以左腎水腫為表現的後腹腔畸胎瘤: 病例報告及文獻回顧

陳經國、沈坤宏

奇美醫學中心 外科部 泌尿外科

Huge retroperitoneal teratoma with initial presentation of left hydronephrosis: a case report and review of literature

Keng-Kok Tan、Kun-Hung Shen

Division of Urology, Department of Surgery, Chi Mei Medical Center, Taiwan

Purpose: Teratomas often occur in midline structures as the mediastinum, retroperitoneum, and sacrococcygeal region. Retroperitoneal teratomas represent 1–11% of primary retroperitoneal tumors. They are usually identified only after they have grown to huge proportions. There is a 25% chance of malignancy. Surgical resection remains the mainstay of therapy and is required for definitive diagnosis. We present a case with huge retroperitoneal teratoma which causes left hydronephrosis.

Case report: A 40-year-old man, with no history of systemic disease, was told to have left hydronephrosis by health examination. There was no flank pain or other discomfort. At our OPD, intravenous pyelography showed suspicious left distal ureteral stone with moderate obstructive uropathy, and a pelvic mass. Further CT revealed a 17cm presacral fat containing mass with anterior compression of rectum, urinary bladder and bilateral distal ureters, resulting in left moderate hydroureteronephrosis, suspicious of teratoma. Diagnostic left ureteroscopy was first performed for relieving obstruction, but failed because left ureteral stenosis and angulation because of external compression. Exploratory laparotomy for tumor excision was performed. During the surgery, a 17x17cm round tumor occupying retroperitoneal space was found. It had smooth surface, but adhesion with peritoneum, pelvic floor, and sacrococcygeal area were noted. Multiple septa with different contents within each cavity were found, including calcifications, hair, adipose tissue, fluid, and blood. The pathology reported mature teratomas. The patient is now receiving follow-up at our OPD and the recovery was uneventful.