Dr. Prashant Jain
Sr. Consultant
Paediatric Surgery
BLK Centre for Child Health
BLK Super Speciality
Hospital, New Delhi

Germ Cell Tumours are a varied group of benign and malignant neoplasms derived from primordial germ cells. They occur in a variety of sites, both gonadal and extragonadal. Gastric teratoma is an extremely rare form of teratoma accounting for only 1% of all teratoma. The immature and malignant types are even rarer, with only 16 cases reported till date. Case of a 3-month old infant, who had a rapidly growing large abdominal mass and was diagnosed to have a grade III immature gastric teratoma, is discussed in detail below:

THE CASE

A baby boy of 3-months was brought to BLK with a rapidly growing abdominal mass in the upper abdomen. Antenatal history was normal and there was no associated history of vomiting and malena. On examination, the boy had a large nontender well-defi ned mass of 8x7 cm² extending from the left hypochondrium to the right hypochondrium. Hematological profi le and beta HCG level were within the normal limits while alpha feto protein level was markedly elevated. Ultrasound abdomen revealed large midline mass with solid and cystic components. Contrast enhanced tomography of the abdomen and chest revealed a large retroperitoneal heterogenous mass pushing the left kidney inferiorly and displacing the gut to the right, with no evidence of calcifi cation. Other visceral organs were normal. There was no evidence of lymphadenopathy and ascites.

THE PROCEDURE

On surgical exploration, there was a large intraperitoneal exophytic mass of size 8x9x8 cm³ arising from the greater curvature and the posterior wall of the stomach occupying whole of the lesser sac. The Tumour was of variegated consistency with no involvement of adjacent structures and lymphadenopathy. Whole of the Tumour mass was excised along with the involved gastric wall. Stomach was repaired in two layers. Histopathological examination revealed cystic solid teratoid neoplasm with both mature and immature elements. Mature tissues consisted of squamous epithelium, small intestine, cartilage and glial tissue including choroid plexus were visualised. Immature elements consisted of primitive neuroepithelial tissue and primitive mesenchyme.

THE RESULT

Post operative period was uneventful, and AFP levels at discharge came down to 5300 ng/mL. On follow up, the AFP levels fell to 3.7 ng/mL by 6 months. The baby has been asymptomatic on regular follow up with no recurrence