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Year : 2021  |  Volume : 64  |  Issue : 5  |  Page : 95-96
Immature gastric teratoma in an infant: A rare entity with review of literature


Department of Pathology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India

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Date of Submission29-Mar-2020
Date of Decision30-Apr-2020
Date of Acceptance08-Jun-2020
Date of Web Publication7-Jun-2021
 

How to cite this article:
Sathe P, Agnihotri M, Manudhane R, Shinde S. Immature gastric teratoma in an infant: A rare entity with review of literature. Indian J Pathol Microbiol 2021;64, Suppl S1:95-6

How to cite this URL:
Sathe P, Agnihotri M, Manudhane R, Shinde S. Immature gastric teratoma in an infant: A rare entity with review of literature. Indian J Pathol Microbiol [serial online] 2021 [cited 2021 Oct 16];64, Suppl S1:95-6. Available from: https://www.ijpmonline.org/text.asp?2021/64/5/95/317910




A 7-month-old male child was admitted with chief complaints of vomiting, palpable abdominal mass, and progressive distension of abdomen since 10 days. Systemic examination revealed a 10 × 10 cm, non tender, mobile, firm to hard mass in the epigastric region. Routine blood investigations were within normal limits. Serum alpha-fetoprotein (AFP) level was 6257 ng/mL (Normal value 0.89–8.78 ng/mL). Computed Tomography (CT) scan showed a well-defined heterogeneously enhancing lesion of size 9.9 × 9.1 × 7.9 cm, arising exophytically from the lesser curvature of stomach. The lesion contained calcified and fat density areas. On exploratory laparotomy, the tumor was seen arising from the lesser curvature of the stomach and was completely excised with a rim of the gastric wall as the mass was protruding into the lumen [Figure 1]a.
Figure 1: (a) Gross-Tumor was circumscribed, soft to firm, and attached to the stomach mucosa (arrow). (b) Cut surface was solid-cystic with few glistening areas. (c) Tumor extended into the muscularis externa without involving the mucosa (H and E, x 40). (d-f). Various mature tissues from all the three germ layers were seen (H and E, x 100). (g and h)- Immature neuroglial tissue showing rosettes and neuropil, occupying >4 fields per slide (H and E, x 100 x 400)

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Grossly, the tumor was circumscribed, soft to firm, and measured 10.5 × 10 × 8 cm. Cut surface showed predominantly solid areas with few mucin-filled tiny cysts and glistening foci [Figure 1]b. Microscopy revealed a tumor in the gastric wall composed of various tissues derived from all the three germ layers [Figure 1]c. There was skin, adipose tissue, cartilage, bone with marrow, various epithelia (squamous, respiratory, gastrointestinal), smooth muscle, clusters of ganglion cells, choroid plexus, melanin-containing tissue, blood vessels, and multiple foci of calcification [Figure 1]d,[Figure 1]e,[Figure 1]f. Mature as well as foci of immature neuroglial tissue showing rosettes and neuropil, occupying more than four high-power fields (x 40 magnification) was seen [Figure 1]g and [Figure 1]h. Mitotic activity was present in these areas. No other germ cell tumor component was present. The tumor was seen extending into the muscularis externa and submucosa without the involvement of mucosa. Histopathology diagnosis given was grade 3, immature teratoma of the stomach with intramural extension. The raised level of AFP in this case was due to the presence of abundant immature neuroepithelial tissue. The patient was not given chemotherapy. On follow-up, there was no recurrence of the tumor and AFP level was 94.8 ng/mL 2 months postoperatively.

The most common sites of occurrence of teratomas in infancy and childhood are sacrococcygeal (60%–65%), gonadal (10%–20%), mediastinal (5%–10%), and presacral (5%) regions.[1] The stomach is a very rare site with an incidence of less than 1% and usually seen in neonates and infants.[2] Males are largely affected.[3] There are about 100 cases of gastric teratoma reported in the literature. The site of origin can be anywhere in the stomach, the commonest being the posterior wall and the least common is lesser curvature.[3] It can be exogastric (58%–70%) or endogastric (30%).[4]

The majority of gastric teratomas are mature. Approximately 35 cases of immature variety have been published, of which 13 cases have occurred in the lesser curvature.[5] The presence of an immature neuroepithelial element is suggestive of immature teratoma, as in the present case.[5],[6] Barolia et al. had reviewed these 13 cases.[6] Four cases were diagnosed in neonatal age, one in antemortem period, and the remaining nine between 3 to 8 months of age. All were male and serum AFP was raised in eight cases. Histological grade was available in 7/13 cases, of which three cases were of grade1 and two cases each of grade 2 and 3, respectively. All were completely excised with no recurrence except one which had incomplete excision. We are adding one more case to the 13 reported cases of immature gastric teratomas arising from the lesser curvature of the stomach.

Treatment of choice for gastric teratoma is complete resection. Long-term monitoring of serum AFP levels is indicated in an immature teratoma of high histological grade.[6]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Senocak ME, Kale G, Buyukpamukcu N, Hicsonmez A, Caglar M. Gastric teratomas in children including the third reported female case. J PediatrSurg1990;25:681-4.  Back to cited text no. 1
    
2.
Gupta DK, Srinivas M, Dave S, Agarwala S, Bajpai M, Mitra DK. Gastric teratoma in children. Pediatr Surg Int 2000;16:329-32.  Back to cited text no. 2
    
3.
Gangopadhyay AN, Pandit SK, Sinha A. Gastric teratoma-review of literature. Indian J Pediatr1992;59:541-4.  Back to cited text no. 3
    
4.
Gobel U, Calaminus G, Engert J, Kaatsch P, Gadner H, Bökkerink JP, et al. Teratomas in infancy and childhood. Med Pediatr Oncol 1998;31:8-15.  Back to cited text no. 4
    
5.
Anilkumar MG, Jagadishkumar K, Girish GN, Sunila. Immature gastric teratoma in an infant. Indian J Surg 2013;75:453-5.  Back to cited text no. 5
    
6.
Barolia DK, Mathur V, Gupta PK, Garg D, Yadav RK, Dogra N, et al. Immature gastric teratoma arising from lesser curvature. World J Surg Surgical Res 2018;1:1013.  Back to cited text no. 6
    

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Correspondence Address:
Mona Agnihotri
Department of Pathology, Seth GS Medical College and KEM Hospital, Parel, Mumbai, Maharashtra - 400 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJPM.IJPM_297_20

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