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A 48-year-old female with a history of hypothyroidism, type 2 diabetes mellitus, and developmental disability presented to the emergency room for generalized abdominal pain. Computed tomography (CT) abdomen/pelvis exhibited an incidental 6 cm left adrenal mass. Endocrinology was consulted for further workup, and CT adrenal exhibited findings consistent with a mature teratoma measuring 6.5 × 5.9 × 6.8 cm with fat density (yellow arrow), soft tissue density (red arrow), and calcium (purple arrow) consistent with two teeth with enamel. Teratomas are solid tumors that originate from embryonal germ layers and are most commonly found in the ovaries; however, primary adrenal teratomas are exceedingly rare, accounting for only 0.13% of all adrenal tumors [1]. While most are benign and hormonally inactive—as in this patient, whose metanephrines and dexamethasone suppression tests were normal—they carry a small risk of malignant transformation [1]. Although this case exhibited calcifications consistent with teeth, other morphological manifestations of adrenal tumor calcifications include punctate, coarse, linear, curvilinear, or rim-like/eggshell [2]. This case highlights the importance of recognizing heterogenous midline or retroperitoneal masses that “defy” the expected anatomy of the organ of origin. For the patient's comfort, her guardian opted for conservative management with active clinical surveillance.
Contributors
All authors made individual contributions to authorship. S.S. was involved in the diagnosis and management of this patient. W.B. was involved in the interpretation of the radiological image. N.B. was involved in data acquisition. S.S., N.B., and W.B. contributed to drafting the manuscript. N.B. critically revised the manuscript for important intellectual content. All authors reviewed and approved the final draft.
Contributor Information
Nudar Bhuiya, Department of Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH 44109, USA.
William Baughman, Department of Radiology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH 44109, USA.
Sapna Shah, Department of Endocrinology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH 44109, USA.
Funding
No public or commercial funding.
Disclosures
None declared.
Informed patient consent for publication
Informed consent obtained directly from the patient's guardian.
References
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