A 1-day old male neonate presented with abdominal distension.
The child was initially evaluated with Ultrasound, which showed a large septated multiloculated cystic abdominal mass, with echogenic foci within the septae. On colour Doppler, the lesion showed internal vascularity.
Contrast-enhanced abdominal CT demonstrated a large cystic abdominal mass with multiple enhancing septations and calcifications within the septae. The mass was seen in close proximity to the lesser curvature of the stomach, extending into the mediastinum along the oesophagus. No intraluminal extension was seen. On arterial phase images, the left gastric artery was seen supplying the mass.
It displaced the bowel loops laterally, left kidney inferiorly, and pancreas posteriorly. No solid component or fat density was identified. There was no infiltration of other organs.
Teratomas are germ cell tumours with components from all three germ cell layers.
Gonadal teratomas are observed more often in older children, and extragonadal teratomas in infants and neonates [1,2].
Common extragonadal locations include the sacrococcygeal location and mediastinum, while less than 1% originate from abdominal viscera such as the stomach [2,3].
Most of the reported gastric teratomas are mature teratomas . Gastric teratomas tend to occur in infants and toddlers and have a male predisposition .
Common clinical manifestations include abdominal distension, palpable abdominal mass, and vomiting [1,4].
Surgical resection forms the mainstay of treatment, and the prognosis is generally good .
A combination of radiographs, ultrasound, and CT can be used to make the diagnosis.
On plain radiographs, calcifications can be demonstrated in about 50% of cases .
Ultrasound findings usually include a heterogeneous mixed solid and cystic mass with calcifications, though demonstrating the organ of origin is most often not possible .
CT is helpful in determining the organ of origin of the lesion and in delineating its extent. Common features include a cystic lesion with internal calcifications and fat component [1,4].
Differentials for an abdominal lesion with such an appearance include Wilm’s tumour, cystic neuroblastoma, mesenteric lymphangioma, and angiomyolipoma .
Presence of bilateral normal kidneys is helpful in excluding Wilms’ tumour and angiomyolipoma .
The presence of calcifications and fat, along with organ of origin being the stomach, can help exclude neuroblastoma, and suggest the diagnosis of gastric teratoma .
Gastric teratomas are a rare entity, however characteristic features such as their cystic nature, presence of fat and calcifications, and gastric origin on CT can help in their accurate diagnosis. Establishing the organ of origin in a large mass, such as in the featured case, can be challenging; and the possibility of gastric teratoma needs to be kept in mind in such cases.
The child was subsequently operated, and the final diagnosis was a benign mature gastric teratoma.
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