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Published on: January 14, 2014
A unique case of gliomatosis peritonei in a man, following a retroperitoneal teratoma
Meera Chauhan1, Roger Kockelbergh2, Guy Faust1
1Department of Oncology, University Hospitals of Leicester NHS Trust, Leicester, Leicestershire, UK.
Abstract:
We present an unusual case of a 56-year-old man presenting with abdominal swelling. Imaging revealed a large abdominal 23 cm cystic mass, which radiologically appeared to be related to the small bowel. There was an attempted surgical removal by the general surgeons. It was histologically confirmed as a retroperitoneal cystic teratoma with immature neural elements with incomplete resection margins. Residual disease was found at re-imaging 3 months later and a further block dissection was performed, with histology confirming recurrence. Thirteen months later, imaging revealed recurrent disease with peritoneal involvement. At laparoscopic exploration, there was peritoneal seeding, and biopsies confirmed a diagnosis of gliomatosis peritonei, secondary to the retroperitoneal teratoma. The patient proceeded to have combination chemotherapy to achieve stable disease on imaging. A month after completion, sadly, the disease progressed; the patient received best supportive care.
Insights
A rare retroperitoneal cystic teratoma recurred, leading to gliomatosis peritonei. Despite surgery and chemotherapy, the aggressive tumor progressed, ultimately requiring best supportive care for this abdominal mass.
Area of Science:
- Oncology
- Surgical Pathology
- Gastroenterology
Background:
- Retroperitoneal cystic teratomas are rare tumors, often presenting with non-specific symptoms like abdominal swelling.
- Malignant transformation or aggressive behavior in teratomas can lead to complex clinical challenges.
Observation:
- A 56-year-old man presented with a large abdominal cystic mass.
- Initial surgery revealed a retroperitoneal cystic teratoma with immature neural elements.
- Recurrent disease with peritoneal seeding (gliomatosis peritonei) was diagnosed.
Findings:
- Incomplete resection margins contributed to tumor recurrence.
- Gliomatosis peritonei developed secondary to the primary retroperitoneal teratoma.
- The patient's disease progressed despite combination chemotherapy and supportive care.
Implications:
- This case underscores the aggressive nature of recurrent retroperitoneal teratomas.
- Highlights the importance of complete resection and vigilant surveillance.
- Emphasizes the limited treatment options for advanced gliomatosis peritonei.
