Year : 2006 | Volume
: 16 | Issue : 4 | Page : 567--570
Two cases of immature mesenteric teratoma
C Raychaudhari, H Prajapati, HK Shah
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
14, Gnandeep Society, Near Shikhodi Talavadi, Anand 388001 Gujarat
|How to cite this article:|
Raychaudhari C, Prajapati H, Shah H K. Two cases of immature mesenteric teratoma.Indian J Radiol Imaging 2006;16:567-570
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Raychaudhari C, Prajapati H, Shah H K. Two cases of immature mesenteric teratoma. Indian J Radiol Imaging [serial online] 2006 [cited 2019 Nov 12 ];16:567-570
Available from: http://www.ijri.org/text.asp?2006/16/4/567/32270
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.  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. ,,
Here, we report two cases of immature mesenteric teratoma. Till date, only two cases of immature mesenteric teratoma have been published in the literature. ,
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.
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.
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. 
Diagnosis is done by imaging modalities and examination of histological specimen. Immune histochemistry may also be required.  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.  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. , 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. 
The behavior of immature teratoma in adolescents and adults is less predictable and may be associated with poor clinical outcome. 
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. 
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