The "Monstrous tumor" of Adrenal gland: A case report and review of literature on adrenal teratomas

Introduction and clinical importance: Teratomas are neoplasms originating from pluripotent cells, rising from more than one or all three embryonic germinal layers. The nomenclature "Teratoma" is derived from the Greek word "teras" which translates to the word "monster". One of the rarest locations is the adrenal gland, with adrenal teratomas representing only 0.13 % of all adrenal tumors. Case presentation: A 36-year-old female, morbidly obese, was found to have a right adrenal mass after she presented to our surgical outpatient clinic with a complaint of abdominal pain. The mass was found on an abdominal computed tomography (CT) scan, which revealed a large retroperitoneal lesion measuring 29 x 15 x 22 cm and displacing the IVC, pancreas, duodenum, right kidney, and ascending colon. The differential diagnosis based on the patient's workup was adrenal teratoma, myolipoma, angiolipoma, and liposarcoma. The patient underwent an uneventful open right adrenalectomy. The final histopathology confirmed the diagnosis of a mature right adrenal cystic teratoma weighing 4 kg. The last follow-up was 3 years postoperatively with no evidence of recurrence on CT scan.Clinical discussion: A thorough discussion of the clinical presentations of the reported cases in the literature including the first reported case in the English literature. Furthermore, the use of the different modalities of diagnosis e.g., Ultrasonography, CT scan, and MRI. Also, the mainstay modality of treatment and the debate of minimal invasive laparoscopic adrenalectomy vs open adrenalectomy. Finally, the discussion of the period of following up the patient after successful operation and the removal of the tumor were presented.Conclusion: Adrenal teratoma is extremely uncommon entity, with a great percentage of patient presenting with a non-specific presentation or are asymptomatic. Initial diagnosis might be made radiologically. However, a confirmatory diagnosis is based on the histopathological examination. The workup must rule out other possible differential diagnoses, like metastastis or functional tumors. Finally, surgical resection is the mainstay treatment of adrenal teratoma with an excellent survival rate.