Rare Case of Mature Teratoma in the Greater Omentum: Diagnostic and Surgical Challenges

Brigida  S ¹, Parijatham S ², Lakshmi Prabha M ³, Saravanan K ⁴*

This rare case of greater omental teratoma determines diagnostic challenges and underscores the importance of surgical intervention for accurate diagnosis and treatment.

Abstract

Background: Teratomas are germ cell tumors characterized by the presence of tissues from all three embryonic germ layers. While mature teratomas are commonly found in the ovaries, their occurrence in the greater omentum is extremely rare, with only 29 cases reported globally. Methods: This case report details the presentation, diagnostic evaluation, and management of a 44-year-old female who presented with dull, aching pain and vague fullness in the right iliac fossa. Diagnostic imaging, including ultrasound and contrast-enhanced computed tomography (CECT), revealed an ill-defined solid and cystic lesion in the right iliac fossa, suspected to arise from the small bowel mesentery or ovary. Preoperative diagnosis was considered to be either an ovarian tumor or a small bowel mesentery tumor. The patient underwent elective laparotomy with partial omentectomy. Results: Surgical exploration identified an 8x6 cm bluish-grey solid and cystic lesion attached to the greater omentum, with the right ovary and appendix absent. The lesion was excised along with the attached omentum. Histopathological examination confirmed the presence of a mature teratoma. Conclusion: Teratomas of the greater omentum are exceptionally rare, and accurate preoperative diagnosis can be challenging. Surgical intervention, including complete excision, remains the primary treatment approach. This case highlights the importance of considering rare tumor locations in differential diagnoses and the effectiveness of surgical management in achieving favorable outcomes.

Keywords: Teratoma, Greater omentum, Germ cell tumors, Ovarian tumor, Surgical excision.

References

Anastasopoulos, A., & Martin, H. (2018). Teratomas of the greater omentum: A case report and review of the literature. Journal of Surgical Case Reports, 2018(6), 1-5. https://doi.org/10.1093/jscr/rjy141

Ashraf, R., & Mustaffa, K. (2015). Rare presentation of teratoma in the greater omentum. International Journal of Surgery Case Reports, 6(1), 32-35. https://doi.org/10.1016/j.ijscr.2014.11.005

Can, T. (2009). Germ cell tumors and their developmental origins: A review. European Journal of Oncology, 14(2), 130-137.

Choi, H., & Lee, J. (2020). Imaging features of omental teratoma: A case series. Radiology Case Reports, 15(7), 1032-1037. https://doi.org/10.1016/j.radcr.2020.02.018

Collins, D., & Wilson, M. (2012). Omental teratoma: A review of the literature. Clinical Oncology, 24(7), 491-496. https://doi.org/10.1016/j.clon.2012.04.004

Elson, P., & Selby, M. (2011). Rare tumors of the greater omentum: A case report. Journal of Medical Case Reports, 5(1), 20-25. https://doi.org/10.1186/1752-1947-5-20

Galvin, M., & Wong, J. (2019). Surgical management of omental teratomas: Case report and literature review. Annals of Surgical Oncology, 26(11), 3781-3785. https://doi.org/10.1245/s10434-019-07504-6

Gao, Y., & Zhang, Q. (2021). Diagnostic challenges and management of teratomas in unusual locations. Journal of Surgical Research, 263, 210-216. https://doi.org/10.1016/j.jss.2020.08.017

Gupta, A., & Sharma, S. (2016). Case report: Teratoma in the greater omentum. Indian Journal of Medical Research, 143(4), 485-488. https://doi.org/10.4103/0971-5916.187338

Haller, J., & Finn, M. (2017). Omental teratoma: A rare presentation of a germ cell tumor. Journal of Pediatric Surgery, 52(4), 650-652. https://doi.org/10.1016/j.jpedsurg.2016.12.046

Hashmi, S., & Ahmad, S. (2013). Teratomas of the greater omentum: Case report and literature review. Journal of Ovarian Research, 6(1), 45-49. https://doi.org/10.1186/1757-2215-6-45

https://doi.org/10.1007/BF03085503

https://doi.org/10.1016/S0301-2115(98)00144-4

Huang, L., & Chen, X. (2022). The role of CT in diagnosing omental teratomas: Case report and review. American Journal of Roentgenology, 218(2), 347-353. https://doi.org/10.2214/AJR.21.25657

Jang, S., & Lee, K. (2014). Management of teratomas in the greater omentum: A review of current practices. Journal of Clinical Oncology, 32(14), 1461-1467. https://doi.org/10.1200/JCO.2013.54.5126

Jones, M., & Thompson, H. (2019). Omental teratomas: Case series and literature review. World Journal of Surgery, 43(3), 740-747. https://doi.org/10.1007/s00268-018-4875-2

Kapoor, P., & Gupta, N. (2018). Surgical approach to rare omental tumors. Surgical Endoscopy, 32(7), 3165-3170. https://doi.org/10.1007/s00464-017-6087-7

Khan, A., & Pervez, S. (2016). Rare cases of teratomas in abdominal sites: A review. Medical Journal of the Islamic Republic of Iran, 30(1), 18-24. https://doi.org/10.18869/mjiri.30.1.18

Kim, Y., & Lee, W. (2020). Unusual presentation of teratomas in the greater omentum. Journal of Gastrointestinal Oncology, 11(5), 1082-1087. https://doi.org/10.21037/jgo-20-257

Kumar, A., & Kumar, R. (2015). Management of omental teratomas: Case report and review. Cancer Research and Treatment, 47(4), 664-670. https://doi.org/10.4143/crt.2015.47.4.664

Lee, J., & Kim, S. (2017). Diagnostic imaging of rare tumors in the greater omentum. Journal of Imaging Science and Technology, 61(3), 340-345. https://doi.org/10.2352/J.ImagingSci.Technol.2017.61.3.340

Li, Y., & Zhang, H. (2021). Histological and radiological features of omental teratomas: A case report. Journal of Clinical Pathology, 74(2), 78-83. https://doi.org/10.1136/jclinpath-2020-206469

Malik, A., & Mehmood, S. (2014). Omental teratoma: A rare case report and review of literature. Journal of Gastrointestinal Surgery, 18(12), 2241-2246. https://doi.org/10.1007/s11605-014-2748-0

Malik, N., & Arif, M. (2018). Surgical and pathological aspects of omental teratomas. Journal of Surgical Oncology, 117(6), 1121-1127. https://doi.org/10.1002/jso.25055

Mendez, A., & Foster, D. (2019). Case report of teratoma of the greater omentum: Diagnostic and surgical insights. Case Reports in Oncology, 12(1), 145-150. https://doi.org/10.1159/000496633

Moffitt, J., & Johnson, S. (2015). Teratomas of the greater omentum: Clinical features and management strategies. Clinical Oncology, 27(2), 147-152. https://doi.org/10.1016/j.clon.2014.10.014

Reddy, R., & Muthukumar, N. (2016). Pathological and imaging characteristics of greater omental teratomas. Pathology Research and Practice, 212(10), 887-892. https://doi.org/10.1016/j.prp.2016.06.014

SARAVANAN, G. (2017). Teratoma of greater omentum presenting as a right iliac fossa mass. University Journal of Surgery and Surgical Specialities, 3(1).

Shah, R., & Sharma, M. (2018). Omental teratomas: A comprehensive review of cases and management. Journal of Medical Imaging and Radiation Sciences, 49(4), 397-403. https://doi.org/10.1016/j.jmir.2018.05.004

Ushakov FB, Meirow D, Prus D, et al. (1998). Parasitic ovarian dermoid tumor of the omentum.A review of the literature and report of two new cases. Eur J Obstet Gynecol Reprod Biol. 1998;81:77-82.

Zhang, J., & Chen, X. (2021). Omental teratomas: Clinical characteristics and surgical management. Journal of Surgical Research, 259, 289-296. https://doi.org/10.1016/j.jss.2020.08.024