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Year : 2023  |  Volume : 66  |  Issue : 1  |  Page : 205-206
Mature cystic teratoma of stomach in a 6-year-old child: Usual tumor at an unusual location

1 Department of Pathology, Lady Hardinge Medical College, New Delhi, India
2 Department of Pediatric Surgery, Lady Hardinge Medical College, New Delhi, India

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Date of Submission05-Oct-2021
Date of Decision02-Nov-2021
Date of Acceptance05-Nov-2021
Date of Web Publication18-Jan-2023

How to cite this article:
Osama MA, Chatterjee P, Singh S, Sarin YK. Mature cystic teratoma of stomach in a 6-year-old child: Usual tumor at an unusual location. Indian J Pathol Microbiol 2023;66:205-6

How to cite this URL:
Osama MA, Chatterjee P, Singh S, Sarin YK. Mature cystic teratoma of stomach in a 6-year-old child: Usual tumor at an unusual location. Indian J Pathol Microbiol [serial online] 2023 [cited 2023 Mar 20];66:205-6. Available from:

   Case History Top

A 6-day-old male child presented in the outpatient department of pediatric surgery with complaints of a lump in the abdomen since 15 days. There was associated dull aching pain and constipation. On abdominal palpation, a large cystic swelling was noted predominantly in the left flank region extending to the midline. The mass was firm in consistency, freely mobile with distinctly identifiable borders. Contrast-enhanced computed tomography (CECT) scan revealed a well-defined encapsulated heterogeneous mass composed of solid and cystic areas along with areas of calcification, adipose tissue, and soft tissue attenuation [Figure 1]a. Intraoperatively, a well-encapsulated tumor composed of mixed solid and cystic areas, arising from lesser curvature, was seen [Figure 1]b. Mass was excised completely, and sent for histopathological examination. Grossly, the mass measured 16 × 14 × 9 cm. Serial slicing revealed solid cystic areas; the solid areas were gritty to cut. Many cysts varying in size from 1 to 1.5 cm diameter filled with pultaceous material and hair shafts were noted [Figure 1]c. Microscopic examination revealed a tumor composed of various derivatives of ectoderm, mesoderm, and endoderm. Ectodermal derivatives included multiple cysts lined by stratified squamous epithelium with keratinous flakes [Figure 2]a and glial tissue [Figure 2]b. Among the endodermal derivatives, gastrointestinal (duodenal, ileal, and colonic mucosa) [Figure 2]c, respiratory mucosal lining [Figure 3]a, and mucinous glands were found. Whereas mesodermal derivatives included mature cartilaginous [Figure 3]b, adipose tissue, and bony lamellar fragments enclosing marrow spaces [Figure 3]c, no immature neuroepithelium was identified. Hence, the overall histological picture was suggestive of mature gastric teratoma (grade 0). The child is doing well at 1-month follow-up. No chemotherapy or radiotherapy was given.
Figure 1: (a) Axial contrast-enhanced CT image showing a well-defined encapsulated heterogeneous mass composed of solid and cystic areas (green arrow), bony fragment (white arrow); (b) Intraoperative picture showing a well-encapsulated mass arising from lesser curvature; (c) Cut surface showing adipose tissue (white solid arrow), cartilage fragments (black arrow) with multiple cysts filled with pultaceous material (red arrow)

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Figure 2: (a) Multiple cysts lined by stratified squamous epithelium (black arrow), filled with pultaceous material (H&E 40×); (b) Multiple nodules of mature glial tissue (green arrow) (H&E 40×); (c) Ileal mucosal lining (red arrow) with underlying muscle wall (H&E 40×)

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Figure 3: (a) Respiratory mucosal lining (ciliated columnar epithelium) (black arrow) and underlying mature glial (red arrow) (H&E 100×); (b) Lobules of cartilage (white arrow) along with brunner's glands (green arrow) and overlying duodenal mucosa (yellow arrow) (H&E 40×); (c) Bony lamellar fragments enclosing marrow spaces with hematopoietic cells (blue arrow) (H&E 100×)

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   Discussion Top

Teratomas are embryonic neoplasms that arise from totipotent cells and contain elements from all three germ layers (i.e., ectoderm, mesoderm, and endoderm) and can be benign or malignant in nature. Teratomas typically form in the ovary and testicle.[1] Extra-gonadal teratomas have been reported in sacrococcygeal/presacral region, mediastinum, and retroperitoneum.[2] Gastric teratoma is a rare tumor, accounting for less than 1% of all teratomas in infants and children.[3] This tumor usually occurs in children, especially neonates. This tumor arises most commonly from the posterior wall of the stomach and can be exogastric or endogastric.[4] Although gastric teratomas can arise from any part of the stomach, the common sites where it is encountered are the lesser curvature of stomach, antrum, and fundus of stomach. Some of these tumors are pedunculated and are attached by a pedicle to the stomach. The present case showed an interesting morphological feature comprising of a fully developed intestine with all the three layers (mucosa, submucosa, and muscularis propria with myenteric plexus). The intestinal mucosal lining was colonic majorly and duodenal focally. Histopathological grading of the tumor is the single most important prognostic factor and the degree of immaturity correlates with the ultimate prognosis of children.[4] Teratomas are subdivided into mature or immature subtypes depending on constituent element. Grade 0 is mature and regarded as benign. The amount of immature neuroectoderm in grade 1 is ≤1 low-power field, in grade 2 it's >1 but ≤3 low-power fields, while in grade 3 the immature tissue occupies >3 low-power fields. Grade 0, 1, and 2 pure teratomas have the potential to become malignant (Grade 3), and malignant pure teratomas have the potential to metastasize. They are classified into mature and immature teratomas based on the presence and degree of differentiation of neuroglial tissue. Mature gastric teratomas are benign and have a good prognosis after complete surgical excision.[5]

   Conclusion Top

We have reported this case to emphasize that a diagnosis of teratomas should be considered in an infant presenting with abdominal lump. There is paucity of published data in the literature about this rare tumor entity. The detection of immature component carries a prognostic implication and hence, extensive sampling is essential.

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.

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Conflicts of interest

There are no conflicts of interest.

   References Top

Ulbright TM. Germ cell tumors of the gonads: A selective review emphasizing problems in differential diagnosis, newly appreciated, and controversial issues. Mod Pathol 2005;18:61-79.  Back to cited text no. 1
Ueno T, Tanaka YO, Nagata M, Tsunoda H, Anno I, Ishikawa S, et al. Spectrum of germ cell tumors: From head to toe. Radiographics 2004;24:387-404.  Back to cited text no. 2
Herman TE, Siegel MJ. Congenital gastric teratoma. J Perinatol 2008;28:786–7.  Back to cited text no. 3
Aihole JS, Babu MN, Jadhav V, Javaregowda D. Gastric teratoma: An unusual presentation and location. Indian J Med Paediatr Oncol 2017;38:563-5.  Back to cited text no. 4
[PUBMED]  [Full text]  
Ijaz L, Aslam I, Sheikh A, Mirza B. Mature gastric teratoma: The mixed exogastric and endogastric variety. APSP J Case Rep 2011;2:17.  Back to cited text no. 5

Correspondence Address:
Priti Chatterjee
Department of Pathology, Lady Hardinge Medical College, New Delhi
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijpm.ijpm_991_21

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