Primary Mature Cystıc Teratoma Mimickıng an Adrenal Mass in an Adult Male Patient
A 54-year-old previously healthy male patient developed acute, left upper quadrant abdominal and left flank pain. This pain lasted several hours and then resolved spontaneously. When he was admitted to the hospital, on ultrasound and an abdominal and pelvic CT scan, he was found to have an 8-cm×7-cm×6-cm solid and cystic mass in the left (surrenal area) retroperitoneum containing bone and multiple soft tissue densities (). The tumor had calcification and was not well enhanced. There was no evidence of distant metastasis. The tumor was also examined by magnetic resonance imaging (MRI). We also diagnosed that the tumor originated in the left adrenal gland, because the normal adrenal gland could not be recognized by CT or MRI. The patient had hypertension for which he was taking amlodipine 5 mg daily. However, plasma levels of catecholamines, rennin, aldosterone, adrenocorticotropic hormone, and cortisol were within the normal range. Tumor markers, such as serum alpha-fetoprotein, lactate dehydrogenase, carcinoma antigen 125, neuron-specific enolase, and carbohydrate antigen 19-9, were examined because it was possible that the tumor did not originate from the adrenal gland.\nThe patient underwent resection of the lesion through a flank incision by 11th rib resection. The retroperitoneal dissection was tedious and difficult, but the mass was excised in its entirety (). The left adrenal gland was normal. The resected retroperitoneal cystic mass measured 8 cm×7 cm×6 cm and weighed 153 g (). The final pathological evaluation of the tumor was a mature teratoma without malignant components. Macroscopically, the specimen was a 6 cm ×5 cm ×4 cm fluctuating mass. On incision, cystic material came off and a thinly walled cyst was left. The cyst wall thickness was approximately 1 mm with only some minor excrescents. Histologically, the cystic cavity was lined by ciliated columnar cells () and the excrescents were hyalin cartilage islands under this epithelium with some lobules of seromucinous glands (). No immature elements were seen and the diagnosis was a mature cystic teratoma pathologically. Because these tumors usually represent metastasis from other primary sites, additional imaging with CT of the chest and scrotal ultrasonography was performed. No other primary tumor was identified. Therefore, we diagnosed the mass as a primary retroperitoneal teratoma. After 12 months of follow-up, the patient was free of recurrence.