Through a routine antenatal ultrasound examination of 37-year-old woman at 38 weeks' gestation, a 6 cm-diameter mixed solid and cystic mass was found in the left suprarenal area of her fetus. The following antenatal magnetic resonance image showed a larger cystic mass with a central solid component. The surgical exploration of the mass was performed in 50 days after delivery and by the pathologic examination a grade III immature teratoma was found. The retroperitoneal immature teratomas are extremely rare in childhood. To our Knowledge this is the first reported case about congenital retroperitoneal immature teratoma. The immature teratoma should be included in the differential diagnosis of fetal suprarenal mass and the serum alpha-fetoprotein level should be included in the initial laboratory examination at birth.
Adult ; alpha-Fetoproteins ; Diagnosis, Differential ; Female ; Fetus ; Humans ; Neuroblastoma* ; Parturition ; Pregnancy ; Prenatal Diagnosis ; Teratoma* ; Ultrasonography

PURPOSE: Pathogenesis and treatment of spontaneous dissecting aneurysm of the intracranial vertebral artery (VA) remain controversial. This study was designed to provide management strategies and to improve management outcome in patients with these aneurysms. MATERIALA AND METHODS: Among a total of 1,990 patients treated for intracranial aneurysms from February 1992 to June 2005, 28 patients (1.4%) were treated either by surgery (8 patients) or neurointervention (20 patients) for spontaneous dissecting aneurysms of the intracranial VA. Twenty-two patients had ruptured aneurysms. We analyzed indications of surgery or neurointervention for each case, and assessed the management outcome at a 6-month follow-up. RESULTS: For selection of therapeutic options, patients were initially evaluated as possible candidates for neurointervention using the following criteria: 1) poor clinical grade; 2) advanced age; 3) medical illness; 4) unruptured aneurysm; 5) equal or larger opposite VA; 6) anticipated surgical difficulty due to a deep location of the VA-posterior inferior cerebellar artery (PICA) junction. Surgery was considered for patients with: 1) high-risk aneurysms (large or irregular shaped); 2) smaller opposite VA; 3) failed neurointervention; or 4) dissection involving the PICA. Management outcomes were favorable in 25 patients (89.3%). Causes of unfavorable outcome in the remaining 3 patients were the initial insult in 2 patients, and medical complications in one patient. CONCLUSION: Ruptured aneurysms must be treated to prevent rebleeding. For unruptured aneurysms, follow-up angiography would be necessary to detect growth of the aneurysm. Treatment modality should be selected according to the clinical characteristics of each patient and close collaboration between neurosurgeons and neurointerventionists is essential.
Adult ; Aged ; Aneurysm, Dissecting/*pathology/surgery/therapy ; Aneurysm, Ruptured/pathology/surgery/therapy ; Female ; Follow-Up Studies ; Humans ; Intracranial Aneurysm/*pathology/surgery/therapy ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Vertebral Artery/*pathology/surgery