Resection of ruptured hepatic teratoma in an adult

Abstract

Introduction: Extragonadal locations of teratomas are uncommonly reported in the literature. Teratomas are neoplasms usually found in the gonadal organs: ovaries and testis. The majority of teratomas are found in the pediatric age group. Furthermore, teratomas originating in the liver are exceedingly rare with only 11 case reports in adult populations.

Presentation of case: We present a case of a 65 year-old female who presented to hospital with sudden onset abdominal pain from a centrally located ruptured hepatic teratoma on CT scan. The patient underwent urgent surgery. The diagnosis of cystic mature teratoma was confirmed on histopathology. Patient was discharged on post-operative day 5. At 12 week follow-up, no post-operative complications were identified.

Discussion: Hepatic teratomas are a rarely encountered neoplasm, especially in the adult population. Our case report is unique, as it represents the only clinical presentation of mass rupture in an adult liver teratoma. CT scan identified a well circumscribed mass containing adipose tissue, fluid, and calcifications characteristic of teratoma. Complete surgical resection is mainstay treatment. A definitive diagnosis of a mature teratoma is confirmed by histopathological findings.

Conclusion: Presented is a rare case of ruptured hepatic teratoma in an adult who underwent surgical resection.

Keywords: Case report; General surgery; Hepatic teratoma; Hepatobiliary; Surgery; Teratoma.

Fig. 1

CT Abdomen/Pelvis showing axial section of CT a large mass in the right upper quadrant measuring approximately 15 × 12 × 11 cm. A conspicuous fat fluid level is present, as well as partial rim calcification.

Fig. 2

MRI Abdomen/Pelvis T1/T2 signal axial section of right upper quadrant mass with presence of fat fluid level and no internal enhancement.

Fig. 3

MRI Abdomen/Pelvis Coronal section of right upper quadrant mass demonstrating mass effect and marked upward displacement of right diaphragm.

Fig. 4

The internal aspect of the cyst (A) contained adherent hair (arrow) while the external aspect (B) demonstrated areas of necrosis, hemorrhage and fibrinopurulent exudates. Several detached fragments of cyst contents consisted of conglomerates of hair admixed with soft, caseous, necrotic material (C).

Fig. 5

Histological examination revealed hyalinized cyst wall containing distended bile ducts (asterisk) and areas of dystrophic calcification (arrow, A, 40X). Numerous hair shafts within the cyst wall were identified (arrow, B, 100X) as well as foreign body giant cells (arrows, C) surrounding fragments of keratin (asterisks, C, 100X). Sections from the cyst content showed hair shafts cut transversely (circle) and longitudinally (arrow) with surrounding necrotic material (D, 200X). All sections stained with hematoxylin and eosin.