Aim

To retrospectively review the cases of gastric germ cell tumors (GCT), treated at our centre in the last 4 years (2014–2018)

Methods

All cases of gastric GCT diagnosed and treated at our institute in the last 4 years were retrospectively reviewed. The demographic profiles of the patients, clinic–pathological features and follow–up data were recorded.

Results

Four cases of gastric GCT were diagnosed and treated at our institute in the past 4 years. All our cases were boys. Their ages ranged from 4 days to 8 years. Out of the 4 cases, 3 were teratoma (2 mature, 1 immature) and 1 was yolk sac tumor (YST). On follow–up, all patients were asymptomatic with no evidence of recurrence. All cases differed in their age at presentation and clinical symptoms.

Case 1

A 4 day old new–born presented with massive abdominal distension, respiratory distress and poor feeding. Surgical exploration revealed a huge lump arising from the greater curvature of the stomach and was completely excised. Histopathology confirmed the diagnosis of immature teratoma.

Case 2

One year old male presented to the emergency with history of malaena and hematemesis of 2 weeks duration. Upper gastrointestinal (GI) endoscopy with computed tomography (CT) of the abdomen showed an ulcerated, bilobed mass across the greater curvature of the stomach having an intra–gastric and an extra–gastric component. Complete surgical excision with repair of the stomach was performed. Histopathology confirmed mature teratoma.

Case 3

An eight year old boy presented with history of pain in left upper abdomen of 2 months duration. CT abdomen revealed a large heterogeneous mass with fluid, soft tissue, bone and fat attenuation mixed with chunky calcifications, in relation to the greater curvature of stomach. Surgical excision revealed mature teratoma.

Case 4

A 3 year old boy presented with recurrent episodes of malaena and anaemia of 2 months duration. Upper GI endoscopy revealed deep excavated ulcer on the lesser curvature of stomach.  CT abdomen revealed large heterogeneously enhancing soft tissue mass lesion on the lessercurvature of stomach with multiple liver and omental metastasis. Serum alpha–fetoprotein (AFP) was 21000 ng/ml. Trucut biopsy from the mass was suggestive of YST. Following 3 courses of chemotherapy, sleeve gastrectomy with excision of the mass with omentectomy with biopsy of the liver nodules was done. Histopathology revealed only necrotic tissue with no evidence of residual malignancy.

Conclusion

Gastric GCT is an exceptionally rare embryonic neoplasm, which can have diverse clinical presentation depending on the age and site of involvement. With recent advances in imaging, an accurate pre–operative diagnosis is possible. Gastric GCT have an excellent prognosis if treated promptly and complete surgical excision is usually curative.