Malignant teratoma of the spleen.

CASE REPORT First admission A 69 year old white woman was admitted to the Norwalk Hospital April 15, 1968 complaining of left upper quadrant pain and vomiting of two days' duration. She was acutely ill, temperature 101°F., with a somewhat distended abdomen. There was generalized abdominal tenderness particularly in the left upper and right lower quadrants. A large firm,' tender mass was felt in the left upper abdomen. Laboratory data were: hemoglobin 14.4 gm!100 ml.; wbc 7,400/cu mm; polymorphonuclears 83%o, 'stabs 1%o, lymphocytes 9%, eosinophils 3%o, monocytes 3%o, basophils 1%o. Urinalysis, blood urea nitrogen and serum electrolytes were within normal limits.'X-ray film of the abdomen showed a soft tissue mass in the'left upper abdomen. On intravenous pyelogram, this mass appeared to displace the left kidney inferiorly and medially. She underwent surgical exploration that night through a midline incision. Findings included an acutely inflammed appendix and a huge freely moveable' spleen 'but no ascites. The ovaries were atrophic and the pancreas unremarkable.-No disease of other organs was found. The spleen and appendix were removed. "The patient's postoperative course was uneventful and 'she went home on the 17th day. Findings in the appendix grossly and microscopically were typical of acute appendicitis. The spleen measured 18 X 15 x 15 cm. and weighed 2,500 grams. Most of it .was occupied by a large monolocular cyst (Fig. 1) the wall of which averaged 2 mm. in thickness. There were saccular outpouchings and papillary project'ions of the lining -(Fig. 2). There were'large areas of calcification in the wall, appe'aring as thin, 'large, flat plaques. The cyst contained about 1,500 ml. of a thin yellow-brown -turbid liquid. Cytologic exam'ination of the fluid did not yield atypical cells. This cyst was intimately attached to