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Year : 2010  |  Volume : 53  |  Issue : 4  |  Page : 872-873
Mature cystic teratoma of the liver in an adult female


Giansagar Medical College and Hospital, Banur, Rajpura, Dist. Patiala, Punjab, India

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Date of Web Publication27-Oct-2010
 

How to cite this article:
Madan M, Arora R, Singh J, Kaur A. Mature cystic teratoma of the liver in an adult female. Indian J Pathol Microbiol 2010;53:872-3

How to cite this URL:
Madan M, Arora R, Singh J, Kaur A. Mature cystic teratoma of the liver in an adult female. Indian J Pathol Microbiol [serial online] 2010 [cited 2020 Nov 24];53:872-3. Available from: https://www.ijpmonline.org/text.asp?2010/53/4/872/72022


Sir,

By definition, a teratoma must contain tissue derivatives of at least two or more germ cell layers-namely, ectoderm, mesoderm and endoderm. [1] They comprise 1 - 15% of the childhood tumors. [2]

These tumors most commonly occur, in order of decreasing frequency, in the ovaries, testes, mediastinum, retroperitoneum, sacrococcygeal region, cranium and rarely in the gastrointestinal tract and liver. [3],[4] Most liver teratomas are seen in patients under three years of age, likely reflecting their proposed congenital origin. [3] Their histological components are skin appendages, cartilage, bone, tooth, adipose tissue and less commonly glial and glandular tissue. [5]

34-year-old female presented with abdominal distension of one-month duration and vomiting. On examination, there was a lump in the epigastrium extending to right hypochondrium.

Ultrasound revealed a cystic mass in the right lobe of the liver. Computed tomography (CT) scan showed a mass attached to the right lobe of liver. Laparotomy was performed and the mass was separated from the right lobe of the liver. Gross examination revealed a large mass of mixed solid and cystic consistency measuring 13.5 × 8.5 × 3.5 cm. Cut section showed sebaceous material admixed with hair. Microscopically, it showed a wide variety of benign and mature tissues including skin appendages, neural tissues, skeletal and smooth muscle cells, cartilage, glandular epithelium and adipose tissue. [Figure 1], [Figure 2], [Figure 3], [Figure 4] No signs of malignancy were seen in the tissue sections. The final pathological diagnosis was a benign cystic teratoma.
Figure 1: Low power view showing ganglion cells, adipose tissue and smooth muscle cells (H and E, ×40); inset view shows magnified view of ganglion cells

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Figure 2: Low power view showing adipose tissue and cartilage (H and E, ×100)

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Figure 3: Low power view showing interlacing bundles of smooth muscle cells (H and E, ×100)

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Figure 4: Low power view showing pilosebaceous unit and adipose tissue (H and E, ×100)

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They mostly occur in the ovaries or the sacrococcygeal region in children. Liver is a very rare site of its occurrence. [5] Even in pediatric patients where they are most commonly seen, they account for less than 1% of all liver neoplasms. [5] For reasons unknown, they more commonly occur in female patients and are most common in the right hepatic lobe. Most are discovered incidentally, as there is no typical clinical presentation. [3] Compression of the surrounding structures can cause symptoms of abdominal distension, nausea and vomiting. [5]

Plain radiographs usually show a soft tissue mass with fat and calcification. Ultrasonography may demonstrate a hypoechoic (representing calcification or fat) or anechoic (representing cystic portion of the mass) component. Calcification appears as high density foci on CT whereas fat is identified as hypodense. [3],[5] Occasionally, there may be no calcium and diagnosis can be difficult on CT as was found in this case. [1]

These are usually well-encapsulated lesions and are easily resec table from the surrounding hepatic parenchyma as was discovered by our surgeon. [3],[5] Complete resection remains the best treatment option. [3]

They can be categorized as benign or malignant based on histological features and the number of mitotic cells noted. In the present case, no immature tissue or mitotic figures were evident. So a diagnosis of benign cystic teratoma was made.

The differential diagnosis to be considered in the cystic lesions of the liver can be primary congenital cysts, infectious (echinococcal, abscesses), traumatic and neoplasms with cystic degeneration (lipoma, lymhangioma, paraganglioma and leiomyoma) [1] However, a definitive diagnosis of teratoma and its differentiation from all these lesions can easily be made on histopathological examination.

 
   References Top

1.Ayyappan AP, Singh SE, Shah A. Mature cystic teratoma in the falciform ligament of the liver. J Postgrad Med 2007;53:48-9.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Rao PL, Venkatesh A, Murthy VS. Cystic teratoma in the bare area of liver. Indian J Pediatr 1987;54:275-8.  Back to cited text no. 2
[PUBMED]    
3.Martin LC, Papadatos D, Michaud C, Thomas J. Best cases from the AFIP: Liver teratoma. Radiographics 2004;24:1467-71.   Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Winter TC 3rd, Freeny P. Hepatic teratoma in an adult: Case report with a review of literature. J Clin Gastroenterol 1993;17:308-10.  Back to cited text no. 4
[PUBMED]    
5.Rahmat K, Vijayananthan A, Abdullah JJ, Amin SM. Benign teratoma in an adult: A rare case of cholangitis. Biomed Imaging Interv J 2006;2:20-4.  Back to cited text no. 5
    

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Correspondence Address:
Manas Madan
21A, Sandhya Enclave, Majtha Road, Amritsar - 143001, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.72022

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  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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