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Fast enlarging immature gastric teratoma in a preterm neonate: a rare and intricate occurrence
Maria Manousi, Maria Yvelise De Verney, Chrysanthi Chlapoutaki, Panayiota Kafritsa, Maria Klavdianou, Christos Salakos
IASO Children's Hospital, Athens, Greece
Introduction
Gastric teratomas are rare tumors. Ten congenital cases are reported, with 40% complications such as hemorrhage, compartment syndrome, or rupture. The immature variant needs special attention.
Case Presentation
A male neonate was delivered at 32 weeks of gestation via emergency cesarean section due to Doppler signs of fetal distress. The 34-year-old mother, gravida 2:1, had been referred to our center due to prenatal US findings of polyhydramnios and hyperechogenic bowel. Intrauterine MRI showed a large abdominal mass. The newborn (2860 g) presented with respiratory distress and low Apgar scores. Immediately intubated, he was admitted to the NICU for stabilization with mechanical ventilation and inotropic support. At examination, there was marked abdominal distension. Postnatal MRI revealed a large intra-abdominal mass with cystic and solid components and calcifications, compatible with teratoma, displacing abdominal organs and causing elevation of the diaphragm. Laparotomy on day 3 of life identified a huge tumor (400g) originating from the lesser curvature of the stomach, with mostly exogastric growth. A near-total gastrectomy was performed, with complete resection of the tumor and an end-to-end anastomosis between the esophagus and gastric antrum. Histopathology confirmed an immature gastric teratoma(Grade 2). The early postoperative period was uneventful. He was discharged from the NICU on the 45th postoperative day with full oral feedings and went on regular gastroenterologic and oncologic surveillance. At the age of 18 months, he started to present neuroglycopenic symptoms compatible with "late dumping syndrome" as postprandial hypoglycemia (PPH). Contrast studies showed delayed gastric transit and an enlarged gastric antrum. PPH is being managed conservatively.
Conclusion
Due to their rapid fetal growth and potential complications, gastric teratomas require early diagnosis, multidisciplinary perinatal care, and complete surgical excision. Postoperative oncologic and gastroenterologic close surveillance is mandatory. Gastric surgery in children poses a risk of "late dumping syndrome."