Prenatal and Postnatal Ultrasonographic Characteristics of Immature Teratoma in the Gastric Wall: a case report

Prenatal and Postnatal Ultrasonographic Characteristics of Immature Teratoma in the Gastric Wall: a case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Prenatal and Postnatal Ultrasonographic Characteristics of Immature Teratoma in the Gastric Wall: a case report yijin chen, li huang, wen xiong This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3970072/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Teratomas are germ cell tumors derived from three embryonic germ layers. Most of them are benign mature teratomas and are frequently observed in the sacrococcygeal region, gonads, and mediastinum, the occurrence of immature teratomas in the gastric wall is extremely rare. Case summary: A 31-year-old pregnant woman's ultrasound at 36 weeks revealed a mass in the fetus's left mid-abdominal cavity. An immature teratoma originating from the stomach wall was suggested by neonatal CT and ultrasound scans. The neonate successfully underwent tumor excision, with pathology affirming the diagnosis. Conclusions: Immature gastric teratomas are rare tumors with malignant potential. Their diagnosis leans heavily on ultrasonographic features and histopathology. The case highlights the diagnostic utility of prenatal ultrasound. Currently, total resection of the tumor is the recommended treatment. Immature Gastric Teratoma Ultrasound Prenatal Diagnosis Figures Figure 1 Figure 2 Introduction Teratomas are germ cell tumors originate from three embryonic germ layers. They can be pathologically classified into mature and immature teratomas, with mature ones being more common. The criteria for classification are typically based on the presence and degree of differentiation of neuroglial tissue; immature teratomas may contain immature and embryonic tissue from all three germ layers, with the most prevalent malignant tissue subtype being primitive neuroectodermal tissue [ 1 ]. The grading system is determined by the quantity of immature neural tissue present [ 2 ]. Teratomas are predominantly found in the sacrococcygeal region, gonads, and mediastinum. Gastric teratomas are extremely rare, having an incidence of less than 1% in all types of teratoma [ 3 ]. This report describes a case of an immature gastric teratoma, focusing on its antenatal and postnatal ultrasonographic characteristics, and the neonatal received timely surgical interventions after birth. Case description A 31-year-old pregnant woman underwent an ultrasound examination at 36 weeks of gestation. The ultrasound examination detected a mass with mixed echogenicity, primarily solid in nature and exhibiting signs of encapsulation. The mass was found to be approximately 6.7x7.1x5.0cm in size and located in the left mid-abdominal cavity of the fetus. The color doppler flow imaging (CDFI) reveals the presence of limited blood flow signals internally. The mass was located on the left side of the portal vein's left branch, compressing the gastric bubble, which was positioned anteriorly to the left of the mass (Fig. 1 ). The ultrasound examination revealed the presence of a heterogeneous echogenic mass located in the mid-abdominal cavity of the fetus, which is suspected to be a tumorous lesion originating from the left liver. The woman delivered a male neonate at the completion of the gestational period. Postnatally, the infant exhibited mild respiratory distress, without any apparent additional abnormalities being noted. Tumor marker tests indicated that the levels of alpha-fetoprotein (AFP) were above 2000.00ng/ml, while the levels of human chorionic gonadotropin (HCG) were measured at 9.84mIU/ml. Upon palpation of the left abdomen, a solid mass measuring approximately 9x7cm was detected. The neonatal ultrasound examination revealed the presence of a mixed echogenic mass, primarily composed of solid components, with dimensions of approximately 10.1x8.6x7.2cm, located within the left mid-abdominal cavity. Multiple punctate calcifications were observed within the mass. The boundary between the mass and the wall of the stomach was not clear, and their movements were coordinated. Relative movement was observed between the mass, the left liver, and the left kidney. The solid portion of the mass exhibited a notable presence of blood flow signals, as evidenced by a RI value of 0.51 (Fig. 2 ). The ultrasound examination suggested the possibility of an immature teratoma originating from the gastric wall. The neonatal abdominal enhanced computed tomography (CT) scan revealed the presence of a substantial soft tissue mass within the left abdominal cavity, accompanied by punctate calcifications. The demarcation between the mass and the adjacent gastric wall was indistinct, indicating a diagnosis of an immature teratoma of the stomach wall. Following the completion of preoperative preparations, the neonate underwent abdominal tumor excision at two days of age. The pathological examination confirmed the presence of an immature teratoma within the gastric wall. The postoperative recovery was good. Prenatal US. Prenatal fetal intra-abdominal mixed echogenic mass closely adjacent to the left liver, compressing the liver, with minimal blood flow signals visible within. Postnatal US. Postnatal mixed echogenic mass in the abdominal cavity of the newborn, predominantly solid, with abundant blood flow. Discussion and conclusions The prevailing evidence indicates that the majority of teratomas can be attributed to the malignant transformation of fetal germ cells originating from the fetal yolk sac. Tealium's theory posits that gonadal tumors may develop from these germ cells migrating normally, while extragonadal tumors are thought to arise from the primordial germ cells that have undergone abnormal migration, this hypothesis also explains the predilection of these tumors to occur in midline positions, and it is worth noting that the stomach, prior to intestinal rotation, is positioned along the midline [ 4 ]. The clinical manifestations of immature teratomas located in the gastric wall are atypical. The most frequent symptoms are abdominal distension, palpable mass, and vomiting. Additionally, the tumor's size and location causing diaphragmatic splinting could lead to difficulties in both feeding and respiration. Histopathology is the golden standard for the diagnosis of teratomas, and it is essential for determining their maturity level. The risk of malignancy and a poorer prognosis correlate with higher histopathological grades. Compared with mature teratomas, immature teratomas exhibit larger sizes on average, and show more solid components on imaging [ 5 ]. Their ultrasonographic features include: an upper abdominal mass with indistinct boundary to the stomach wall, predominantly solid components, heterogeneous internal echoes, and sonographic appearances similar to the “comet-tail sign”. Sometimes, calcifications and echoes of fatty tissue are accompanied; blood flow within the tumor can be visualized with a low resistance index. For any type of teratoma, optimal treatment includes complete surgical excision of the tumor, accompanied by vigilant postoperative follow-up. Neonates with gastric teratomas have reported higher survival rates compared to other types of neonatal teratomas [ 6 ]. Elevated levels of alpha-fetoprotein (AFP) can be detected preoperatively, which is synthesized in the fetal liver, yolk sac and gastrointestinal tract, whereas teratomas may contain intestinal tissue, and AFP > 100 ng/dl is an excellent indicator of the presence of malignant components such as yolk sac elements [ 7 ]. Therefore, serum AFP levels are helpful for diagnosing tumors, identifying malignant transformations, and detecting postoperative recurrence or residual tumor, but its predictive value as a marker for assessing the malignant potential of immature gastric teratomas is uncertain [ 8 ]. In this case, the newborn had a sizable abdominal mass, accompanied by symptoms of respiratory distress. Ultrasonography showed a cystic-solid mixed echogenic mass with scattered calcifications, predominantly cystic, poorly demarcated from the adjacent gastric wall, and CDFI showed a solid component within the mass with blood flow signal, which could be differentiated from meconium peritonitis and neuroblastoma. Elevated AFP levels were consistent with the characteristics of a teratoma. Due to the tumor's proximity to the left lobe of the liver, it exerts pressure on the liver, and liver tumors are more common than gastric wall tumors in the fetal period, additionally, elevated AFP levels can also be observed with liver tumors, making it challenging to differentiate this tumor from hepatic tumors. Although immature teratoma of the gastric wall is a rare disease, when ultrasound reveals a solid-dominant mass near the gastric wall with a large volume, accompanied by echogenicity indicative of calcification and adipose tissue, CDFI shows blood flow signals, and there are associated symptoms along with an elevated AFP, consideration should be given to this condition. Although the accuracy of ultrasound examination may be influenced by factors such as maternal obesity, amniotic fluid, and fetal position [ 9 ], prenatal ultrasound graphic examination is valuable for the detection and diagnosis of gastric teratomas. Complementary imaging modalities like CT and magnetic resonance imaging (MRI) can also assist in diagnosis. The ultimate diagnosis of teratoma depends on histopathological examination. Surgical intervention is the recommended treatment. Abbreviations CDFI: Color Doppler Flow Imaging AFP: alpha-fetoprotein HCG: human chorionic gonadotropin US: Ultrasonography CT: computed tomography MRI: magnetic resonance imaging Declarations Data availability Datasets used and/or analyzed in the current study are available from the corresponding author by request. Acknowledgements The authors thank the patient and his family for consenting to report this case information. Funding This work did not receive any specific grant from funding agencies in the public, commercial, or not-forprofit sectors. Author information Authors and Affiliations Department of Ultrasound, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China. Yijin Chen, Li Huang, Wen Xiong Contributions YC reviewed the literature, collected the patient data, and drafted the manuscript. WX and LH revised the manuscript. WX provided the radiologic images and revised the imaging part. LH provided and revised the histopathological part. The final manuscript was read and approved by all authors. Corresponding authors Wen Xiong Ethics declarations Ethics approval and consent to participate Our study was granted an exemption from requiring ethics approval from the Ethics Committee of Sichuan Provincial People's Hospital, as it was observation report. All the experiment protocol for involving human data was in accordance with the guidelines of our institutional or Declaration of Helsinki in the manuscript, and the written informed consent from study participant`s legal guardian was obtained. Consent for publication Written informed consent was obtained from the patient’s legal guardian for publication of this case report and any accompanying images. Competing interests The authors declare that they have no competing interests. References He Z, Lu Y, Xie C. Fast-growing immature ovarian teratoma during pregnancy: a case report and a review of the literature. BMC Pregnancy and Childbirth. 2022 Jun 27;22(1):519. Iavazzo C, Vorgias G, Iavazzo PE, Gkegkes ID. Fertility sparing approach as the standard of care in young patients with immature teratomas. Journal of the Turkish German Gynecological Association. 2017 Mar;18(1):43. Parvin S, Sengupta M, Mishra PK, Chatterjee U, Banerjee S, Chaudhuri MK. Gastric teratoma: a series of 7 cases. Journal of pediatric surgery. 2016 Jul 1;51(7):1072-7. Ananthakrishnan N, Agarwal P, Satheesa R. Laparoscopic surgical management of a gastric dumbbell teratoma. Indian Pediatrics Case Reports. 2021 Jan 1;1(1):40. Chang MY, Shin HJ, Kim HG, Kim MJ, Lee MJ. Prepubertal testicular teratomas and epidermoid cysts: comparison of clinical and sonographic features. Journal of Ultrasound in Medicine. 2015 Oct;34(10):1745-51. Isaacs Jr H. Perinatal (fetal and neonatal) germ cell tumors. Journal of pediatric surgery. 2004 Jul 1;39(7):1003-13. Selvarajan, N., Kathirvelu, G., Ramalingam, T. R., Mokrala, U. B. S., Karunakaran, P., & Tharanendran, H. (2021). Immature gastric teratoma: A case report. Journal of Indian Association of Pediatric Surgeons, 26(6), 464. Van Heurn LJ, Knipscheer MM, Derikx JP, van Heurn LW. Diagnostic accuracy of serum alpha-fetoprotein levels in diagnosing recurrent sacrococcygeal teratoma: a systematic review. Journal of pediatric surgery. 2020 Sep 1;55(9):1732-9. Hu Q, Yan Y, Liao H, Liu H, Yu H, Zhao F. Sacrococcygeal teratoma in one twin: a case report and literature review. BMC Pregnancy and Childbirth. 2020 Dec;20:1-6. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3970072","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":281238929,"identity":"124fb5ee-bf5b-43a8-b18a-645c305676bb","order_by":0,"name":"yijin chen","email":"","orcid":"","institution":"University of Electronic Science and Technology of China","correspondingAuthor":false,"prefix":"","firstName":"yijin","middleName":"","lastName":"chen","suffix":""},{"id":281238930,"identity":"245b3829-27f4-4776-bfd3-465819cfeb21","order_by":1,"name":"li huang","email":"","orcid":"","institution":"University of Electronic Science and Technology of China","correspondingAuthor":false,"prefix":"","firstName":"li","middleName":"","lastName":"huang","suffix":""},{"id":281238931,"identity":"dd81c44b-2de6-4b63-9d22-4b84ebdca0e5","order_by":2,"name":"wen xiong","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAsElEQVRIiWNgGAWjYBACNv7+Bwc+/KiRI14Ln8QZxoMze44ZE69FjiGH+TAPG3NiA/EOYzh74AAPD1t63/EExg8fc4jRwtyXcEDCQiZ35pkHzJIztxFlywGDAwY8bLkbbiSwMfMSpyXB4ABQcboBCVpyDA4cYGNOIEGLxLGEg409xwxnnnnYTJxf5PubD3/+86NGnu948sEPH4nRggAHSIgamJYEUnWMglEwCkbBSAEAmls7LQVSvGkAAAAASUVORK5CYII=","orcid":"","institution":"University of Electronic Science and Technology of China","correspondingAuthor":true,"prefix":"","firstName":"wen","middleName":"","lastName":"xiong","suffix":""}],"badges":[],"createdAt":"2024-02-19 13:29:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3970072/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3970072/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":53197852,"identity":"bbd7be0b-f3e3-4abe-b894-d33302fa196a","added_by":"auto","created_at":"2024-03-21 18:43:03","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":349276,"visible":true,"origin":"","legend":"\u003cp\u003ePrenatal US. Prenatal fetal intra-abdominal mixed echogenic mass closely adjacent to the left liver, compressing the liver, with minimal blood flow signals visible within.\u003c/p\u003e","description":"","filename":"fig.1.png","url":"https://assets-eu.researchsquare.com/files/rs-3970072/v1/c8d8a63c4449bf4591f5b74b.png"},{"id":53197853,"identity":"6f0146fe-aed2-464b-b6a0-e02fbcf625ef","added_by":"auto","created_at":"2024-03-21 18:43:03","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":215736,"visible":true,"origin":"","legend":"\u003cp\u003ePostnatal US. Postnatal mixed echogenic mass in the abdominal cavity of the newborn, predominantly solid, with abundant blood flow.\u003c/p\u003e","description":"","filename":"fig.2.png","url":"https://assets-eu.researchsquare.com/files/rs-3970072/v1/0f471afa35c90c914f509012.png"},{"id":59342775,"identity":"a68ed2fc-66e7-4d58-a24b-91b5d6e5cb8a","added_by":"auto","created_at":"2024-06-30 06:46:50","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1028507,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3970072/v1/aa40b780-ed18-4d35-b1e8-be0338128719.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prenatal and Postnatal Ultrasonographic Characteristics of Immature Teratoma in the Gastric Wall: a case report","fulltext":[{"header":"Introduction","content":"\u003cp\u003eTeratomas are germ cell tumors originate from three embryonic germ layers. They can be pathologically classified into mature and immature teratomas, with mature ones being more common. The criteria for classification are typically based on the presence and degree of differentiation of neuroglial tissue; immature teratomas may contain immature and embryonic tissue from all three germ layers, with the most prevalent malignant tissue subtype being primitive neuroectodermal tissue [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The grading system is determined by the quantity of immature neural tissue present [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Teratomas are predominantly found in the sacrococcygeal region, gonads, and mediastinum. Gastric teratomas are extremely rare, having an incidence of less than 1% in all types of teratoma [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. This report describes a case of an immature gastric teratoma, focusing on its antenatal and postnatal ultrasonographic characteristics, and the neonatal received timely surgical interventions after birth.\u003c/p\u003e"},{"header":"Case description","content":"\u003cp\u003eA 31-year-old pregnant woman underwent an ultrasound examination at 36 weeks of gestation. The ultrasound examination detected a mass with mixed echogenicity, primarily solid in nature and exhibiting signs of encapsulation. The mass was found to be approximately 6.7x7.1x5.0cm in size and located in the left mid-abdominal cavity of the fetus. The color doppler flow imaging (CDFI) reveals the presence of limited blood flow signals internally. The mass was located on the left side of the portal vein's left branch, compressing the gastric bubble, which was positioned anteriorly to the left of the mass (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The ultrasound examination revealed the presence of a heterogeneous echogenic mass located in the mid-abdominal cavity of the fetus, which is suspected to be a tumorous lesion originating from the left liver. The woman delivered a male neonate at the completion of the gestational period. Postnatally, the infant exhibited mild respiratory distress, without any apparent additional abnormalities being noted. Tumor marker tests indicated that the levels of alpha-fetoprotein (AFP) were above 2000.00ng/ml, while the levels of human chorionic gonadotropin (HCG) were measured at 9.84mIU/ml. Upon palpation of the left abdomen, a solid mass measuring approximately 9x7cm was detected. The neonatal ultrasound examination revealed the presence of a mixed echogenic mass, primarily composed of solid components, with dimensions of approximately 10.1x8.6x7.2cm, located within the left mid-abdominal cavity. Multiple punctate calcifications were observed within the mass. The boundary between the mass and the wall of the stomach was not clear, and their movements were coordinated. Relative movement was observed between the mass, the left liver, and the left kidney. The solid portion of the mass exhibited a notable presence of blood flow signals, as evidenced by a RI value of 0.51 (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The ultrasound examination suggested the possibility of an immature teratoma originating from the gastric wall. The neonatal abdominal enhanced computed tomography (CT) scan revealed the presence of a substantial soft tissue mass within the left abdominal cavity, accompanied by punctate calcifications. The demarcation between the mass and the adjacent gastric wall was indistinct, indicating a diagnosis of an immature teratoma of the stomach wall. Following the completion of preoperative preparations, the neonate underwent abdominal tumor excision at two days of age. The pathological examination confirmed the presence of an immature teratoma within the gastric wall. The postoperative recovery was good.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003ePrenatal US. Prenatal fetal intra-abdominal mixed echogenic mass closely adjacent to the left liver, compressing the liver, with minimal blood flow signals visible within.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003ePostnatal US. Postnatal mixed echogenic mass in the abdominal cavity of the newborn, predominantly solid, with abundant blood flow.\u003c/p\u003e"},{"header":"Discussion and conclusions","content":"\u003cp\u003eThe prevailing evidence indicates that the majority of teratomas can be attributed to the malignant transformation of fetal germ cells originating from the fetal yolk sac. Tealium's theory posits that gonadal tumors may develop from these germ cells migrating normally, while extragonadal tumors are thought to arise from the primordial germ cells that have undergone abnormal migration, this hypothesis also explains the predilection of these tumors to occur in midline positions, and it is worth noting that the stomach, prior to intestinal rotation, is positioned along the midline [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe clinical manifestations of immature teratomas located in the gastric wall are atypical. The most frequent symptoms are abdominal distension, palpable mass, and vomiting. Additionally, the tumor's size and location causing diaphragmatic splinting could lead to difficulties in both feeding and respiration.\u003c/p\u003e \u003cp\u003eHistopathology is the golden standard for the diagnosis of teratomas, and it is essential for determining their maturity level. The risk of malignancy and a poorer prognosis correlate with higher histopathological grades. Compared with mature teratomas, immature teratomas exhibit larger sizes on average, and show more solid components on imaging [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Their ultrasonographic features include: an upper abdominal mass with indistinct boundary to the stomach wall, predominantly solid components, heterogeneous internal echoes, and sonographic appearances similar to the “comet-tail sign”. Sometimes, calcifications and echoes of fatty tissue are accompanied; blood flow within the tumor can be visualized with a low resistance index.\u003c/p\u003e \u003cp\u003eFor any type of teratoma, optimal treatment includes complete surgical excision of the tumor, accompanied by vigilant postoperative follow-up. Neonates with gastric teratomas have reported higher survival rates compared to other types of neonatal teratomas [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Elevated levels of alpha-fetoprotein (AFP) can be detected preoperatively, which is synthesized in the fetal liver, yolk sac and gastrointestinal tract, whereas teratomas may contain intestinal tissue, and AFP \u0026gt; 100 ng/dl is an excellent indicator of the presence of malignant components such as yolk sac elements [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Therefore, serum AFP levels are helpful for diagnosing tumors, identifying malignant transformations, and detecting postoperative recurrence or residual tumor, but its predictive value as a marker for assessing the malignant potential of immature gastric teratomas is uncertain [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn this case, the newborn had a sizable abdominal mass, accompanied by symptoms of respiratory distress. Ultrasonography showed a cystic-solid mixed echogenic mass with scattered calcifications, predominantly cystic, poorly demarcated from the adjacent gastric wall, and CDFI showed a solid component within the mass with blood flow signal, which could be differentiated from meconium peritonitis and neuroblastoma. Elevated AFP levels were consistent with the characteristics of a teratoma. Due to the tumor's proximity to the left lobe of the liver, it exerts pressure on the liver, and liver tumors are more common than gastric wall tumors in the fetal period, additionally, elevated AFP levels can also be observed with liver tumors, making it challenging to differentiate this tumor from hepatic tumors.\u003c/p\u003e \u003cp\u003eAlthough immature teratoma of the gastric wall is a rare disease, when ultrasound reveals a solid-dominant mass near the gastric wall with a large volume, accompanied by echogenicity indicative of calcification and adipose tissue, CDFI shows blood flow signals, and there are associated symptoms along with an elevated AFP, consideration should be given to this condition. Although the accuracy of ultrasound examination may be influenced by factors such as maternal obesity, amniotic fluid, and fetal position [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], prenatal ultrasound graphic examination is valuable for the detection and diagnosis of gastric teratomas. Complementary imaging modalities like CT and magnetic resonance imaging (MRI) can also assist in diagnosis. The ultimate diagnosis of teratoma depends on histopathological examination. Surgical intervention is the recommended treatment.\u003c/p\u003e "},{"header":"Abbreviations","content":"\u003cp\u003eCDFI: Color\u0026nbsp;Doppler\u0026nbsp;Flow\u0026nbsp;Imaging\u003c/p\u003e\n\u003cp\u003eAFP: alpha-fetoprotein\u003c/p\u003e\n\u003cp\u003eHCG: human chorionic gonadotropin\u003c/p\u003e\n\u003cp\u003eUS: Ultrasonography\u003c/p\u003e\n\u003cp\u003eCT: computed tomography\u003c/p\u003e\n\u003cp\u003eMRI: magnetic resonance imaging\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eData availability\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eDatasets used and/or analyzed in the current study are available from the corresponding author by request.\u003c/p\u003e\u003cp\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank the patient and his family for consenting to report this case information.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis work did not receive any specific grant from funding agencies in the public, commercial, or not-forprofit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthor information\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAuthors and Affiliations\u003c/p\u003e\n\u003cp\u003eDepartment of Ultrasound, Sichuan Provincial People\u0026apos;s Hospital, University of Electronic Science and Technology of China, Chengdu, China.\u003c/p\u003e\n\u003cp\u003eYijin Chen, Li Huang, Wen Xiong\u003c/p\u003e\n\u003cp\u003eContributions\u003c/p\u003e\n\u003cp\u003eYC reviewed the literature, collected the patient data, and drafted the manuscript. WX and LH revised the manuscript. WX provided the radiologic images and revised the imaging part. LH provided and revised the histopathological part. The final manuscript was read and approved by all authors.\u003c/p\u003e\n\u003cp\u003eCorresponding authors\u003c/p\u003e\n\u003cp\u003eWen Xiong\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEthics declarations\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eOur study was granted an exemption from requiring ethics approval from the Ethics Committee of Sichuan Provincial People\u0026apos;s Hospital, as it was observation report. All the experiment protocol for involving human data was in accordance with the guidelines of our institutional or Declaration of Helsinki in the manuscript, and the written informed consent from study participant`s legal guardian was obtained.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient\u0026rsquo;s legal guardian for publication of this case report and any accompanying images.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHe Z, Lu Y, Xie C. Fast-growing immature ovarian teratoma during pregnancy: a case report and a review of the literature. BMC Pregnancy and Childbirth. 2022 Jun 27;22(1):519.\u003c/li\u003e\n\u003cli\u003eIavazzo C, Vorgias G, Iavazzo PE, Gkegkes ID. Fertility sparing approach as the standard of care in young patients with immature teratomas. Journal of the Turkish German Gynecological Association. 2017 Mar;18(1):43.\u003c/li\u003e\n\u003cli\u003eParvin S, Sengupta M, Mishra PK, Chatterjee U, Banerjee S, Chaudhuri MK. Gastric teratoma: a series of 7 cases. Journal of pediatric surgery. 2016 Jul 1;51(7):1072-7.\u003c/li\u003e\n\u003cli\u003eAnanthakrishnan N, Agarwal P, Satheesa R. Laparoscopic surgical management of a gastric dumbbell teratoma. Indian Pediatrics Case Reports. 2021 Jan 1;1(1):40.\u003c/li\u003e\n\u003cli\u003eChang MY, Shin HJ, Kim HG, Kim MJ, Lee MJ. Prepubertal testicular teratomas and epidermoid cysts: comparison of clinical and sonographic features. Journal of Ultrasound in Medicine. 2015 Oct;34(10):1745-51.\u003c/li\u003e\n\u003cli\u003eIsaacs Jr H. Perinatal (fetal and neonatal) germ cell tumors. Journal of pediatric surgery. 2004 Jul 1;39(7):1003-13.\u003c/li\u003e\n\u003cli\u003eSelvarajan, N., Kathirvelu, G., Ramalingam, T. R., Mokrala, U. B. S., Karunakaran, P., \u0026amp; Tharanendran, H. (2021). Immature gastric teratoma: A case report. Journal of Indian Association of Pediatric Surgeons, 26(6), 464.\u003c/li\u003e\n\u003cli\u003eVan Heurn LJ, Knipscheer MM, Derikx JP, van Heurn LW. Diagnostic accuracy of serum alpha-fetoprotein levels in diagnosing recurrent sacrococcygeal teratoma: a systematic review. Journal of pediatric surgery. 2020 Sep 1;55(9):1732-9.\u003c/li\u003e\n\u003cli\u003eHu Q, Yan Y, Liao H, Liu H, Yu H, Zhao F. Sacrococcygeal teratoma in one twin: a case report and literature review. BMC Pregnancy and Childbirth. 2020 Dec;20:1-6.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Immature Gastric Teratoma, Ultrasound, Prenatal Diagnosis","lastPublishedDoi":"10.21203/rs.3.rs-3970072/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3970072/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: Teratomas are germ cell tumors derived from three embryonic germ layers. Most of them are benign mature teratomas and are frequently observed in the sacrococcygeal region, gonads, and mediastinum, the occurrence of immature teratomas in the gastric wall is extremely rare.\u003c/p\u003e\n\u003cp\u003eCase summary: A 31-year-old pregnant woman's ultrasound at 36 weeks revealed a mass in the fetus's left mid-abdominal cavity. An immature teratoma originating from the stomach wall was suggested by neonatal CT and ultrasound scans. The neonate successfully underwent tumor excision, with pathology affirming the diagnosis.\u003c/p\u003e\n\u003cp\u003eConclusions: Immature gastric teratomas are rare tumors with malignant potential. Their diagnosis leans heavily on ultrasonographic features and histopathology. The case highlights the diagnostic utility of prenatal ultrasound. Currently, total resection of the tumor is the recommended treatment.\u003c/p\u003e","manuscriptTitle":"Prenatal and Postnatal Ultrasonographic Characteristics of Immature Teratoma in the Gastric Wall: a case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-21 18:42:58","doi":"10.21203/rs.3.rs-3970072/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"46e41e7f-3849-41b7-a872-bf945b830081","owner":[],"postedDate":"March 21st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-06-30T06:38:43+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-21 18:42:58","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3970072","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3970072","identity":"rs-3970072","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}