Delayed presentation of mature teratoma with umbilical perforation in a 9-years old female without congenital abdominal wall defects: A rare case report of atypical teratoma location

Abstract

Background

Mature teratomas are benign germ cell tumors that predominantly occur in gonadal regions. Extra-gonadal teratomas, especially in the umbilical region, are rare and often present significant diagnostic challenges. A delayed presentation with umbilical perforation in absence of congenital abdominal wall defects is uncommon.

Case presentation

A 9-year-old female presented with a four-year history of progressively enlarging umbilical mass with occasional discomfort. Examination revealed a firm, pedunculated mass protruding through a perforated umbilicus. A contrasted CT scan, revealed a well-encapsulated heterogeneous mass containing calcifications, with no evidence of deep intra-abdominal involvement. Complete surgical excision of the tumor was performed. Histopathological analysis confirmed a mature teratoma. Recovery was uneventful, and follow-up showed no recurrence.

Discussion

Umbilical teratomas are rare entities, particularly in children without congenital abnormalities. This case illustrates delayed presentation of umbilical perforation and diagnostic challenges in unusual located teratoma, emphasizing the need for high suspicious index when evaluating persistent umbilical masses. Radiology plays a critical role in differentiating these tumors from other conditions like granulomas, infections, or congenital anomalies. Complete surgical excision is the treatment of choice.

Conclusion

This report highlights the rarity and diagnostic complexity of mature teratomas in atypical locations. Early recognition of this rare differential diagnosis in cases of persistent umbilical symptoms is essential to prevent complications such as infection and perforation. Awareness and early intervention are critical to achieving favorable outcomes in such cases. This case contributes to the limited literature on extragonadal teratomas with umbilical perforation and the need for timely diagnosis and management.