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'MONSTER TUMOR REMOVED'
Jenny and Karl McCollom of Mariposa didn’t think about their 17-month-old daughter’s little pot belly. After all, lots of toddlers have a protruding tummy and slightly swayed back until their body begins to grow taller and more proportionate. A recent well-baby exam also didn’t reveal anything unusual.
But the McColloms soon learned their little girl had a monstrous tumor growing inside her abdomen – literally. In fact, it was the largest tumor of this type surgeons at Children’s Hospital Central California had seen in a young child, and was especially complicated due to its location and juxtaposition to major blood vessels. “It was quite shocking,” says Jenny.
When the nurse practitioner in Corva’s primary care physician’s office saw Corva and her mom by chance in town, she suggested they pay another visit. Corva’s arms and legs appeared thinner and her belly slightly larger.
So they did. An abnormal blood test and what felt like an internal organ pushing against Corva’s belly led the physician to refer Corva to Children’s where pediatric specialists determined she likely had a massive abdominal teratoma.
Characterizing the monster tumor
Meaning “monster tumor” in Greek, a teratoma is an encapsulated mass with tissue or organ components derived from all three embryonic germ layers – mesoderm, endoderm and ectoderm. The different specialized cells that make up the body come from one of these germ layers. Present at birth, teratomas may contain hair, teeth, bone and rarely, more complex parts such as eyes, torso, hands and feet. Fluid-filled cysts may reside within the teratoma’s capsule, sometimes producing a structure resembling a fetus.
Medical experts think teratomas may occur during the cell differentiation process when the embryo begins developing in the womb. The teratoma typically develops in the child’s ovary, testes, neck or torso, gradually becoming a recognizable mass.
In Corva’s case, the teratoma formed in the back of her abdominal cavity. It grew so large it pushed her pancreas from the back to the front of her tummy, making her pancreas vulnerable to injury.
“It wouldn’t have been good if she had a belly blow,” says Dr. Adam Gorra, a pediatric surgeon at Children’s who surgically removed Corva’s tumor with Dr. Michael Allshouse, Children’s medical director, pediatric surgery and trauma.
“Both doctors explained everything without sugarcoating anything,” says Jenny. “They inspired confidence.”
In case the teratoma was cancerous, the McColloms met beforehand with Dr. Vonda Crouse, a long-time pediatric oncologist at Children’s. Of the 120 new cancer patients seen each year at Children’s, only about one involves a cancerous teratoma (teratocarcinoma).
Eliminating the unusually large mass
The pediatric surgeons removed the entire tumor. The size of an eggplant, the mass weighed just over a pound, representing nearly 10 percent of Corva’s tiny body.
“It was the largest tumor I’ve seen in a prepubescent child in proportion to their size,” says Dr. Allshouse, who has treated about 500 tumors during his more than 25-year career.
“Corva’s tumor wrapped 270 degrees around the abdominal aorta, the largest and most vital blood vessel in the body,” adds Dr. Gorra. “We were thrilled we got the tumor out without sacrificing important organs.”
As teratomas do, the mass contained multiple types of tissue, including brain, fat, cartilage and more. Thankfully, the tumor was not malignant.
During the four-hour surgery, nurses’ regular updates especially comforted the McColloms. Halfway through, they were told the procedure continued to go well and “The doctors have a surprise for you!”
“We couldn’t imagine what that meant!” recalls Jenny, smiling.
Dr. Allshouse and Dr. Gorra removed a small triangular-shaped tooth from Corva’s tumor. “We show it to everybody,” chuckles Jenny.
If left untreated, teratomas may become so large they burst, or put undue pressure on organs, arteries, vessels, etc. Fortunately, due to an astute nurse practitioner, concerned family and pediatric experts at Children’s Hospital, Corva’s life as a curious toddler continues, including learning to talk and seeing the world with wondrous eyes.
“We’re so happy that ‘monster’ is out!” says Jenny. “Every time I drive by Children’s I think, ‘Thank goodness that’s there!’”