Ann Hepatobiliary Pancreat Surg.  2021 Nov;25(4):544-550. 10.14701/ahbps.2021.25.4.544.

Giant liver teratoma with gliosis peritonei treated by right extended hepatectomy: Overview and case report

• García-Ríos LE
• García-Ávila AK
• Luna-Castillo M
• Anda-González JGD
• Medrano-Guzmán R

• KMID: 2523061
• DOI: http://doi.org/10.14701/ahbps.2021.25.4.544

Abstract

Germ cell tumors (GCTs) are considered as extragonadal if there is no evidence of a primary tumor in the testes or ovaries. GCTs can be classified as seminomas, non-seminomatous, mature teratomas, and immature teratomas based upon histology. Mature teratomas are generally found in prepuberal children. Less than 1% of them have been reported in the gastrointestinal tract and liver. Liver teratomas are extremely rare. There are only 11 cases reported in adults up to 2018. Isolated liver metastasis of ovarian teratoma is also very rare. We present a case of a late metachronous recurrence of liver cystic teratoma with gliosis peritonei in a female adult treated by a right extended hepatectomy along with a literature review.

Keyword

Teratoma; Hepatectomy; Gliosis; Neoplasms; Germ cells and embryonal

Figure

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  Fig. 1 Magnetic resonance imaging (MRI) demonstrating a liver mass with multiple distinct intensities. Cystic and solid features involving right liver at IV and VIII segments of 160 mm × 180 mm × 90 mm are shown. (A) Coronal MRI in T2 with hypo-intense component suggesting bone calcifications (arrow). (B) Coronal MRI in T2 demonstrating heterogeneous mass in the right liver lobe (IV, V, and VIII), and free liver segments (arrow). (C) Axial MRI in T1 with hypo-intense cystic component (arrow). (D) Axial MRI in T1 with another perspective of cystic component of the tumor (arrow), showing Couinaud liver segments in contact with tumor (roman numeral). IVC, inferior vena cava; Ao, aorta.

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  Fig. 2 A 29-year-old female computed tomography in arterial phase. (A) Coronal plane that demonstrating liver mass extension (T), involving the IV, V, and VIII liver segments. Low attenuation in the middle of the mass highly suggestive of fat and hypodense image suggestive of hair (arrow). (B) Low attenuation in the middle of the mass highly suggestive of fat and hypodense image suggestive of hair (arrow). (C) Axial plane showing Rokitansky nodule (arrow). (D) Axial plane where sebaceous tissue is identified (arrow), with features suggestive of liver teratoma.

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  Fig. 3 Trans-operative photo after surgical excision of liver teratoma. (A) Surgical limit of the neoplasia lateral to IV liver segment (arrow) (II, III), residual liver Couinaud segments from left liver (LL), right colon (RC), and stomach (S) are shown. (B) Pearly areas over pelvic recess compatible with gliomatosis peritonei (arrows) and right ovary (Ro).

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  Fig. 4 Surgical specimen product of right extended hepatectomy. (A) Liver teratoma (T) involving IV, V, and VIII liver segments, compression of falciform ligament (arrow), and inferior vena cava (IVC). (B) Upper view demonstrating the extension to IV and VIII liver segments with falciform ligament (arrows). (C) Inferior view showing the tumor extension (T) to the liver segments (IV, VIII), gallbladder (Gb), cystic duct (green arrow), right branch of right liver artery (red arrow), and right branch of portal vein (blue arrow). RL, right liver lobe; CBD, common bile duct; PV, portal vein; PLA, principal liver artery.

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  Fig. 5 Specimen mounted in a model after surgical excision to illustrate their anatomical relationships, tumor size, and proper orientation of resected liver segments. IVC, inferior vena cava; RL, right liver lobe; Gb, gallbladder; CBD, common bile duct; PV, portal vein; PLA, principal liver artery; LL, left liver lobe.

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  Fig. 6 Photomicrograph with H&E stain. (A) High power field (HPF) 10×. Photomicrograph showing liver parenchyma and cystic lesion with keratin. (B) HPF 20×. Photomicrograph showing mature neuroectodermal elements: sebaceous glands, apocrine metaplasia and epithelia lining of cylindrical ciliated epithelium. (C) HPF 20×. Neuroectodermal elements with rosette formation, ined by crowded basophil cells with hyperchromatic nuclei. (D) HPF 20×. Immature mesenchymal elements: adipose tissue and stroma. (E) HPF 20×. Neuroglia and dystrophic calcification of the psammoma type in gliomatosis peritonei. (F) HPF 10×. Squamous epithelium in transition with immature elements of pigmented neuroepithelium.

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