extragonadal occurrence is rare , and it is usually found in the anterior mediastinum , retroperitoneum , and sacrococcygeal region . primary retroperitoneal teratoma is unusual in patients above the age of 30 years ; only 10% have been reported to occur after that age . teratomas confined to the adrenal gland are exceptional ; only 3 cases have been reported in the english - language literature . we report 2 cases of mature teratomas of the adrenal gland that were laparoscopically excised . an 8-year - old boy was seen for lumbar pain after a fall . upon physical examination , excretory urogram revealed a mass in the upper pole of the right kidney ( figure 1 ) . abdominal computed tomography showed an 8-cm heterogenous right adrenal lesion with calcifications ( figure 2 ) . laparoscopic transperitoneal exploration was carried out , and a complete right adrenal resection was performed . no bleeding occurred during surgery , and the patient was discharged home after 48 hours . the tumor was found to be a mature cystic teratoma located in the right adrenal . three years after surgery , the patient remained asymptomatic and was free of tumor recurrence . a 61-year - old obese woman was incidentally diagnosed with a left adrenal mass during spinal surgery . computed tomographic scan revealed an 8-cm solid left adrenal lesion ; no calcifications were noted . the patient underwent percutaneous drainage of the collection and was discharged on postoperative day 10 . pathologic examination of the tissue confirmed a mature cystic teratoma that measured 8 cm in diameter and weighed 54 g. after 12 months , a small access port - site hernia was diagnosed . an 8-year - old boy was seen for lumbar pain after a fall . upon physical examination , excretory urogram revealed a mass in the upper pole of the right kidney ( figure 1 ) . abdominal computed tomography showed an 8-cm heterogenous right adrenal lesion with calcifications ( figure 2 ) . laparoscopic transperitoneal exploration was carried out , and a complete right adrenal resection was performed . no bleeding occurred during surgery , and the patient was discharged home after 48 hours . the tumor was found to be a mature cystic teratoma located in the right adrenal . three years after surgery , the patient remained asymptomatic and was free of tumor recurrence . a 61-year - old obese woman was incidentally diagnosed with a left adrenal mass during spinal surgery . computed tomographic scan revealed an 8-cm solid left adrenal lesion ; no calcifications were noted . the patient underwent percutaneous drainage of the collection and was discharged on postoperative day 10 . pathologic examination of the tissue confirmed a mature cystic teratoma that measured 8 cm in diameter and weighed 54 g. after 12 months , a small access port - site hernia was diagnosed . retroperitoneal teratomas are extremely rare . generally , the exact location is difficult to define . differentiation of a retroperitoneal teratoma in the para - adrenal area from a true adrenal teratoma is tricky . to our knowledge , only 3 cases of para - adrenal teratoma and adrenal 
 teratoma have been described . clinical presentation at diagnosis is usually vague with unspecific lumbar and abdominal pain . on computed tomographic scans magnetic resonance t2 weighed images show teratoma as a highlighted intensity around the tumor components . according to lam et al , of 149 consecutive laparoscopic adrenalectomies performed in the last 10 years at our institution , only 2 ( 1.34% ) were adrenal teratomas . pathologic criteria for benign lesions were met in both cases : absence of malignant or immature elements in the tumor , absence of other similar lesions in other parts of the body , normal serum levels of afp and hcg , and absence of recurrence in the long - term follow - up . we prefer transperitoneal laparoscopic adrenalectomy for adrenal tumors , because it is a minimally invasive , well - tolerated , highly effective technique . laparoscopic transperitoneal adrenalectomy is a feasible and effective technique that enables excellent oncologic results . to our knowledge