Gastric Teratoma: Report of an 8-Year-Old Boy Presenting with Repeated Gastrointestinal Bleeding
S.A. Mirbagheri MD,* A.R. Nahidi MD,** S. Pour-Mohammad MD***
*Department of Gastroenterology, Amir-Alam Hospital, Tehran University of Medical Sciences, Tehran, **Department of Surgery, Sina Hospital, and ***Department of Pathology, Golestan Hospital, Ahwaz University of Medical Sciences, Ahwaz, Iran
Reports on gastric teratoma are rare. In the majority of cases the disease occurs in male neonates or children and with a lesser frequency in adolescents. This rare tumor usually manifests as an abdominal mass, resulting in gastrointestinal bleeding and/or obstructive picture. Diagnosis is aided by presence of calcifications on plain abdominal radiogram, ultrasonography or CT scan. Surgery is the only acceptable management performed either by tumor resection or gastrectomy. The tumor has a benign nature and except in a few cases, complete cure can be attained. This paper reports on an 8-year-old boy who had two episodes of upper GI bleeding with a four-year interval. The episodes occurred at the ages of four and eight with no interim symptoms. The tumor was detected as a mass lesion on endoscopy and pathology was compatible with teratoma after the full removal of the tumor. Four years of follow-up showed no relapse.
Key Words · Stomach · neoplasm · gastric teratoma · gastrointestinal bleeding · abdominal calcification
Introduction
Benign gastric tumors are rare in children and include hyperplastic and adenomatous polyp, leiomyoma and lipoma. Gastric teratoma is rare and occurs only during childhood (mostly in neonates).1 To date, less than one hundred cases have been reported in literature. Most of the reported cases are males but it has also been observed, albeit with lesser frequency, in females.2 The disease usually occurs in children younger than one year of age especially neonates, however, there are reports of this tumor in older children.3
Gastric teratoma may present as an abdominal mass, gastrointestinal bleeding and/or obstructive picture. This report presents a case of an eight-year-old boy who presented with repeated upper GI bleeding.
Case Report
An eight-year-old boy was admitted for hematemesis and melena. He was the third offspring of a family with two older and two younger siblings who were all in good health. He was a product of a normal delivery and had good physical growth. There was a past history of hematemesis and melena when he was four years old for which he was admitted to another center. He was discharged apparently in a good general condition after receiving blood transfusion and treatment with H2 blocker, and had not experienced any further problems until his admission at 8 years of age. At that time, no further evaluation was done to detect the cause of the bleeding as the parents refused an endoscopy. The patient was discharged with a probable diagnosis of erosive gastritis.
On admission, routine steps were taken to stabilize the hemodynamic status. Abdomen was soft with fullness of the epigastrium but no definite mass was palpable. Hemoglobin level was 7.3 g/dl with a hematocrit of 20%, a platelet count of 210000 per ml and a leukocyte count of 10500 showing a normal differential. Blood coagulability tests were normal. To determine the cause of bleeding, after gastric lavage, upper GI endoscopy was performed which revealed a fundal gastric tumor with a deep ulcer (Fig 1). Biopsy of the mass did not aid diagnosis.
After correction of hemoglobin, a laparotomy was performed and a relatively large mass of 6´ 6´ 8 cm was found in the gastric submucosa on the greater curvature toward the fundus showing a predominantly extraluminal growth. The rest of the abdominal organs were normal. The tumor was fully excised and the stomach was saved.
Microscopic examination revealed gastric tissue with an intramural neoplasm. The lining epithelium was intact and the neoplasm was composed of mature cartilage, lymphoid, respiratory and nerve tissue which was compatible with teratoma (Fig 2).
The post-operative course was uneventful and the patient was discharged in good general condition. Regular follow-ups over a four year period revealed no evidence of tumor relapse.
Discussion
Abdominal teratomas are very rare and mostly extra-gastric in origin. Out of 17 abdominal teratomas reported during 15 years in Taiwan, only one was of gastric origin, the rest were located in the retroperitoneal space.4 Gastric teratoma may manifest as a palpable abdominal mass, abdominal obstruction and/or gastrointestinal bleeding. Although the majority of cases present during early childhood (mostly less than one year of age), there are few reports of delayed diagnosis in adolescents.5 Diagnosis of gastric teratoma might be feasible by the presence of calcification on plain abdominal radiogram and more accurately on abdominal CT.6,7 Treatment of this tumor is surgical removal and the prognosis is excellent.8 Post-operative occurrence of Hodgkin's disease,9 coincidence of adenocarcinoma10 and occasional cases of malignant teratoma detected in neonates have been reported. 11,12 Coincidence of gastric teratoma with Wiedemann-Beckwith syndrome13 and peritoneal gliomatosis have also been described.
The points worth highlighting in this report are the diagnosis of gastric teratoma in a child of eight years and a clinically asymptomatic course over the four years post-operative period since in the majority of existing reports the symptoms occur during infancy.
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