Retroperitoneal Tumors

The retroperitoneum is an unusual site for germ cell tumors. Germ cell tumors in the retroperitoneum represent 4% of all gonadal and extragonadal germ cell tumors in this pediatric age group. In respect to age, they occur in a wide range of individuals, from new-borns to persons in the sixth decade of life. Approximately 7% of these tumors are malignant.54,55 The spectrum of gross and microscopic morphology is very similar to that seen in all other sites. Most arise in

Testicular Replacement Surgery
Figure 22-16. A, Replacement of a testicle by multicystic teratoid-appearing tumor confined to the parenchyma by intact tunica. B, Microscopic appearance, showing endodermal sinus tumor (right) and embryonic tumor reminiscent of blastoma with immature teratoma (left) (original magnification x40).
Teratoma Infant

Figure 22-17. A, An infant with a large sacrococcygeal teratoma. (Courtesy of Dr. Donald B. Shaul, CHLA Surgery Division.) B, Magnetic resonance images of a patient with sacrococcygeal teratoma (T1-weighted image at left, T2-weighted image at right); sagittal views demonstrate a large mass extending from the sacrococcygeal region. Within the mass, there are necrotic regions that are hypointense on T1-weighted images and hyperintense on T2-weighted images. The hyperintense foci on T1-weighted images most likely represent calcifications. The sacrum is dysplastic. C, Gross cut surface of the same sacrococcygeal teratoma after resection shows complex multicystic areas and solid uniform firm areas; these solid areas contained grade 3 immature teratoma and endodermal sinus tumor elements throughout. D, Another example of mature cystic sacrococcygeal teratoma; this was composed of all mature tissues and was filled with seromucinous fluid.

Figure 22-17. A, An infant with a large sacrococcygeal teratoma. (Courtesy of Dr. Donald B. Shaul, CHLA Surgery Division.) B, Magnetic resonance images of a patient with sacrococcygeal teratoma (T1-weighted image at left, T2-weighted image at right); sagittal views demonstrate a large mass extending from the sacrococcygeal region. Within the mass, there are necrotic regions that are hypointense on T1-weighted images and hyperintense on T2-weighted images. The hyperintense foci on T1-weighted images most likely represent calcifications. The sacrum is dysplastic. C, Gross cut surface of the same sacrococcygeal teratoma after resection shows complex multicystic areas and solid uniform firm areas; these solid areas contained grade 3 immature teratoma and endodermal sinus tumor elements throughout. D, Another example of mature cystic sacrococcygeal teratoma; this was composed of all mature tissues and was filled with seromucinous fluid.

the retroperitoneal soft tissue, but rarely, adrenal and renal teratomas are encountered (Figure 22-21). This is a frequent location for metastatic testicular germ cell tumors (Figure 22-22). Biopsies should be performed on unresectable tumors, and measurements of serum markers should be obtained, in an attempt to find malignant elements that will require systemic therapy to shrink the mass and make it resectable.

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