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Best Cases from the AFIP

Liver Teratoma¹

¹ From the Departments of Diagnostic Imaging (L.C.M., D.P., C.M.) and Pathology (J.T.), Ottawa Hospital, Ottawa, Ontario, Canada. Received October 21, 2003; revision requested December 16 and received January 28, 2004; accepted April 5. All authors have no financial relationships to disclose. Address correspondence to L.C.M., Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710 (e-mail: luciekilger@hotmail.com).

View larger version (159K): [in a new window]   Figure 1.  Contrast-enhanced CT scan of the abdomen shows a well-defined lesion along the posterior right lobe of the liver. The lesion contains a fluid component (1), a fatty component (2), and some calcification (3).

View larger version (142K): [in a new window]   Figure 2.  Coronal scout MR image of the abdomen, obtained with true fast imaging with steady-state precession, shows the lesion extending into the bare area of the liver. However, the image does not demonstrate the site of origin of the lesion by means such as a "claw" of tissue surrounding the lesion (the claw sign).

View larger version (151K): [in a new window]   Figure 3a.  (a) Axial out-of-phase T1-weighted MR image shows that the mass has three different signal intensities: marked low signal intensity (1), in keeping with fluid within a cystic component; high signal intensity (2), which represents fatty tissue; and a focus that is relatively isointense to muscle (3), in keeping with a soft-tissue component. (b) Axial fat saturation T2-weighted MR image shows fluid (marked high signal intensity) (1) and the fatty component (2), which has decreased in signal intensity like the adjacent retroperitoneal and subcutaneous macroscopic fat. (c) Axial contrast-enhanced MR image shows minimal peripheral enhancement (arrow), as if there were a capsule.

View larger version (156K): [in a new window]   Figure 3b.  (a) Axial out-of-phase T1-weighted MR image shows that the mass has three different signal intensities: marked low signal intensity (1), in keeping with fluid within a cystic component; high signal intensity (2), which represents fatty tissue; and a focus that is relatively isointense to muscle (3), in keeping with a soft-tissue component. (b) Axial fat saturation T2-weighted MR image shows fluid (marked high signal intensity) (1) and the fatty component (2), which has decreased in signal intensity like the adjacent retroperitoneal and subcutaneous macroscopic fat. (c) Axial contrast-enhanced MR image shows minimal peripheral enhancement (arrow), as if there were a capsule.

View larger version (149K): [in a new window]   Figure 3c.  (a) Axial out-of-phase T1-weighted MR image shows that the mass has three different signal intensities: marked low signal intensity (1), in keeping with fluid within a cystic component; high signal intensity (2), which represents fatty tissue; and a focus that is relatively isointense to muscle (3), in keeping with a soft-tissue component. (b) Axial fat saturation T2-weighted MR image shows fluid (marked high signal intensity) (1) and the fatty component (2), which has decreased in signal intensity like the adjacent retroperitoneal and subcutaneous macroscopic fat. (c) Axial contrast-enhanced MR image shows minimal peripheral enhancement (arrow), as if there were a capsule.

View larger version (184K): [in a new window]   Figure 4a.  (a) Photograph of the gross pathologic specimen shows a lobulated mass that contains copious amounts of hair and characteristic yellow sebaceous material. (b) Photograph of the cut specimen shows a smooth-walled cavity that contained a sebaceous substance.

View larger version (185K): [in a new window]   Figure 4b.  (a) Photograph of the gross pathologic specimen shows a lobulated mass that contains copious amounts of hair and characteristic yellow sebaceous material. (b) Photograph of the cut specimen shows a smooth-walled cavity that contained a sebaceous substance.

View larger version (159K): [in a new window]   Figure 5a.  Photomicrographs show skin tissue with sebaceous glands and hair follicles (arrow in a), neural tissue (arrow in b), and choroid plexus-like tissue (arrow in c), which confirm the diagnosis of a teratoma.

View larger version (188K): [in a new window]   Figure 5b.  Photomicrographs show skin tissue with sebaceous glands and hair follicles (arrow in a), neural tissue (arrow in b), and choroid plexus-like tissue (arrow in c), which confirm the diagnosis of a teratoma.

View larger version (192K): [in a new window]   Figure 5c.  Photomicrographs show skin tissue with sebaceous glands and hair follicles (arrow in a), neural tissue (arrow in b), and choroid plexus-like tissue (arrow in c), which confirm the diagnosis of a teratoma.