WOFAPS 2025 8th World Congress of Pediatric Surgery

Samia Belhassen ¹, Afef Toumi ¹, Sabrine Ben Youssef ¹, Radhouene Ben Salah ¹, Sami Sfar ¹, Amine Ksia ¹, Mongi Mekki ¹, Sawsen Chakroun ², Maha Ben Mansour ², Mohsen Belghith ¹, Lassaad Sahnoun ¹

¹ Pediatric surgery department, Fattouma Bourguiba Hospital.
² Pediatric anaesthesia and intensive care department, Fattouma Bourguiba Hospital, Monastir, Tunisia

Background:
Gliomatosis peritonei (GP) is a rare condition characterized by the presence of mature glial tissue in the peritoneal cavity, typically associated with immature ovarian teratomas. While GP is usually benign and carries a favorable prognosis, malignant transformation has been reported.

Case Presentation:
A 12-year-old girl with no prior medical history presented with abdominal pain and vomiting. Clinical examination revealed a right iliac fossa mass. Imaging showed a large, heterogeneous abdominopelvic mass with calcifications, likely of left ovarian origin, displacing the right ureter and iliac vessels. Tumor markers revealed elevated AFP (2170 UI/L) and negative β-hCG, suggesting an immature teratoma with a yolk sac component. Emergency surgery was performed due to suspected ovarian torsion.

Intraoperatively, a ruptured bilobed left ovarian mass (~20 cm) was found, adherent to the omentum, transverse colon, and small bowel. No ascites, peritoneal nodules, or lymphadenopathy were noted. A left adnexectomy, omentectomy, and peritoneal biopsies were performed. Histology confirmed a ruptured grade 3 immature teratoma without yolk sac elements. Tumor deposits were present in the omentum.

Postoperatively, the patient received three cycles of BEP (Bleomycin, Etoposide, Cisplatin). Despite an initial drop in AFP, follow-up imaging at 3 months showed radiological progression per RECIST 1.1 criteria, with increasing size of subdiaphragmatic, hepatic hilar, and pelvic nodules, and new subcapsular hepatic lesions. PET scan revealed hypermetabolic activity suggestive of viable tumor.

After multidisciplinary review, cytoreductive surgery was performed, including resection of all the nodules from the right hemidiaphragm, hepatic hilum, pelvis, and paracolic gutter. The postoperative course was uneventful, and histopathology revealed mature teratoma tissue, consistent with gliomatosi peritonei

Conclusion:
This case highlights the rare evolution of immature ovarian teratoma into GP in a pediatric patient. Complete surgical resection remains the cornerstone of treatment for mature peritoneal implants. GP should be considered in any child with peritoneal or omental nodules following treatment for immature teratoma, especially in the context of declining AFP and radiologic progression.