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IMAGES IN PATHOLOGY
Year : 2007  |  Volume : 53  |  Issue : 1  |  Page : 48-49

Mature cystic teratoma in the falciform ligament of the liver


1 Department of Radiodiagnosis, Christian Medical College, Vellore, Tamil Nadu, India
2 Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India

Date of Submission04-Dec-2005
Date of Decision18-Jan-2006
Date of Acceptance16-Feb-2006

Correspondence Address:
A P Ayyappan
Department of Radiodiagnosis, Christian Medical College, Vellore, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0022-3859.30330

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How to cite this article:
Ayyappan A P, Singh S E, Shah A. Mature cystic teratoma in the falciform ligament of the liver. J Postgrad Med 2007;53:48-9

How to cite this URL:
Ayyappan A P, Singh S E, Shah A. Mature cystic teratoma in the falciform ligament of the liver. J Postgrad Med [serial online] 2007 [cited 2019 Nov 17];53:48-9. Available from: http://www.jpgmonline.com/text.asp?2007/53/1/48/30330


A 38-year-old woman presented with severe epigastric pain radiating to the back. She had a similar episode six months before that lasted for a week and was treated elsewhere as pancreatitis. She was afebrile. Liver function tests and serum levels of amylase and lipase were normal. Physical examination showed tenderness and a palpable mass in the epigastrium. The computed tomography (CT) scan demonstrated a lobulated, nonenhancing soft tissue density lesion in the intersegmental fissure [Figure - 1]. Inferiorly the lesion extended along the hepatoduodenal ligament. The lesion did not reveal calcifications or areas with fat density. There was no evidence of ascites, lymphadenopathy or metastases. At surgery, a 4-cm-diameter cyst containing sebaceous material was excised from within the folds of the falciform ligament. The vascular supply to the tumour appeared to arise from a pedicle in the base of the falciform ligament. There was no peritoneal inflammation. Histopathology of the lesion revealed a mature cystic teratoma with congested cyst wall and infarcted contents [Figure - 2]. Her postoperative course was uneventful.


 :: Discussion Top


Pathologic conditions of the falciform ligament leading to surgical intervention are exceedingly rare.[1] We document a case of mature cystic teratoma in the falciform ligament. We believe this is the second reported case of a mature cystic teratoma arising from the falciform ligament; the first being from Japan in 1976.[2]

Cystic lesions of the falciform ligament have been classified by Brown[1] as being either primary or secondary. Primary cysts stem from congenital developmental aberrations. Secondary cysts include infectious causes (echinococcal cyst and abscess), traumatic origins (bile extravasation and liquefaction of a hematoma) and neoplasms with cystic degeneration. Unusual lesions that have been described in the falciform ligament include lipoma, lymphangioma, paraganglioma, leiomyosarcoma, solitary fibrous tumor, low-grade fibromyxoid sarcoma, and endodermal sinus (yolk sac) tumor.[3] Lipomatous appendage, gangrene of the falciform ligament and internal hernias through a congenital window in the falciform ligament have also been described.[4],[5]

Cystic teratomas are congenital tumors that contain derivatives of all three germ layers. They are thought to arise from pluripotential embryonal cells. The characteristic constellation of findings are the presence of a fat-containing mass with a dependent element whose CT numbers are greater than normal fat (mixture of fat, hair, debris and fluid) and calcification (teeth and/or abortive bone) in a solid prominence (Rokitansky protuberance, dermoid plug). Areas of solid tissue density are frequently present in cystic teratomas and may represent gelatinous, proteinaceous fluid or connective tissue.

Occasionally, as seen in the above case, there may be no calcium or fat and diagnosis can be difficult on CT.[6]

Modern cross-sectional imaging modalities can identify a lesion in the falciform ligament area and help differentiate solid from cystic lesions with variable certainty. In the differential, a long list of lesions must be considered and histopathological evaluation is usually required for definitive diagnosis. The treatment for most falciform ligament lesions is surgical excision. Diagnostic laparoscopy can aid in anatomical localization, biopsy and surgical planning. It also offers the advantage of therapeutic possibilities like resection in cases with segmental fatty tissue necrosis or twisted lipomatous appendage of the falciform ligament.[3],[4]

 
 :: References Top

1.Brock JS, Pachter HL, Schreiber J, Hofstetter SR. Surgical diseases of the falciform ligament. Am J Gastroenterol 1992;87:757-8.  Back to cited text no. 1  [PUBMED]  
2.Abe H, Ikeda K, Wantanabe I. Teratoma of the ligamentum teres of the liver - A case report. Fukushima J Med Sci 1976;23:1-10.  Back to cited text no. 2    
3.Harish K, Ashok AC, Alva NK. Low grade fibromyxoid sarcoma of the falciform ligament: A case report. BMC Surg 2003;3:7.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Coulier B, Cloots V, Ramboux A. US and CT diagnosis of a twisted lipomatous appendage of the falciform ligament. Eur Radiol 2001;11:213-5.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.Losanoff JE, Kiossey KT. Isolated gangrene of the round and falciform liver ligaments: A rare cause of peritonitis: Case report and review of the world literature. Am Surg 2002;68:751-5.  Back to cited text no. 5    
6.Friedman AC, Pyatt RS, Hartman DS, Downey EF Jr, Olson WB. CT of benign cystic teratoma. AJR Am J Roentgenol 1982;138:659-65.  Back to cited text no. 6  [PUBMED]  


    Figures

[Figure - 1], [Figure - 2]

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Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
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