Maddali Radhika, Balasundaram Palanikumar, Farber Benjamin A, LaTuga Mariam S
Department of Pediatrics, Division of Neonatology, The Children's Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, USA.
Department of Pediatrics, Division of Neonatology, Mercy Health, Javon Bea Hospital, University of Illinois College Medicine of Rockford, Rockford, USA.
Cureus. 2024 Dec 10;16(12):e75450. doi: 10.7759/cureus.75450. eCollection 2024 Dec.
Retroperitoneal teratomas are rare neoplasms in neonates, presenting with nonspecific symptoms and variable clinical features, making diagnosis challenging. Radiological investigations, particularly fetal ultrasound and contrast-enhanced computed tomography, play a critical role in their detection. Differential diagnoses include neuroblastoma, adrenal hemorrhage, and congenital cystic lesions, which share overlapping clinical and imaging features. This case report describes a neonate delivered at 39 weeks of gestation, weighing 2.93 kg, to a 30-year-old gravida 2, para 1 mother with unremarkable serological tests during pregnancy. Fetal ultrasonography performed at 31 weeks, followed by magnetic resonance imaging at 35 weeks, revealed a large, multi-cystic, and solid lesion located above the left kidney. Postnatal physical examination identified a firm, non-tender abdominal mass that was confined to the left side and did not cross the midline. Imaging studies, including abdominal radiographs, ultrasonography, and contrast-enhanced computed tomography, confirmed a large left supra-renal mass. Meta-iodo-benzyl-guanidine scintigraphy combined with single-photon emission computed tomography showed no activity in the mass. Serum alpha-fetoprotein levels were within the normal range for term neonates, and the infant had normal beta-human chorionic gonadotropin and urine homovanillic acid levels. The infant underwent exploratory laparotomy on the sixth postnatal day, confirming an immature teratoma without malignant components. Postoperatively, AFP levels demonstrated the expected physiological decline, consistent with the absence of malignant components. The infant was discharged on postnatal day 35. This case highlights the diagnostic complexities of retroperitoneal teratomas in neonates and underscores the critical role of antenatal ultrasound and a multidisciplinary approach in ensuring effective diagnosis and management.
腹膜后畸胎瘤在新生儿中是罕见的肿瘤，表现为非特异性症状和多样的临床特征，这使得诊断具有挑战性。影像学检查，尤其是胎儿超声和增强计算机断层扫描，在其检测中起着关键作用。鉴别诊断包括神经母细胞瘤、肾上腺出血和先天性囊性病变，它们具有重叠的临床和影像学特征。本病例报告描述了一名孕39周出生、体重2.93千克的新生儿，其母亲为30岁经产妇，孕2产1，孕期血清学检查无异常。孕31周时进行了胎儿超声检查，孕35周时进行了磁共振成像检查，结果显示左肾上方有一个大的多囊实性病变。出生后体格检查发现左侧有一个质地硬、无压痛的腹部肿块，局限于左侧，未越过中线。包括腹部X线平片、超声和增强计算机断层扫描在内的影像学检查证实左肾上腺有一个大肿块。间碘苄胍闪烁显像联合单光子发射计算机断层扫描显示肿块无活性。足月新生儿血清甲胎蛋白水平在正常范围内，婴儿的β-人绒毛膜促性腺激素和尿高香草酸水平正常。婴儿在出生后第6天接受了剖腹探查术，证实为无恶性成分的未成熟畸胎瘤。术后，甲胎蛋白水平呈现预期的生理性下降，这与无恶性成分相符。婴儿于出生后第35天出院。本病例突出了新生儿腹膜后畸胎瘤的诊断复杂性，并强调了产前超声和多学科方法在确保有效诊断和管理中的关键作用。
