Hepatic Teratoma: An Unusual Presentation of a Germ Cell Neoplasm

Primary hepatic teratoma is an exceptionally rare germ cell tumor. Its pathogenesis in the liver, an uncommon site for germ cell tumors, remains poorly understood. We present a case of a primary hepatic teratoma in a young adult female to highlight its clinical presentation, radiological hallmarks, and management. A 20-year-old female presented with a five-month history of dull, aching pain in the upper abdomen. Physical examination revealed a non-tender, palpable mass in the right hypochondrium. Routine blood investigations, including liver function tests and serum alpha-fetoprotein, were within normal limits. Contrast-enhanced computed tomography of the abdomen revealed a large, well-defined heterodense mass (~10.2 x 5.3 cm) in the liver. The mass exhibited characteristic heterogeneity with components of fat, calcification, and soft tissue, creating a mass effect on adjacent abdominal vessels. Based on the imaging findings, a provisional diagnosis of a complex benign tumor, likely a teratoma, was made. The patient underwent a successful surgical resection. Histopathological examination confirmed the presence of mature tissues derived from all three germ layers, leading to the definitive diagnosis of a mature cystic teratoma of the liver. This case underscores that primary hepatic teratoma, while exceedingly rare, should be considered in the differential diagnosis of a complex, heterogeneous liver mass, particularly in young patients. Cross-sectional imaging is pivotal in suggesting the diagnosis by identifying pathognomonic elements like fat and calcification. Complete surgical excision remains the cornerstone of treatment and is typically curative for mature lesions, emphasizing the importance of accurate radiological and histopathological correlation.