A 14 year old girl was admitted to the 3rd Army Hospital on 29th Oct. 66, complaining of abdominal distension and general weakness. Patient had noticed a small mass in her left upper quadrant for the past 3 years. It was free of any symptoms.
However, thirty-five days prior to admission this mass began rapidly enlarging to the point where she was unable to breath upon sitting up and some discomfort in her upper abdomen.
Physical examination revealed chronically ill shape and markedly under-nourished condition. Abdomen is grossly distended with huge mass occupying the entire upper abdomen being approximately 25X35 cm in size The mass has a fluid wave clinically, and feels cystic.
Laboratory data was normal except slight anemia. Chest X-ray is within normal limits except for high bilateral diaphragm secondary to intra-abdominal mass. IVP reveals right kidney to be in normal position and the large abdominal mass noted to be present with the inferior displacement of the colon and up lifting of the stomach. Upon careful inspection there is a calcified region which appears to be in the left upper quadrant.
Upon laparatomy an extremely large cystic mass measuring approximately 25 x 35 cm was present in the abdominal cavity. This mass was cystic in character and on palpation had some solid consistency in the area of the left kidney. The stomach had been pushed anteriorly and superiorly, the large bowel inferiorly. The mass seem to arise within the lesser sac. The mass could be shelled out with combination of blunt and sharp dissection. The mass could then be removed from its origin.
Grossly the specimen consits of a large cystic mass measuring 20 x 20 x 30 cm. The surface was smooth, in part nodular and in part covered by membranous adhesions. Most of the surface was graish white colored but there were some bluish nodules and areas of hemorrhage. On section it showed multiloculated cystic structure and contained hemorrhagic fluid and semisoft greasy tissue and intermingled with cartilage and bone time.
Microscopically, representaves of the 3 embryonal layers were found. The mesodermal elements predominated as cartilage, bone, smooth muscles, connective tissue. Entodermal tissue were presented by columnar epithelium and goblet cells as seen in large intestine and ciliated columnar epithelium suggesting of bronchus membrane. All cells of the specimen are mature and well differentiated. We can not find malignant change: Benign teratoma retroperitoneal.
Postoperative course was excellant up to the present.
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