Retroperitoneal mature cystic teratoma involving the left adrenal gland in a 75-year-old male: a case report and literature review

Abstract

Primary retroperitoneal teratomas involving adrenal glands are extremely uncommon, particularly in elderly males. Only a few case reports have been documented in the literature so far. We report a mature cystic retroperitoneal teratoma in the region of left adrenal gland in an asymptomatic 75-year-old male patient. It was incidentally found on an abdominal computed tomography scan and was thought to be an adrenal adenoma. Because of its relatively large size and the patient’s request, he underwent a laparoscopic left adrenalectomy. Histopathological examination revealed a benign mature cystic retroperitoneal teratoma in the region of the left adrenal gland. The patient had an uneventful postoperative course and is free of recurrence after 20 months of follow-up. Considering the diagnostic difficulty of retroperitoneal teratoma by radiologic imaging, and its risk of malignancy, surgical resection via a minimally invasive approach would be the best diagnostic and therapeutic option. A literature review on teratomas is included.

Primary Retroperitoneal Teratoma in a Young Male: A Case Report

“…This risk is higher in adults than in children (26% vs. 10%) [3,6]. Malignant teratomas (0.2%-2%) have the potential to metastasize to the lung and lymph nodes [7]. Although there are no specific tumor markers for teratomas, some immature teratomas may have elevated serum AFP levels [8].…”

“…Imaging helps in not only diagnosing PRT but also delineating its relationship with adjacent structures, which is subsequently also useful in planning the surgery. Teratomas can be classified as mature, immature, or non-dermal [5,7]. Macroscopically cystic teratomas which contain mature tissue and sebaceous material are benign; while solid teratomas are composed of immature embryonic tissue along with fatty, cartilaginous, fibrous, and bony elements are frequently malignant [5,8].…”

“…Macroscopically cystic teratomas which contain mature tissue and sebaceous material are benign; while solid teratomas are composed of immature embryonic tissue along with fatty, cartilaginous, fibrous, and bony elements are frequently malignant [5,8]. Based on the excess of dermal elements in teratomas, they can also be classified as epidermoid (contain stratified squamous epithelium), dermoid (contain dermal elements like hair), or teratoid (contain columnar epithelium and sebum) [7]. The mainstay of the treatment is complete surgical resection.…”

“…Despite complete surgical resection malignant teratomas frequently recur [5,8]. The reported five-year survival for benign teratomas is 100% and for malignant tumors, it is about 67% [7,9,10]. Differential diagnosis of various diseases likes a secondary from genitalia, soft tissue sarcoma, neurogenic mass, tuberculosis, Kaposi sarcoma, Castleman disease, and growing teratoma syndrome (development of a mature teratoma following chemotherapy for a non-seminomatous germ cell tumors) shall be considered [11].…”

“…There is a risk of malignant transformation of teratomas, which may be the cause of relapse if a tumor is not excised completely during surgery. Late relapse is defined as recurrence after two years of completion of primary treatment [7]. These malignant variants respond poorly to adjuvant treatment.…”