Primary Right Adrenal Teratoma in a Postmenopausal Female: a Case Report and Review of Literature

Abstract

Non-seminomatous germ cell tumors with structural components from all three cellular lineages are called teratomas. We report a rare case of a primary right adrenal teratoma in a postmenopausal female, presenting with abdominal pain. Ultrasound revealed a complex cystic shadow in the perihepatic region superior to the upper pole of the right kidney, which was suggestive of a complex supra-renal space-sequence-occupying lesion. Computerized tomography revealed a large-sized mature single multilobulated complex cystic lesion in the right hypochondrial lumbar region arising from the right adrenal gland. A right-sided transperitoneal adrenalectomy was performed. The resected mass (18 × 13 × 10 cm) was well encapsulated. Cut surfaces showed cystic mass filled with necrotic gray-white pultaceous material, along with a solid white gelatinous area. Microscopic sections showed a tumor which displayed differentiation along various tissue lineages. After immunohistochemical examinations, the tumor was confirmed to be a mature cystic teratoma. Mature teratomas show a good prognosis, and surgical resection and follow-up remain the standard approach.

Keywords: Adrenal teratoma; Germ cell tumor; Mature cystic teratoma; Open adrenalectomy; Retroperitoneal mass.

Fig. 1

Axial computerized tomography sections of the abdomen. Right retroperitoneal adrenal mass (red star), compressed inferior vena cava (green star), and the right kidney (sky-blue star)

Fig. 2

Coronal (left) and sagittal (right) sections of computerized tomography of the abdomen. Adrenal mass in red star

Fig. 3

Gross view of the resected specimen. The specimen measured 18.0 × 13.0 × 10.0 cm. The outer surface was nodular and well encapsulated. The cut surface showed multiple cysts filled with necrotic and pultaceous material with areas of fat and gelatinous material.

Fig. 4

Microphotographs of the mature cystic teratoma in the adrenal gland. A–B Whole of the adrenal gland was replaced by cystic spaces lined by mature ectodermal tissue composed of stratified squamous epithelium and unremarkable compressed adrenal parenchyma was seen at the periphery (hematoxylin and eosin ×50, ×100). C–D Mature stratified squamous epithelium with keratinous debris (hematoxylin and eosin ×100). E Areas of fibroadipose tissue (hematoxylin and eosin ×100)