A 25-year-old male patient with a primary retroperitoneal teratoma is described. The chief complaint was right hypochondralgia during exercise for seven days. Various diagnostic imagings disclosed an expansive, heterogeneous and fat-rich mass associated with multiple cystic lesions in the right suprarenal fossa. Sagittal, transaxial and coronal magnetic resonance imaging scan visualized the extent and character of the tumor very clearly. Histological examination of the tumor removed through a thoracoabdominal approach showed cystic teratoma with out malignant transformations

HIRANO, Shoji

KARINO, Tetsuji

KAWAGUCHI, Shoichi

KITAGAWA, Kiyohide

MIKAWA, Ikuo

SAITO, Katsuhiko

Kyoto University Research Information Repository

TitlePrimary retroperitoneal teratoma in an adult: ultrasonographic,computer tomographic and magnetic resonance imagingdemonstrationsAuthor(s)HIRANO, Shoji; KAWAGUCHI, Shoichi; MIKAWA, Ikuo;KARINO, Tetsuji; KITAGAWA, Kiyohide; SAITO, KatsuhikoCitation泌尿器科紀要 (1988), 34(11): 2031-2034Issue Date1988-11URL http://hdl.handle.net/2433/119761RightType Departmental Bulletin PaperTextversionpublisherKyoto UniversityActa Urol. Jpn. 34: 2031-2034, 1988 2031 PRIMARY RETROPERITONEAL TERATOMA IN AN ADULT: ULTRASONOGRAPHIC, COMPUTER TOMOGRAPHIC AND MAGNETIC RESONANCE IMAGING DEMONSTRATIONS Shoji HIRANO, Shoichi KAWAGUCHI and Ikuo MIKAWA From the Department oj Urology, Kouseiren Takaoka Hospital (ChieJ: Dr. I. Mikawa) Tetsuji KARl NO From Ihe First Department q( Internal Medicine, Kouseircn Takaoka Hospital (ChieJ: Dr. K. Nishide) Kiyohide KITAGAWA From the DejJartment oj Radiolog.y, Kouseiren Takaoka HosjJitai (ChieJ: Dr. T. Yamahana) Katsuhiko SAITO From the Second Department q( Pathology, School oj Medicine, Kanazawa Universit.y (Director: ProJ. Y. Nakanuma) A 25-year-old male pa'tient with a primary retroperitoneal teratoma is described. The chief complaint was right hypochondralgia during exercise for seven days. Various diagnostic imagings disclosed an expansive, heterogenous and fat-rich mass associated with multiple cystic lesions in the right suprarenal fossa. Saggital, transaxial and coronal magnetic resonance imaging scan visualized the extent and character of the tumor very clearly. Histological examination of the tumor removed through a thoracoabdominal approach showed cystic teratoma with out rna· lignant transformations. Key words: Retroperitoneum, Teratoma, Adult, Magnetic Resonance Images INTRODUCTION In the recent advance and spread of the diagnostic modalities including ultrasono-graphy (USC), computerized tomography (CT) and magnetic resonance imaging (MRI) the diagnosis and differentiation of the space-occupying lesions deep in the body have been becoming more easierl,~l. Especially concerning the extent, character and relationship between the tumor and adjacent structures, the diagnostic proce· dures of USC, CT and MRI can pick up some useful information noninvasively for retroperitoneal tumors. Primary retroperitoneal teratoma cons· titutes approximately 10% of all primary retroperitoneal tumors and is rare in adults because of its congenital nature3). The occurrence rate of retroperitoneal teratoma was 30% for the third decade4l . Fortunate· ly, the diagnosis and differentiation of retroperitoneal teratoma have been estab-lished through the evaluation of USC, CT and MRI according to the several new case reports5,6l. We have encountered a 25-year-old male patient with benign retro-peritoneal teratoma arising from the sup-rarenal fossa, and some valuable pictures of USC, CT and MRI are presented in this report. CASE REPORT Case A 25-year-old man in whom right hypochondralgia during exercise had been occurring for one week, visited our In-ternal Medicine Clinic on June 24th, 1987. Past and family history were noncontrib-utory. Physical examination revealed no particular findings except slightly decrea-2032 Acta Uro\. Jpn. Vo\. 34, No. 11, 1988 sed respiratory sound of the right lung. Although fluoroscopy gave negative find-ings, abd_ominal USG (Sonolayer-V, SSA-gOA, Toshiba, Tokyo) disclosed a large hyperechoic mass containing multiple cystic lesions in the suprarenal region (Fig. 1). Intravenous pyelography showed the right kidney displaced distinctly downwards. CT (TCT-60A, Toshiba, Tokyo) scanning revealed a large, well-demarcated and het-erogeneous mass pushing up the liver and expanding to the median line, in which fat and fluid-containing cysts were thought to be main components and tiny calci-fication was seen (Fig. 2) . The patient was admitted on July 1, and laboratory test results including endoclinological and Fig. I. Saggital (left) and right intercostal ultrasonograph (right) of the upper abdomen. A large hyperechoic mass (white arrow) containing multiple cysts (black arrow) occupies the right suprarenal fossa beneath the liver (L). Fig. 2. Enhanced CT scan shows a well-de_ marcated and expansive tumor which compresses the liver (L), including a large amount of adipose tissues with multiple fluid-containing cysts (f ) in its center. embryonic antigen analyses were normal. No definite feeding artery to the tumor was identified by angiography. The isotope accumulated in a part of tumor lesion on 67gallium scan. Imaging with a l.5-Tesla superconducting MRI unit (Signa system, General Electric, Milwaukee) was performed at Kanazawa University Hos}Jital. Images were produced via a selective irradiation technique using 2-dimensional Fourier transformation with Fig. 3 A. Saggital MR image (TE 500 msec and TE 25 msec) shows a heteroge-neous tissues. Inferior vena cava (black arrow) is markedly displased. Fig. 3 B. Coronal MR image (TR 500 msec and T E 25 msec). A large retro-peritoneal tumor pushes away the liver (L) and the right kidney (black arrow) downwards. The upper border of the right kidney is clearly demarcated and separated from the tumor. Hirano el al.: Retroperitoneum.Teraloma 2033 a 256 x 128-pixel matrix. The spin-echo imaging sequences were accomplished with a repetition time of 500 msec, echo-delay of 25 msec, and number of excitations of two. Saggital, transaxial and coronal scans were carried out with a section thickness of 10 mm. Saggital, transaxial and cornal scans showed the shape and extent of the mass stereoscopically (Fig. 3A and 3B). Signal intensity of circumscribing material was high, similar to subcutaneous adipose tissue. Preoperative diagnosis was teratoma. Tumor removal was done through a thoracoabdominal approach at the nineth intercostal space on July 15. Adherence with adjacent structures was mild. The right adrenal gland could be identified on examination of the suprarenal fossa. The tumor weighed 1,000 g and was 18 x 16 x 13 cm. in size. Fat tissue was the main com-ponent on the cut surface, in which the cystic structures had whitely turbid fluid and fibrotic tissue as a hard induration. No bones or teeth were observed clearly. Microscopically, the tumor consisted of many types of mature tissue. Stromal elements were composed of mainly mature fat tissue and some foci of cartilago and striated muscle could be seen. Mucin-producing column cells or ciliated column cells lined the cyst walls. Respiratory mucosa with glands and thyroid tissue were also seen, but skin was not. Histological diagnosis of benign cystic teratoma was made. The patient was discharged on August 4. DISCUSSION Concerning the origin of the retroperi-toneal teratoma, the migration and growth theory of embryonic tissues from the prim-itive streak was broadly accepted because the retroperitoneal tumor frequently arises in an immediately preaxian or parame-dian location'). No significant laterality of primary retroperitoneal teratoma was observed. Primary retroperitoneal tera-toma has not frequently manifested clinical signs, such as abdominal pain, nausea, ano-rexia and so on, until the tumor becomes large enough to influence the structure and function of the adjacent organs. The differentiation of teratoma from other retroperitoneal tumors has been difficult prior to the advance and wide spread use of USC, CT and MRI. Even the biochem-ical character of retroperitoneal tumor is now noninvasively revealed using these modern diagnostic equipments. In addi-tion to intratumoral calcification including dental structures or bone formation in the radio Ius cent and hypovascular tumor on conventional radiographic methods, adi-pose tissues and muscle elements can be detected easily by USC, CT and MRI. However, malignant transformation which constitutes 25.8% of retroperitoneal tera-tomas has not significantly been detected even now. Needle biopsy has not always been liable because of heterogeneity oftera-toma. Final diagnosis of retroperitoneal teratoma should be made through tumor resection. Thoracoabdominal approach provided a good access for the removal of large retroperitoneal teratoma in the suprarenal fossa. Engel and associates4) reported a case retroperitoneal teratoma without the colatera1 adrenal gland. There is no satisfactory explanation of absence of the colateral adrenal gland. Prognosis is good in benign retroperitoneal teratoma, while poor in malignant teratoma. REFERENCES 1) William RD and Hrick H: Magnetic reso-nance imaging in urology. J Urol 132: 641-649, 1984 2) Siekavissa JL, Bernardino ME and Samaan NA: Suprarenal mass and its differential diagnosis. Urology 1981; 18: 625-632 1981 3) Pak GT and Tabah EJ: Collective review: primary retroperitoneal tumors. A study of 120 cases. Int Abst Surg 99: 209-231 and 313-341, 1954 4) Engel RM, Elkins RC and Fletcher RD: Retroperitoneal teratoma. Review of litera-ture and presentation of an unusual case. Cancer 22: 1068-1073, 1968 5) Weinstein BJ, Lenkey JL and William S: Ultrasound and CT demonstration of a benign cystic teratoma arising from the retroperitoneum. Amer J Radiol 133: 936-938, 1979 6) Terada Y, Kato A, Kishi Y, Niijima T and Yashiro N: Nuclear magnetic resonance imaging of a benign cystic teratoma in the 204 Acta Urol. Jpn. Vol. 34, No. 11, 1988 retroperitoncum. J Urol 137: 306-108, 1987 7) Palumbo II, Cross ICL, Smith AN and Barouas AA: Primary teratomas of the   lateral retroperitoneal spaces. Surgery 26:   149-159, 19498) Bruneton JN, Diarcl F, Douillard JP, Sabatier JC and Tavernier J17: Primary retroperitoneal teratoma in adults. Radiology   134: 613-616, 1980  (Accepted for publication December 28, 1987)和文抄録成人に見られた後腹膜腔原発の良性奇形腫の1例厚生連高岡病院泌尿器科(部 長:美 川郁夫)平野 章治,川口 正一,美 川 郁夫厚生連高岡病院第一内科(部 長:西 出啓二郎)狩 野 哲 次厚生連高岡病院放射線科(部 長:山端輝夫)北 川 清 秀金沢大学医学部第二病理学教室(主 任:中 沼安二教授)斉 藤 勝 彦原発性後腹膜奇形腫を有した25歳男子の1症例を報告する.主訴は1週間前から続く体動時の右季肋下部痛である.種々の画像診断法により右腎上窩に周囲を圧排する,不均一だが脂肪組織に富んだ腫瘍が認められた,核磁気共鳴によるCTス キャンに よる矢状,水 平 お よび 冠 状 断層 像 に よ り,腫 瘍 の性 格 お よび 広 がりが 明 瞭に 示 された.経 胸腹 的 ア ブP一 チに よ り摘除され た 腫瘍 の 組 織 所 見 はcysticteratomaで,悪性所 見 は 認め られ なか った.(泌尿 紀 要34:2031-2034,1988)

成人に見られた後腹膜腔原発の良性奇形腫の1例

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成人に見られた後腹膜腔原発の良性奇形腫の1例

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