Retropleural teratoma presenting as an abdominal mass in a 9-month-old boy



      Teratomas are rare tumors that present most commonly in the anterior mediastinum and retroperitoneum. To date, the retropleural primary site has not been reported.

      Case Presentation

      A 9-month-old boy presented with a large, painless, right-sided abdominal mass. Laboratory values, including tumor markers α-fetoprotein and β-human chorionic gonadotropin, were within normal limits. Diagnostic imaging, including abdominal ultrasound, computed tomographic scan, and magnetic resonance imaging, suggested a large retroperitoneal mass consistent with a teratoma. Because the mass was thought to be arising from the retroperitoneum, an abdominal approach was chosen. After adequate exposure, it became clear that the tumor was arising from above the diaphragm. The diaphragm was incised, and the pleural cavity was entered. The tumor was found in the retropleural space where it was dissected away from the inferior vena cava, aorta, and chest wall. The patient recovered without complications.


      Histologic examination revealed a mature cystic teratoma with no malignant features. The patient has been disease-free at 7-year follow-up, based upon both clinical examination and diagnostic imaging.


      This is the first case report of a teratoma arising from the retropleural space. Preoperative imaging may be inaccurate for guiding surgical planning because the diaphragm may not be clearly visualized with current diagnostic techniques. Surgeons should be cautious regarding the location of tumors that arise near the diaphragm and should plan surgical resection carefully.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Pediatric Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Dehner L.P.
        Germ cell tumors of the mediastinum.
        Semin Diagn Pathol. 1990; 8: 266-284
        • Billmire D.
        • Vincour C.
        • Rescorla F.
        Malignant mediastinal germ cell tumors: an intergroup study.
        J Pediatr Surg. 2001; 36: 18-24
        • Gatcombe H.G.
        • Assikis V.
        • Kooby D.
        • et al.
        Primary retroperitoneal teratomas: a review of the literature.
        J Surg Oncol. 2004; 86: 107-113
        • Lewis B.D.
        • Hurt R.D.
        • Payne W.S.
        • et al.
        Benign teratomas of the mediastinum.
        J Thorac Cardiovasc Surg. 1983; 86: 727-731
        • Lakhoo K.
        • Boyle M.
        • Drake D.P.
        Mediastinal teratomas: review of 15 pediatric cases.
        J Pediatr Surg. 1993; 28: 1161-1164
        • Karl S.R.
        • Dunn J.
        Posterior mediastinal teratomas.
        J Pediatr Surg. 1985; 20: 508-510
        • Bitar F.F.
        • El-Zein C.
        • Tawil A.
        Intrapericardial teratoma in an adult: a rare presentation.
        Med Pediatr Oncol. 1998; 30: 249-251
        • Ustun M.O.
        • Demircan A.
        • Paksoy N.
        • et al.
        A case of intrapulmonary teratoma presenting with hair expectoration.
        Thorac Cardiovasc Surg. 1996; 44: 271-273
        • Greif J.
        • Schwarz Y.
        • Sperber F.
        • et al.
        Benign cystic teratoma simulating organized empyema.
        Pediatr Pulmon. 1997; 23: 310-313
        • Traubici J.
        • Daneman A.
        • Hayes-Jordan A.
        • et al.
        Primary germ cell tumor of the diaphragm.
        J Pediatr Surg. 2004; 39: 1578-1580
        • Spak E.W.
        • Rector J.T.
        • Camarca M.A.
        Neonatal intrathoracic teratoma presenting as a posterolateral chest wall mass.
        Arch Pediatr Adolesc Med. 1994; 148: 831-832
        • Oosterhuis J.W.
        • Stoop H.
        • Honecker F.
        • et al.
        Why human extragonadal germ cell tumours occur in the midline of the body: old concepts, new perspectives.
        Int J Androl. 2007; 30: 256-264
        • Moeller K.H.
        • Rosado-de-Christenson M.
        • Templeton P.A.
        Mediastinal mature teratoma: imaging features.
        Am J Roentgenol. 1997; 169: 985-990
        • Quillin S.P.
        • Siegal M.J.
        CT features of benign and malignant teratomas in children.
        J Comput Assist Tomogr. 1992; 16: 722-726
        • Tarver R.D.
        • Conces Jr, D.J.
        • Cory D.A.
        • et al.
        Imaging the diaphragm and its disorders.
        J Thorac Imaging. 1989; 4: 1-18
        • Barone G.W.
        • Eidt J.F.
        • Webb J.W.
        • et al.
        The anterior extrapleural approach to the thoracolumbar junction revisited.
        Am Surg. 1998; 64: 372-375
        • Knapp R.H.
        • Hurt R.D.
        • Payne W.S.
        • et al.
        Malignant germ cell tumors of the mediastinum.
        J Thorac Cardiovasc Surg. 1985; 89: 82-89