Primary adrenal teratoma: An unusual tumor - Challenges in diagnosis and surgical management

Abstract

We report a rare case of a 25-year-old lady who presented with right hypochondriac pain associated with weakness for 3 months. Her hormonal evaluation was normal. Computed tomography scan revealed an adrenal mass for which a right open transperitoneal adrenalectomy was performed, and the lesion was diagnosed as mature teratoma on histopathological examination. Teratoma is an unusual neoplasm which arises from one or all the three germ layers. Extragonadal teratomas are rare in adults as compared to children and are mostly retroperitoneal in location, constituting only 4% of all primary teratomas. Primary adrenal teratomas are even rarer and to the best of our knowledge, only eight cases have been reported in adults in the past 10 years. Adrenal teratoma can pose a diagnostic challenge because radiologically it mimics myelolipoma, angiomyolipoma, liposarcoma, or pheochromocytoma. Mature teratomas are usually benign but may possess malignant potential, the chances of which are greater in adults as compared to children, making it an important entity requiring a proper diagnosis and management.

Keywords: Adrenal gland tumor; adrenalectomy; teratoma.

Figure 1

(a) Computed tomography scan of abdomen showing a large heterogeneous mass (white arrow) in right adrenal measuring 20 cm × 15 cm with few cystic areas, fat content, and calcifications. (b) Adrenelectomy specimen (c) Cut surface displaying (white arrow) a variegated appearance with prominent fatty area

Figure 2

Microscopic examination of adrenelectomy specimen displaying: (a) startified squamous epithelium, (b) respiratory epithelium, (c) cartilage, (d) hematopoietic component, (e) glial tissue, (f) adrenal tissue [(a), (b), (c) – 400X and (d), (e), (f) – 200X; H&E stain]