Retroperitoneal mature teratoma complicating dilated cardiomyopathy in an infant:A case report and literature review

Objective To explore the experience of diagnosis and treatment of retroperitoneal benign teratoma complicated with dilated cardiomyopathy (DCM) in an infant. Methods Clinical data,pathological characteristics,therapeutic schedule and prognosis of a case of retroperitoneal mature teratoma complicating DCM admitted to Shanghai Pediatric Medical Center Affiliated to Shanghai Jiaotong University Medical College in 2013 were retrospectively analyzed,and related literatures at home and abroad were also reviewed. Results The case was a baby girl who was 4 months and 24 days old.She was born at full term and was hospitalized for detecting abdominal tumor for 4 months.Abdominal CT showed a large hypodense heterogeneous mass in the left abdominal cavity containing nodular calcification,fat,and liquid,and a small amount of peritoneal effusion.Mature teratoma was considered.Preoperative serum AFP was 7.85μg/L.Cardiac ultrasound showed globular dilatation of left ventricle,decreased left ventricular systolic function and mild to moderate mitral regurgitation,with LVEF of 29.1%.cTn-T of 0.89μg/L,B-HCG of 0.02 TU/ml,CKMB of 2.1 U/L,and NT-proBNP of 3 076 pg/ml.Mia and excessive catecholamine secretion were excluded.The results of virological and metabolic tests were normal.Intraoperative exploration revealed that the tumor originated from the posterior peritoneum.The tumor capsule was intact and mixed with cysts and solid.The size of the tumor was about 20 cm×15 cm×11 cm,and the surface of the tumor was irregular.Pathological diagnosis was (retroperitoneal) teratoma (mature),with glial tissue and adrenal tissue.After resection of the tumor,dilated cardiomyopathy was gradually improved and cardiac function gradually recovered.LVEF increased from 29.1% (before operation) to 49.2% (after 3 months),68.1% (after 6 months) and 68.3% (up to now).AFP decreased from 7.85 ng/ml (before operation) to 6.65 ng/ml (after 3 months),3.75 ng/ml (after 6 months) and 3.70 ng/ml (up to now).NT-proBNP decreased from 3 076 pg/ml (before operation) to 1 580 pg/ml (after 3 months),157 pg/ml (after 6 months) and 150 pg/ml (up to now).Till May 2019,the patient's condition was stable. Conclusion Retroperitoneal mature teratoma complicated with DCM is a rare disease in infants.According to the nature,stage and grade of teratoma,appropriate surgery or surgery plus chemotherapy should be applied.Associated DCM can be alleviated after resection of the tumor.