Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 26, 2020; 8(8): 1489-1494
Published online Apr 26, 2020. doi: 10.12998/wjcc.v8.i8.1489
Duodenal mature teratoma causing partial intestinal obstruction: A first case report in an adult
Tharintorn Chansoon, Napat Angkathunyakul, Rangsima Aroonroch, Jakrapan Jirasiritham
Tharintorn Chansoon, Napat Angkathunyakul, Rangsima Aroonroch, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
Jakrapan Jirasiritham, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
Author contributions: Chansoon T designed the report, collected data and wrote the manuscript; Jirasiritham J was the surgeon; and Angkathunyakul N, Aroonroch R, and Jirasiritham J participated in patient care and the editing of the manuscript; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for the publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Tharintorn Chansoon, MD, Doctor, Department of Pathology, Ramathibodi Hospital, Mahidol University, 207 Thanon Rama VI, Thung Phaya Thai, Ratchathewi, Bangkok 10400, Thailand. ipereen@hotmail.com
Received: March 5, 2020
Peer-review started: March 5, 2020
First decision: March 31, 2020
Revised: April 9, 2020
Accepted: April 17, 2020
Article in press: April 17, 2020
Published online: April 26, 2020
Processing time: 50 Days and 4.3 Hours
Abstract
BACKGROUND

A teratoma is a germ cell tumor that is composed of tissue derived from two or three germ layers. Duodenal teratomas are extremely rare and have been exclusively reported in neonates and children. This is the third case of a teratoma primarily arising in the duodenum and the first case that occurred in an adult.

CASE SUMMARY

A 31-year-old male presented with clinical partial gut obstruction (epigastric pain, nausea, and vomiting). The physical examination showed a palpable ill-defined mass on the left side of the abdomen. The computed tomography scan revealed a multiseptated cystic tumor at the retroperitoneal area. First, he underwent gastrojejunostomy to relieve the symptoms and was referred to a tertiary-care hospital. The second operation revealed a 10-cm solid-cystic mass originating from the third part of the duodenum and adhering to the abdominal aorta and pancreas. Segmental duodenectomy was performed. The pathological diagnosis was a mature cystic teratoma. The patient was asymptomatic at 5 mo after the operation.

CONCLUSION

Duodenal teratomas are extremely rare but should be included in the differential diagnosis in patients who present with intestinal obstruction. Radiological imaging is helpful to reach the preoperative diagnosis. Multidisciplinary team planning is essential to avoid injury to the adjacent organ in duodenal operation.

Keywords: Duodenal teratoma; Mature cystic teratoma; Intestinal obstruction; Germ cell tumor; Retroperitoneal mass; Case report

Core tip: A duodenal teratoma is a germ cell tumor and has been exclusively reported in neonates and children. We report the first case that occurred in an adult, causing partial intestinal obstruction. Duodenal teratoma is extremely rare, but should be included in the differential diagnosis in patients who presents with upper gastrointestinal tract obstruction. Since there are important structures adjacent to the duodenum, radiological imaging is helpful for preoperative planning. Furthermore, multidisciplinary team planning is essential to avoid incidental injury to vital organ structures.