Resection of a mature cystic teratoma of the liver harboring a carcinoid tumor

Abstract

Cystic teratomas are rare pluripotent embryonic tumors which most commonly originate in gonadal organs. Extra-gonadal cystic teratomas are exceedingly uncommon, accounting for only 1% of all cystic teratomas, and have been reported in unusual locations including the kidney, mediastinum and liver. These extra-ovarian cystic teratomas have also been known to harbor other neoplasms including carcinoid tumors. In this report, we describe a unique case of a hepatic cystic teratoma occurring as a combined tumor with a carcinoid in a young female. The patient underwent elective laparoscopic resection of her tumor after extensive radiographic and endoscopic work-up for chronic, non-localizable abdominal pain. We believe the carcinoid tumor arose de novofrom committed differentiation of a cell line within the teratoma, and not metastatic spread.

Figure 1:

(a and b) CT abdomen and pelvis without IV contrast demonstrating tumor in axial (a) and coronal views (b). (c and b). MR abdomen and pelvis with and without IV contrast (Eovist, gadoxetate disodium, Bayer Pharmaceuticals) showing 3.7 × 5 × 2 cm³ complex lesion containing cystic elements, macroscopic fat and calcification in axial (c) and coronal (d) views.

Figure 2:

Liver parenchyma abutting neuroendocrine tumor.

Figure 3:

Skin adnexae and glandular elements of the mature cystic teratoma.

Figure 4:

Thyroid tissue (left) adjacent to liver parenchyma.