Pediatric Pancreatic Teratoma: A Rare Case Report

Abstract

Abstract Introduction/Objective Teratomas are germ cell neoplasms arising from three germinal layers. They are classified as mature or immature. Mature cystic teratomas (MCTs), also known as dermoid cysts, are benign lesions. Common locations include the sacrococcygeal region, ovaries, testes, brain, mediastinumand retroperitoneum. MCT is extraordinarily rare in the pediatric pancreas; only 11 such cases have been reported in the English literature. Methods This eleven-month-old female presented for evaluation of two cystic masses in the body and tail of the pancreas. These masses were initially imaged as anechoic cysts in utero by ultrasound at 19 weeks gestational age and followed carefully over the interval. Her past medical history included a left upper lobectomy for congenital lobar emphysema. The pancreatic cysts were excised by laparoscopy. Results Grossly, the two tan-pink cysts measured 2.5 cm and 3.1 cm in greatest dimensions, had smooth inner linings and contained clear fluid. Microscopically, the cyst linings included low cuboidal, columnar, ciliated pseudostratified columnar respiratory or fundal gastric epithelia with underlying serous/mucous glands and smooth muscle. These findings were diagnosed as MCT. Typically, MCT of pancreas have nonspecific clinical presentations, serum markers and imaging; all depending on the tissue types present; so, the diagnosis is primarily made postoperatively by pathological evaluation. Previously reported cases presented as single cysts, ranged 4 months to 16 years in age and measured 8 to 18 cm in greatest dimension. Complete surgical excision and careful follow-upare the mainstay of therapy Conclusion Pediatric pancreatic MCTs are extraordinarily rare, so the preoperative diagnosis and treatment is difficult. This case of MCT is the first reported multicystic presentation, the first documented fetal imaging and the smallest size in the English literature. This report shows that MCT must be considered in the differential diagnoses of fetal abdominal cysts and in multicystic pediatric pancreatic masses.