Teratomas are composed of somatic cells from two or more germ layers (ectoderm, mesoderm or endoderm)8. Although the child's age being the most affected, in adults it occurs at different locations, such as mediastinum, sacrococcix, retroperitoneum and more often in the gonads7,13. Retroperitoneal teratomas in adults are rare, representing only 1-11% of all primary tumors in that anatomic region9, generally are benign and asymptomatic in the first stages. However when symptoms occur, they are typically due to their size, presenting with abdominal distension and a palpable mass12. Diagnosis can be made by ultrasound, that can identify solid or cystic components, computerized tomography and magnetic resonance imaging, which are both superior than ultrasound to evaluate tumoral extention and relation to adjacent organs2,4,5,12,13. Angiography can be used to detect and evaluate the blood supply. In this article, it is presented a case of a giant retroperitoneal treated with surgical resection.
A 42-year-old male was suffering from an insidious abdominal distention for the last 13 years, that was more remarkable in the initial three years. There was no fever, abdominal pain, or bowel complaints. He denied smoking or drinking abuse. There was not any kind of disease in patient's past or family medical history. He had been treated with spironolactone years before, with no previous investigation, and it was suspended by the occurrence of gynecomastia. On admission, he was clinically in good condition, and presenting an important abdominal distention without tenderness, and bowel sounds preserved. The rest of the examination was unremarkable. Admission laboratory tests showed no abnormalities. An abdominal computerized tomography revealed a mass occupying all regions in the abdominal cavity, showing no apparent origin. The patient underwent exploratory laparotomy that showed a mass weighing approximately 30 kilograms (Figure 1), whose origin was in the retroperitoneum completely displacing the left kidney to the right iliac fossa. The patient did well post-operatively and is currently assymptomatic and has been followed as an outpatient. Histopathological analisys demonstrated heterogeneous contents, with predominant cystic formations and other unctuous and soft components, and the diagnosis of mature teratoma was confirmed by microscopy (Figure 2).
CD133 and AXL have been described as cancer stem cell markers, and c-MYC as a key regulatory cellular mechanism in colorectal cancer (CRC).
Evaluate the prognostic role of the biomarkers CD133, AXL and c-MYC and their association with clinicopathologic characteristics in colorectal adenocarcinomas and adenomas.
A total of 156 patients with UICC stage I-IV adenocarcinomas (n=122) and adenomas (n=34) were analyzed. Tissue microarrays (TMA) from primary tumors and polyps for CD133, c-MYC and AXL expression were performed and analyzed for their significance with clinicopathologic characteristics.
Poorly differentiated adenocarcinomas and disease progression were independent risk factors for poor overall survival. The median overall survival time was 30 months. Positive CD133 expression (35.9% of all cases), particularly of right-sided CRCs (44.8% of the CD133+ cases), was negatively correlated with death in the univariate analysis, which did not reach significance in the multivariate analysis. c-MYC (15.4% of all cases) was predominantly expressed in advanced-stage patients with distant (non-pulmonary/non-hepatic) metastasis. AXL expression was found only occasionally, and predominantly dominated in adenomas, with less penetrance in high-grade dysplasia.
CD133 expression was not associated with inferior overall survival in CRC. While AXL showed inconclusive results, c-MYC expression in primary CRCs was associated with distant metastasis.
Desenvolvido por Surya MKT