機器手臂輔助腹腔鏡腎上腺切除術治療巨大腎上腺畸胎瘤：病例報告與文獻回顧

呂晉典¹、劉惠瑛¹

¹高雄長庚紀念醫院泌尿科

Robotic assisted laparoscopic adrenalectomy for a giant adrenal teratoma:

 A case report and review of literature

Jin-Dien Liu¹、Hui-Ying Liu¹

¹Department of Urology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kaohsiung, Taiwan.

Introduction:

Primary adrenal teratoma is an exceptionally rare extragonadal germ cell tumor. In adults, it is usually non-functional and often detected incidentally. Although computed tomography may suggest the diagnosis by demonstrating fat, calcification, and mixed cystic-solid components, preoperative distinction from other fat-containing adrenal masses remains difficult.

Case Presentation:

A 53-year-old woman was referred for evaluation of an incidentally detected left suprarenal mass. She had no flank pain, hematuria, constitutional symptoms, or endocrine-related complaints. Endocrine evaluation and tumor markers were within normal limits, consistent with a non-functional adrenal tumor. Contrast-enhanced abdominal computed tomography revealed a large left suprarenal retroperitoneal mass measuring approximately 8 × 11 × 12 cm, with fatty, calcified, and enhancing soft-tissue components, displacing the upper pole of the left kidney. CT-guided biopsy showed only fibroadipose tissue with mature adipocytes and did not establish a definitive diagnosis. Because malignancy could not be excluded, robotic-assisted laparoscopic left adrenalectomy was performed. The postoperative course was uneventful, and final pathology confirmed mature teratoma.

Discussion:

This case highlights two important clinical points. First, adrenal mature teratoma remains difficult to diagnose before surgery because imaging findings may overlap with other fat-containing adrenal tumors, and biopsy may be nondiagnostic due to tumor heterogeneity and sampling error. Second, complete surgical excision plays both a diagnostic and therapeutic role. In selected patients without clear evidence of local invasion, robotic-assisted laparoscopic adrenalectomy may be a feasible minimally invasive option even for a large adrenal mass.

Conclusion

Adrenal mature teratoma is a rare non-functional adrenal tumor that can be challenging to diagnose preoperatively. When imaging is suggestive but biopsy is inconclusive, complete excision remains essential for definitive diagnosis and treatment. Our case supports the feasibility of robotic-assisted laparoscopic adrenalectomy in selected patients with a giant adrenal teratoma.