2. Name: Kuao O O
Gender: Fe male
Birthday: 2015/06/13
Birth history: G2P2A0, GA 38weeks, via C/S
Birth body weight: 2560gw
Prenatal examination: no abnormality
Newborn screen: no abnormality
3. Decreased appetite since 2015-09-24
Formula milk 14090 ml Q4H
Abdominal distension
Decreased urine amount
No vomiting, no body weight loss, no constipation
Body weight : 5.9Kg height: 59cm
She was brought to LMD for vaccination and abdominal
mass was suspected.
4. Referred to VGH Kaohsiung on 2015-10-15
Sonography:
A large solid tumor with irregular cystic content,
9.5 x 6.5 cm
Right Kidney : markedly hydronephrosis
Left kidney: can’t be identified
Admission for further treatment
5. Abdominal CT scan on 10/16:
A huge heterogeneous cystic mass with soft tissue
component, septa, and calcification, suspected
immature teratoma, about 13 x 10 cm
Both kidney: hydronephrosis
Bilateral PCN was performed
CT-guided biopsy on 10/16
Pathologic report: compatible with immature teratoma
10/16 AFP: 6863 ng/ml
β-HCG : <1.2 mIU/ml
6. 10/16 CT scan
Huge tumor with
bilateral hydronephrosis aortaCompressed IVC
Suspicous left renal artery
7. 10/22 Neoadjuvant Chemotherapy with
etoposide + bleomycin
11/12 2nd course of chemotherapy
11/09 AFP 1185 ng/ml
11/23 AFP 224.5 ng/ml
Follow up CT on 11/30 showed no obvious change of
the size of teratoma
13. After the operation, the patient recovered uneventfully
and was discharged.
Followed lab:
12/03 AFP 181 ng/ml
12/08 AFP 74.08 ng/ml
Pathologic report: pending
14. Teratomas
sacrococcygeum (41%), ovary (28%), and testis (7%),
mediastinum, retroperitoneum, and other midline
structures (24%)
Retroperitoneal teratoma
Third most common primary retroperitoneal tumor
in the pediatric population after neuroblastoma and
Wilm's tumor
Account for 6% to 11% of primary retroperitoneal
tumors
About 5% of all childhood teratomas
Dehner LP. Germ cell tumors of the mediastinum. Semin Diagn Pathol 1990;8:266-84.
Gatcombe HG, Assikis V, Kooby D, et al. Primary retroperitoneal teratomas: a review of the literature. J Surg Oncol
2004;86:107-13.
C.C.Luo, C.S. Huang Retroperitoneal teratomas in infancy and childhood. Pediatric Surgery International,2005, Volume
21, Issue 7, pp 536-540
15. Bimodal presentation
peaks in the first 6 months of life and early adulthood
usually present with abdominal distension or a
palpable mass
Davidson AJ, Hartman DS, Goldman SM. Mature teratoma of the retroperitoneum: radiologic,
pathologic, and clinical correlation. Radiology 1989;172:421-5.
16. Their massive size and location
major vessel anatomy can be grossly distorted
predisposes to life-threatening injuries to major
blood vessels and adjacent organs
Injuries to aorta, portal vein, renal vein, inferior vena
cava (IVC), esophagogastric junction, and bile ducts
have also been reported
Vascular encasement appears less common than in
neuroblastoma.
Jones NM, Kiely EM. Retroperitoneal teratomas—potential for surgical misadventure. J Pediatr Surg 2008;43:184-7.
Valeria Solari , Wajid Jawaid . Elective suprarenal and infrarenal cavectomy for excision of giant retroperitoneal teratoma
in infancy J Pediatr Surg 2011;46:E37-E40
17. Preoperative imaging may be unable to predict
accurately the positions of the major vessels
Complete excision of tumor offers the best
chance of cure