Upper abdominal teratomas in infants: radiological findings and importance of the vascular anatomy

Abstract

Upper abdominal teratomas in infants have typical radiological features. Preoperative delineation of the major vascular anatomy is often imprecise. Significant distortion of vascular anatomy was present in all infants and awareness of this feature impacts on surgical planning.

Elective suprarenal and infrarenal cavectomy for excision of giant retroperitoneal teratoma in infancy

“…vessels and adjacent organs [1]. In contrast to the relatively predictable vascular encasement seen in neuroblastoma, the vascular anatomy of retroperitoneal teratomas can be highly variable [1].…”

“…Although preoperative imaging can be unreliable, aortic displacement is typically contralateral to the side of lateral lesions, whereas with "bilateral" or central tumors, it remains midline, with anterior displacement unreported. In contrast, failure to identify the IVC on preoperative imaging scans is frequent, and at operation, its displacement by tumor is typically anterior [1]. Vascular encasement appears less common than in neuroblastoma.…”

“…Unfortunately, their massive size and location means that major vessel anatomy can be grossly distorted [1]. Because of rarity, most surgical series of these tumors are small; perioperative deaths and major vascular injuries remain problems even for experienced surgical oncologists, with the exception of Luo et al [2][3][4][5].…”

“…In the United Kingdom's largest contemporary surgical report, major bleeding was a problem in all 6 cases of retroperitoneal teratoma [4]. Injuries to aorta, portal vein, renal vein, inferior vena cava (IVC), esophagogastric junction, and bile ducts have also been reported [1][2][3][4]. Although preoperative imaging can be unreliable, aortic displacement is typically contralateral to the side of lateral lesions, whereas with "bilateral" or central tumors, it remains midline, with anterior displacement unreported.…”

“…Vascular encasement appears less common than in neuroblastoma. Given the imaging limitations and displacement of major vessels and kidneys, it is not surprising that life-threatening hemorrhage has at times necessitated urgent repair, ligation, and even excision of major vessels such as the infrarenal IVC [1][2][3][4].…”