Mature Teratomas of the Lesser Omentum
Xiaoqian Lu, Leilei Liu, Dianbo Cao*
Department of Radiology, The First Hospital of JiLin University,Chang Chun, China.
*Corresponding author: Dianbo Cao, Department of Radiotherapy, The First Hospital of Jilin university, 71 Xin Min Zhu Street,Chang Chun,China 130021, China. E-mail: happybo126@126.com/ caotianbo@126.com
Received Date: 05 December, 2017; Accepted Date: 03 March, 2018; Published Date: 13 March, 2018
Citation: Lu X, Liu L, Cao D (2018) Mature Teratomas of the Lesser Omentum. J Surg 2018: 194. DOI: 10.29011/2575-9760.000194
A 39-year-old female was admitted to our hospital
complaining of intermittent distending pain in the epigastrium for 1 month. She
denied the history of any disease or surgery. On admission, there was no mass
detected on palpation. Preoperative laboratory test results were normal, and
tumour marker tests revealed no elevation of cancer antigen. Abdominal CT scan showed a cystic-solid mass in the lesser omentum,
which also contained calcified and adipose components. The mass compressed and
displaced adjacent organs (Figure 1).
Based on typical CT imaging characteristics, mature teratomas was diagnosed before operation. At laparotomy, an encapulated mass measuring 13cm×10cm was found in the region of lesser omentum after opening gastrocolic ligament. Fully dissecting mass from adjacent structures, sebum-like liquid came out and two solid milky-white nodules along with hair were seen within the mass (Figure 2
Most of the wall of cystic-solid mass was removed, leaving only a small portion
of residual cystic wall attached to the pancreatic head. Histopathological
examination of the excised tumor was consistent with typical pattern of benign
mature teratomas (Figure 3). and there was no
evidence of a malignant germ cell component.
It is generally accepted that teratomas arise from
germ cells that fail to mature normally in the gonads. These totipotent cells
can differentiate into tissue components representing derivatives of mesoderm,
ectoderm and endoderm. Macroscopically, teratomas can be divided into either
mature or immature types [1]. Mature cystic
teratomas are cystic tumors composed of well-differentiated derivations from at
least two of the three germ cell layers. Teratomas may develop in multiple
locations such as the ovaries, the testes, the anterior mediastinum, the
retroperitoneal space, the presacral and coccygeal areas, pineal and other
intracranial sites. However, teratomas of the lesser
omentum are extremely rare and the pathogenesis of
the occurrence of this tumor in the omentum is still unclear. CT examination is
highly specific and sensitive for the detection of fat and calcification. Identification for both components within the
lesion can help narrow the diagnosis to liposarcoma, malignant mesenchymoma or teratomas [2].
Principal findings of mature teratomas on CT images are a well-defined
mass with separate cystic and solid components of varying proportions, discrete
areas with densities similar to that of fat, or coarse, globular calcifications
within the solid component. Recognition of these findings may allow the radiologist
to make a correct preoperative diagnosis, but often there are diagnostic
uncertainties about tracking the organ origin of a teratomas
due to huge mass. In fact, there are some debates regarding the origin of
teratomas in our patient, but operative findings and pathological examination
of resected specimen confirm its origin to be from the lesser omentum instead
of the pancreas.
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