Nip at the Bud
Dealing with Giant Germ Cell Tumours in infants
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:
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.
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
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