Ahmed, Z

Hasan, S H

Jafri, N

Muzaffar, S

Yaqoob, N

English

eCommons@AKU

eCommons@AKUDepartment of Pathology and Laboratory Medicine Medical College, PakistanOctober 2003Renal teratoma: A rare entityN YaqoobAga Khan UniversityZ AhmedAga Khan University, zubair.ahmad@aku.eduN JafriAga Khan UniversityS MuzaffarAga Khan UniversityS H. HasanAga Khan University, sheema.hasan@aku.eduFollow this and additional works at: https://ecommons.aku.edu/pakistan_fhs_mc_pathol_microbiolPart of the Microbiology Commons, and the Pathology CommonsRecommended CitationYaqoob, N., Ahmed, Z., Jafri, N., Muzaffar, S., Hasan, S. H. (2003). Renal teratoma: A rare entity. Journal of Pakistan MedicalAssociation, 53(10), 492-493.Available at: https://ecommons.aku.edu/pakistan_fhs_mc_pathol_microbiol/987Renal Teratoma: a Rare EntityN. Yaqoob, Z. Ahmed, N. Jafri, S. Muzaffar, S. H. HasanDepartment of Pathology, Faculty of Health Sciences, The Aga Khan University, Karachi.IntroductionGerm cell tumors can arise not only in the gonadsbut also in the anterior mediastinum, retroperitoneum,parasacral and coccygeal region, perineal and other intracranial sites1 According to Dehner2, extragonadal germ celltumors occur in six general anatomic regions of the bodywhich include head, neck, thorax, abdomen (liver, stomach,kidney), retroperitoneum and sacrococcyx with the greatestnumber of cases occurring in the head. The kidney repre-sents one of the least common sites of extragonadal germcell tumors. Teratomas of the kidney are extremely rare andonly a few cases have been described in the literature.3-5According to Baldwin3 only five cases of the dermoids ofthe kidney are on record. McCurdy reported a case of ter-atoma occurring in a baby boy, 7 weeks old among 31 renalneoplasms in children.4 Teratomas of the pararenal regioninvolving the kidney were reported by Baker and Ragins5and Langley.6 According to Lucke and Schlumberger7, mostof the cases showing teratoid structures in the kidney wereexamples of nephroblastoma. According to Dehner2 thecase of intra renal teratoma reported by him was a bonafideexample of an intrarenal teratoma if retroperitoneal andpara-renal teratomas are eliminated from consideration. Weare presenting a case of mature cystic teratoma (dermoidcyst) in the kidney with an occasional immature element.Case ReportA two month old baby girl was admitted in thedepartment of paediatric surgery of a children hospital, withthe complaints of abdominal distension since birth. Onexamination her weight was 3.5 kgs and her abdomen washugely distended. On palpation a firm mass of about 11 x 6x 6 cms was palpable on left side of the abdomen, whichwas crossing to the right side as well. The mass was non-tender, moving with respiration and the  margins were irreg-ular. Her blood picture showed a haemoglobin concentra-tion of 12.0 gm/dl, X-ray abdomen showed a soft tissuemass with areas of calcification in the left side of theabdomen, which was pushing intestinal loops towards rightand upper side.  Ultrasound of abdomen  revealed a com-plex mass measuring 10.5 x 6 cms, partly cystic and partlysolid in nature on the  left side of abdomen, crossing to theright side. The left kidney was not visualized on ultrasound.Provisional diagnosis of hydronephrosis/ Kidney tumorwas made.Patient was operated upon; laparotomy was donethrough a left supraumblical transverse incision extendingto the right side. A large partly cystic and partly solid masswith extensive areas of haemorrhage in the cystic areas waspresent in the left lumbar region. It was roughly spherical inshape, crossing the midline. After peeling the overlyingdescending transverse colon from the mass, it was resectedout in toto.  Postoperative recovery of the patient wasuneventful and she was discharged on 8th postoperativeday. The specimen was sent  for histopathological examina-tion. Grossly a grayish brown sac like mass was receivedmeasuring 10 x 5.5 x 4.2 cms in maximum dimensions(Figure 1). It weighed 84 Gms. On sectioning a nodular cir-cumscribed lesion was identified measuring 5.5 x 5 cms.  Itwas attached to the cystic wall, which focally showed thick-ened brownish areas in the wall. The entire kidney wasreplaced by the lesion, only a thin rim of renal parenchymawas identified at the periphery. Attached adrenal gland wasalso identified outside the cyst. On sectioning the cut sur-face of this nodule was yellowish brown, haemorrhagic andnecrotic. Multiple sections were taken from the cyst walland from the nodular lesion and vessels. Microscopically small cystic spaces lined by kera-tinizing stratified squamous epithelium with skin adnexaewere identified (Figure 2). The solid areas showed large fociof cartilage and bone formation alongwith salivary gland tis-sue.  Melanin  containing cells  and neuroglial cellswith occasional foci of immature neuroectodermal tissue were also identified (Figure 3). The cyst wall was thick fibromuscular without anylining. Sections from solid areas in the cyst wall revealed immature renal tissue. Normal adrenal gland tissue was also identified. The diagno-sis was mature teratoma with focal immature component.DiscussionAmong common childhood neoplasms presenting as abdominal masses, the most important are neuroblastoma and nephroblastoma(Wilm's tumor). The most common germ cell tumor which occurs during the first year of life is sacrococcygeal teratoma8 Primary renal ter-atomas are exceptionally rare. According to Beckwith9, most lesions reported as renal teratomas appeared to be either Wilm's tumor in whichheterotopic tissues were prominent or retroperitoneal teratomas secondarily invading the kidney. Several authors emphasize the extraordinarydiversity of heteotropic cells and tissues which may be encountered in nephroblastomas..  Beckwith9 suggests that for a tumor to be termed arenal teratoma it should meet two criteria: (a) the primary tumor should be unequivocally of intrarenal origin i.e., the entire lesion should becontained within the renal capsule and there should be no teratomas in remote sites which might have metastasized to the kidney. (b) the tumorshould exhibit unequivocal heterotopic organogenesis. Our case report fulfils both these criteria.References1. Kojiro M, Ohishi H, Isobe H. Carcinoid tumor occurring in cystic teratoma of the kidney: a case report. Cancer 1976;38:1636-40.2. Dehner LP. Intrarenal teratoma occurring in infancy: report of a case with discussion of extragonadal germ cell tumors in infancy. J Pediat Surg 1973;8:369-78.3. Baldwin JF. Dermoids of the Kidney .Surg Gynecol Obstet 1915;20:219.4. McCurdy GA.Renal neoplasms in childhood. J Pathol Bacteriol 1934;39:623.5. Baker WJ,  Ragin AB. Pararenal teratoma. .J Urol 1950;63:982.6. Langley GF. Pararenal teratoma in a boy aged nine years. Br J Urol         1950;22:217.

Renal teratoma: A rare entity

https://ecommons.aku.edu/cgi/viewcontent.cgi?article=1986&amp;context=pakistan_fhs_mc_pathol_microbiol

Renal teratoma: A rare entity

Abstract

Similar works

Full text

Available Versions

eCommons@AKU