李蕎青^1,2、丁慧恭¹、查岱龍¹、孫光煥¹、于大雄¹、吳勝堂¹、高建璋¹

¹三軍總醫院外科部泌尿外科  ²國軍高雄總醫院外科部

Chiao-Ching, Li^1,2, Hui-Gung, Ting¹, Tai-Lung, Cha¹,

Dah-Shyong, Yu¹, Sheng-Tang, Wu¹, Chien-Chang, Kao¹

1. Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

2. Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan

 

A adrenal tumor containing fat, cysts, and calcification on imaging studies is occasionally encountered in clinical practice and is usually diagnosed with myelolipoma. Here, we report a case of such a left suprarenal mass, in which an unexpected pathological diagnosis was made following surgical resection via a minimally invasive approach. The current case highlights limitations of image-based diagnosis of adrenal masses and the diagnostic and therapeutic role of minimally invasive surgery for them.

Medical record is from the 26-year-old woman who had past history of epigastric discomfort. Initially, she went to gastrointestinal outpatient department for treatment. The upper gastrointestinal panendoscopy and ultrasonography of whole abdomen were arranged. The hyperechoic mass-like lesion about 7.5 x 6 x 7.5 cm between pancreatic tail and the left kidney was found. In addition, no significant vascularity of the mass-like lesion was noted. Further evaluation, such as computerized tomography(CT) scan of abdomen and magnetic resonance imaging(MRI) of retroperitoneum were arranged. One lobulated well-defined mass with septa was located left supra-renal space. Low density in CT scan, hypointensity on T1WI and very hyperintensity on T2WI. Besides, no positive findings in endocrine survey was presented. Initially, adrenal myelolipoma was suspected. After laparoscopic removal of supra-renal tumor, the unexpected diagnosis was retroperitoneal mature cystic teratoma.

The laparoscopic removal of supra-renal tumor was performed smoothly without fluctuating blood pressure nor blood transfusion. The patient discharges 5 days after operation. The gross specimen is gray in color and 10x10x3cm in size. Soft to hard in consistence sticky content and hair were presented. There were skin appendage and bone in the tumor. It focally adhered to the normal adrenal gland. Therefore, retroperitoneal mature cystic teratoma was diagnosed.

Retroperitoneal mature cystic teratoma is a relatively rare but clinical important tumor which needs curative resection due to a potential risk of malignancy. Considering the diagnostic difficulty of retroperitoneal teratoma by radiological imaging, surgical resection via a minimally invasive approach may be a viable treatment option in a case of an adrenal mass difficult to distinguish retroperitoneal teratoma from adrenal myelolipoma.