THIRTY KILOGRAMS GIANT RETROPERITONEAL TERATOMA: CASE REPORT

INTRODUCTION

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 gonads^7,13. 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 organs^2,4,5,12,13. 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.

CASE REPORT

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).