Giant retroperitoneal teratoma displacing kidney causing acquired crossed non-fused renal ectopia: rare case report

Abstract

This is a rarest of rare case of surgical resection of giant retroperitoneal teratoma in a 15 yr old female child, causing displacement of left kidney to right by its huge volume (45X30X25cm= 33750cm3), making it appear like acquired crossed confused renal ectopia. Teratomas can occur anywhere in abdomen. Ovary being most common site followed by retroperitoneum. The most common age group is <1yr of age but they can present in any age. There are various case reports describing giant teratomas of various sizes in children and adults. Largest reported size is of 35x35cm size in a 33 yr old female. The case author has operated is rare case ever reported of ‘most voluminous retroperitoneal teratoma in 15 yr old female’ with displacement of all intra-abdominal structures by its volume. Tumor was 45x30x25cm with 12kg weight. When presented patient had complaints of vague discomfort and extreme abdominal distension progressive over last 1 yr. Patient underwent surgery -Excision of tumor, which needed dissection from superior mesentric artery and vein, splenic vein, pancreas, retroperitoneum, splenic vein, diaphragm and left kidney. Left kidney was rotated to right side, causing it to appear like ‘acquired crossed confused renal ectopia’ The left kidney was safely replaced to its original position in left renal fossa. The histopatholgy of tumor was of mature teratoma with no evidence of malignancy. Patient remained symptom free and recurrence free during 5 yrs follow up. Mature cystic teratomas are benign in nature they can attain enormous size in abdomen and can displace any intrabdominal structure. Surgeons should be aware that these big tumors can be resected with preservation of displaced structures in abdomen. Careful surgery is essential for preservation of abdominal organs and to ensure quality of life of patient.