Chansoon Tharintorn, Angkathunyakul Napat, Aroonroch Rangsima, Jirasiritham Jakrapan
Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
World J Clin Cases. 2020 Apr 26;8(8):1489-1494. doi: 10.12998/wjcc.v8.i8.1489.
A teratoma is a germ cell tumor that is composed of tissue derived from two or three germ layers. Duodenal teratomas are extremely rare and have been exclusively reported in neonates and children. This is the third case of a teratoma primarily arising in the duodenum and the first case that occurred in an adult.
A 31-year-old male presented with clinical partial gut obstruction (epigastric pain, nausea, and vomiting). The physical examination showed a palpable ill-defined mass on the left side of the abdomen. The computed tomography scan revealed a multiseptated cystic tumor at the retroperitoneal area. First, he underwent gastrojejunostomy to relieve the symptoms and was referred to a tertiary-care hospital. The second operation revealed a 10-cm solid-cystic mass originating from the third part of the duodenum and adhering to the abdominal aorta and pancreas. Segmental duodenectomy was performed. The pathological diagnosis was a mature cystic teratoma. The patient was asymptomatic at 5 mo after the operation.
Duodenal teratomas are extremely rare but should be included in the differential diagnosis in patients who present with intestinal obstruction. Radiological imaging is helpful to reach the preoperative diagnosis. Multidisciplinary team planning is essential to avoid injury to the adjacent organ in duodenal operation.
畸胎瘤是一种生殖细胞肿瘤，由来源于两到三个胚层的组织构成。十二指肠畸胎瘤极为罕见，仅在新生儿和儿童中有报道。这是第三例主要起源于十二指肠的畸胎瘤，也是首例发生在成人的病例。
一名31岁男性因临床部分肠梗阻（上腹部疼痛、恶心和呕吐）就诊。体格检查发现腹部左侧可触及一个边界不清的肿块。计算机断层扫描显示腹膜后区域有一个多房性囊性肿瘤。首先，他接受了胃空肠吻合术以缓解症状，随后被转诊至三级医院。第二次手术发现一个10厘米的实性囊性肿块，起源于十二指肠第三部，与腹主动脉和胰腺粘连。进行了十二指肠节段切除术。病理诊断为成熟囊性畸胎瘤。术后5个月患者无症状。
十二指肠畸胎瘤极为罕见，但对于出现肠梗阻的患者应列入鉴别诊断。放射影像学有助于术前诊断。多学科团队规划对于避免十二指肠手术中损伤相邻器官至关重要。
