagar, Karamsad 388325, Anand, Guajarat, India

Click here for correspondence address and email

Date of Submission11-Mar-2006
Date of Acceptance20-Oct-2006
 

Keywords: Immature mesenteric teratoma

How to cite this article:
Raychaudhari C, Prajapati H, Shah H K. Two cases of immature mesenteric teratoma. Indian J Radiol Imaging 2006;16:567-70

How to cite this URL:
Raychaudhari C, Prajapati H, Shah H K. Two cases of immature mesenteric teratoma. Indian J Radiol Imaging [serial online] 2006 [cited 2019 Sep 20];16:567-70. Available from: http://www.ijri.org/text.asp?2006/16/4/567/32270

   Introduction Top


Mesenteric teratoma is an extremely rare tumor, arising, akin all other teratomas, from totipotent primordial cells and displays a mixture of tissues of tridermal or bidermal origin. [1] As a rule, in children they are found in the sacrococcygeal region and less frequently in the gonads, cervical area, mediastinum, retroperitoneum, cranial cavity, nasopharynx and the upper jaw. Intra-abdominal positions are extremely rare and only 25 cases of mesenteric teratoma have been reported until 1999. [2],[3],[4]

Here, we report two cases of immature mesenteric teratoma. Till date, only two cases of immature mesenteric teratoma have been published in the literature. [2],[5]


   Case report Top


Case one:

A three month old infant was brought to hospital with chief complains of abdominal distention and vomiting since last 10 to 15 days. On examination, there was hard mass in the central and left side of abdomen. The mass was slightly mobile in transverse axis of the body.

Radiograph of abdomen with chest in supine position was taken. It showed large soft tissue opacity in central and left side of abdomen with displacement of bowel loops towards the right side. Calcification was seen within the soft tissue opacity in lower and middle part of abdomen. [Figure - 1]

USG abdomen revealed a large space occupying lesion (SOL) of around 22cm x 16cm of mixed echogenicity, mainly solid but contained some cystic areas and calcification in it. Minimal ascites was present. [Figure - 2]

CT scan of abdomen revealed large mass of heterogeneous density occupying nearly whole of the abdomen. The mass showed fat density as well as density of calcification. On post contrast study the mass showed heterogeneous enhancement. Small bowel loops were displaced to right side and in upward direction. Both kidneys were displaced posteriorly. Aorta and inferior vana cava were not displaced. Minimal ascites was present. [Figure - 3],[Figure - 4] A diagnosis of teratoma of the mesentery was given. On operation, the mass was noted in the mesentery and the mass was removed. Histopathological report revealed immature teratoma.

Case two:

A two month old infant was brought to hospital with complain of hard swelling on right side of abdomen for the past 10 days. On physical examination, there was hard mass in central and right side of abdomen. The mass was slightly movable in the perpendicular direction of mesentery.

Radiographs of abdomen in anteroposterior and lateral view were taken. It showed large soft tissue opacity in central and right side of abdomen with displacement of bowel loops towards the left side. Calcification was noted within the soft tissue opacity in lower and middle part of abdomen. [Figure - 5] IVU was performed and both kidneys were found to be normal. [Figure - 6]

CT scan of abdomen revealed large mass of heterogeneous density occupying nearly whole of the abdominal space. The mass was extending from epigastric to hypogastric region, and having mainly solid as well as cystic component. The mass showed fat density as well as density of calcification. On post contrast study the mass showed heterogeneous enhancement. The small bowel loops were displaced to left side and in upward direction. Aorta and inferior vana cava were in midline, not displaced. [Figure - 7],[Figure - 8],[Figure - 9] A diagnosis of teratoma of the mesentery was kept and the patient was operated. On operation, the mass was noted in the mesentery and the mass was removed. Histopathological report revealed immature teratoma.


   Discussion Top


Teratomas take origin from totipotent cells and may give rise to neoplasms that contain, in a helter-skelter fashion, bits of bone, epithelium, muscles, fat, nerves and other tissues. They are usually smaller than 10cm, with cystic space, which is filled with a thick sebaceous secretion containing matted hair and sometimes teeth protruding from a nodular projection, which are unbrushed and may be carious. Though the usual sites are ovaries, occasionally testes, extragonadal sites may be affected. Classically the teratoma originates in the midline position. But in the abdomen, it usually takes the position of one of the paravertebral gutters, as in the present case, perhaps due to its size and weight of the solid part of the constituent elements. Mesenteric cystic lymphangioma may mimic cystic teratoma radiologically, when calcification is seen. An abdominal mass freely mobile at right angles to the plane of attachment of the mesentery, being painless at presentation, is usual. Painful abdominal symptoms of the subacute type correlated with compressive phenomenon with repercussion on the excretory route viz, ureterohydronephrosis or causing chills and fever. [6]

Diagnosis is done by imaging modalities and examination of histological specimen. Immune histochemistry may also be required. [6] Ultrasound is useful and can help in the confirmation of the diagnosis but, only a few cases have been reported to make the diagnosis by ultrasound, preoperatively. [2] CT scan is most useful as it detects different densities of mass. Immature teratoma is characterized by the presence of elements that resemble embryonic tissues, including neuroglial or neuro-epithelial components that may coexist along with mature tissues. In most instances, immature teratomas occurring in the fetus and newborn are associated with a favourable prognosis. [7],[8] At MR imaging, sebaceous fat within the tumor produces characteristically high signal intensity on T1-weighted images. Hyperintense foci produced by fat within the tumors almost always allow specific diagnosis of teratomas; chemical shift between the fatty and watery contents is a diagnostic finding at MR imaging. In addition to the detection of fat, gravity-dependent layering, palm tree-like protrusions (Rokitansky protuberance and fat-fluid levels are other imaging characteristics of mature cystic teratomas. A cauliflower-like projection or thickening of the wall with an irregular margin is reported to be a sign of malignant transformation of mature teratomas. [9]

The behavior of immature teratoma in adolescents and adults is less predictable and may be associated with poor clinical outcome. [7]

Immature teratomas contain variable quantities of immature neural tissue. At gross examination, these tumors are large, encapsulated masses with a rich solid component, which are composed of immature neuroectodermal tissue. Immature elements are usually recognized as solid parts at CT and MR imaging. The existence of a solid component can be a sign of an immature teratoma, although mature teratomas sometimes have large solid parts (Rokitansky protuberances). In addition, immature teratomas without such prominent solid parts are occasionally seen. Therefore, distinguishing immature from mature teratomas is very difficult. Some researchers have reported that foci of immature tissues have scattered areas of fat and calcification throughout the lesion. [9]

 
   References Top

1.Al-Arfaj AA, El-Shawarby MA, Al-Mulhim FA et al, Mesenteric cystic teratoma in children. Saudi Med J. 2003 Dec; 24(12): 1388-90.   Back to cited text no. 1    
2.Marcolongo A, Divirgilio G, Bettili G, et al. Immature mesenteric teratoma in a male newborn infant: prenatal ultrasonographic diagnosis and surgical treatment Prenat Diagn.1997; 17: 686-88.   Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Chiba T, Lwami D and Kikuchi Y. Mesenteric teratoma in an 8-old-month girl. J Pediatr Surg. 1995; 30: 120.  Back to cited text no. 3    
4.Mirbagherri SA, Nahid AR, Pour-Mohammad A. Gastric teratoma: report of an 8-year-old boy presenting with repeated gastrointestinal bleeding. Arch Irn Med. 1992; 2: 160-20.  Back to cited text no. 4    
5.Gonzalez-Crussi F, Sotelo-Avila C, deMello DE. Primary peritoneal, omental, and mesenteric tumors in childhood. Semin Diagn Pathol. 1986 May; 3(2): 122-37.  Back to cited text no. 5    
6.De J, Banerjee M, Biswas PK et al, Mature teratoma of the mesentery, J Indian Med Assoc. 2002 Mar; 100(3): 198-9.  Back to cited text no. 6    
7.Carter D, Bibro MC, Touloukian RJ. Benign clinical behavior of immature mediastinal teratomas in infancy and childhood; Report of two cases and review of the literature. Cancer 1982; 49: 398-402.  Back to cited text no. 7  [PUBMED]  
8.Isaacs H Hr. Perinatal (Congenital and neonatal) neoplasms: A report of 110 cases. Pediatr Pathol 1985; 3: 165-216.  Back to cited text no. 8    
9.Teruko Ueno, MD, Yumiko Oishi Tanaka, MD, Michio Nagata, MD, et al. Spectrum of Germ Cell Tumors: From Head to Toe. RadioGraphics 2004; 24:387-404.  Back to cited text no. 9    

Top
Correspondence Address:
H Prajapati
14, Gnandeep Society, Near Shikhodi Talavadi, Anand 388001 Gujarat
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-3026.32270

Rights and Permissions


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6], [Figure - 7], [Figure - 8], [Figure - 9]

This article has been cited by
1 Assessment of immature teratoma by 18F-FDG PET/CT
Ozkan, E. and Yagci, S. and Dogan, M. and Lacin, S. and Kucuk, N.O. and Akbulut, H.
European Journal of Radiology Extra. 2011; 78(3): e143-e146
[Pubmed]
2 Assessment of immature teratoma by 18F-FDG PET/CT
Elgin Ozkan,Sule Yagci,Mutlu Dogan,Seda Lacin,Nuriye Ozlem Kucuk,Hakan Akbulut
European Journal of Radiology Extra. 2011; 78(3): e143
[Pubmed] | [DOI]
3 Immature mesenteric teratoma in an infant: A case report
Srivastava, J., Ghritlaharey, R.K.
Journal of Clinical and Diagnostic Research. 2010; 4(6): 3581-3584
[Pubmed]
4 Immature Teratoma of the Vulva With an Inguinal Lymph Node Metastasis: Report of a Case and Review of Literature :
Nadira Mamoon, Sajid Mushtaq, Noreen Akhter, Ayesha Aslam, Abeera Chaudary, Mamoon Rashid
International Journal of Gynecological Pathology. 2010; 29(2): 197-200
[Pubmed]
5 Immature Teratoma of the Vulva With an Inguinal Lymph Node Metastasis: Report of a Case and Review of Literature
Nadira Mamoon,Sajid Mushtaq,Noreen Akhter,Ayesha Aslam,Abeera Chaudary,Mamoon Rashid
International Journal of Gynecological Pathology. 2010; 29(2): 197
[Pubmed] | [DOI]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Email Alert *
    Add to My List *
* Registration required (free)  


    Introduction
    Case report
    Discussion
    References
    Article Figures

 Article Access Statistics
    Viewed4103    
    Printed83    
    Emailed1    
    PDF Downloaded277    
    Comments [Add]    
    Cited by others 5    

Recommend this journal