Clinical characteristics and surgical management of adult adrenal teratoma: a 15-year experience and systematic review of the literature.

Abstract

OBJECTIVE\nTo summarize the clinical characteristics and surgical management of adrenal teratoma in adults.\n\n\nPATIENTS AND METHODS\nWe retrospectively reviewed 14 patients with adrenal teratoma from January 2002 to June 2017, at two large centers in China and performed a systematic review of 39 patients from our series and published literatures. The clinicopathological characteristics, imaging features, surgical management and outcomes of this rare disease were analyzed.\n\n\nRESULTS\nOur series includes 12 females and 2 males with the median age of 35. 7 patients were treated by open adrenalectomy(OA) and 7 by laparoscopic adrenalectomy(LA) without perioperative complications. All patients were alive without recurrence or canceration over a mean follow-up of 77.1 months. In the systemic review, the male-female ratio was nearly 1:3, with a median age of 29 years. Mean tumor size was 9.4 cm and the distribution was almost the same between left and right side(53.8% vs 46.2%). The most common symptoms were flank or abdominal pain (46.2%), whereas 53.8% patients were asymptomatic. Tumors were often cystic (63.9%) with intratumoral fat (91.7%) and calcifications (80.6%). All patients underwent surgery, including 17 (43.6%) OA and 22 (56.4%) minimally invasive surgery. All tumors were pathologically confirmed mature teratoma except for one.\n\n\nCONCLUSIONS\nAdrenal teratoma is an extremely rare entity, frequently found to be large, benign and cystic. The patient s prognosis is generally good. As for its large volume, OA is the first choice for teratoma in most cases, while the LA can be an option in the small one.