Recurrence of retroperitoneal mature cystic teratoma in an a
A 22-year-old woman presented with right hypochondria pain. Four years ago, she underwent surgery to remove the left ovary dermatome cysts. She began to feel uncomfortable and aching in the lower right quadrant for about 3 months after she first palpated the lesion 2 and 3 months ago. Recently, she noticed an increase in the size of the mass and referred to the clinic. She denied any associated symptoms including fever, loss of appetite, weight loss, nausea, and vomiting. She denied taking any medications, smoking or alcohol consumption and her family history was unremarkable.

Ultrasonography showed a mass of 112 × 110 × 65 mm dimensions in the middle of the liver and right kidney. It was heterogeneous, well circumscribed with irregular borders. The mass did not appear to arise from the right kidney. The mass was adherent to the segment VI of the right lobe of the liver. The mass has been described as a multilocular mixture lesion. Doppler interrogated images were also obtained and revealed minimal internal vascularity

Magnetic resonance imaging of upper and lower abdomen has also been performed. Similarly to ultrasonography and CT scan report, it also shows large multilocular cystic spaces mass with mild enhancing a smooth wall and thin septations as well as a little non enhancing solid contents. The cystic has been hemorrhagic heterogeneous signal intensity in locales with many different phases. Note the absence of detectable calcification or matted tuft of hair in mass.

Laparotomy with excision of the retroperitoneal mass was performed by the right subcostal line (Kocher's laparotomy). A huge retroperitoneal mass was observed. The surgeon found a tumor section stick to the surface of the liver and the stem of mass is derived from the retroperitoneal. Subsequently, complete removal of the mass from the liver surface was successful, and adhesions were released and the tumor was separated from the surrounding tissue. No ascites were observed and based on the findings a decision was made for total excision of a tumor. Finally, a 12 × 8 × 6.5 cm mass was totally excised and sent to the lab for pathologic evaluations. The mass had well-circumscribed smooth borders and rubbery consistency. Cut-section of the mass revealed multilocular cystic spaces, whitish-grey walls, scattered yellowish adipose tissue collections, and mucus secretions. The cyst wall was up to 4-mm thick.

The patient was followed 2 weeks after the surgery, during which she developed no significant complications.

Source: Radiology Case Reports ,Volume 14, Issue 6, June 2019, Pages 692-696

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