ABSTRACT
Extragonadal germ cell tumours (GCTs) are uncommon neoplasms comprising approximately 2%-5% of all GCTs. Of these, approximately 30%-40% occurs as primary retroperitoneal GCTs. This case report details the presentation, diagnosis and management of a 53-year-old man presenting with an incidental finding of a primary extragonadal retroperitoneal teratoma with carcinoid transformation.
Subject(s)
Carcinoid Tumor/pathology , Carcinoma, Neuroendocrine/pathology , Germ Cells/pathology , Retroperitoneal Neoplasms/pathology , Teratoma/pathology , Carcinoid Tumor/surgery , Diagnosis, Differential , Humans , Incidental Findings , Laparotomy/methods , Male , Middle Aged , Rare Diseases , Retroperitoneal Neoplasms/diagnostic imaging , Retroperitoneal Neoplasms/surgery , Teratoma/surgery , Tomography, X-Ray Computed/methods , Treatment OutcomeABSTRACT
Aneurysmal degeneration of the superior mesenteric artery (SMA) is a rare clinical finding, estimated to affect <1% of the general population in postmortem studies. Due to the rare prevalence of aneurysms affecting the SMA, there are no clear or definitive published consensus guidelines for its management at presentation, with both surgical and endovascular options described. An aberrant or replaced right hepatic artery (RRHA) is thought to affect 10-15% of the population. The prevalence of both conditions presenting concomitantly is unknown, but undoubtedly even rarer. We describe the successful management of a symptomatic SMA aneurysm with an RRHA emerging from the aneurysmal sac presenting to our vascular unit. This was repaired via an open surgical approach with SMA aneurysmectomy and interposition grafting using reversed vein with preservation of RHA liver perfusion via a novel reconstruction option. This case highlights the challenge that visceral aneurysms pose, especially when simple or orthodox reconstruction options are limited due to rare or unusual anatomy.
