Jenny and Karl McCollom of Mariposa didn’t think about their 17-month-old daughter’s little pot belly. After all, lots of toddlers tend to have a protruding tummy and slightly swayed back until their body begins to grow taller and more proportionate. A recent well-baby exam at the local primary care physician’s office also hadn’t revealed anything unusual with her health.
But the McColloms would soon learn their little girl had a monstrous tumor growing inside her abdomen – literally. In fact, it was the largest tumor of this type that surgeons at Children’s Hospital Central California had seen in a preadolescent child, and was especially complicated due to its location and juxtaposition to major blood vessels. “It was quite shocking,” recalled Jenny. “We had no idea.”
Taking a second look
An indication that something wasn’t quite right with Corva became apparent when Jenny and her daughter bumped into their primary care physician’s nurse practitioner at a farmers market in their small mountain town. Only a few months after Corva’s last well-baby exam, the nurse practitioner thought the youngster’s arms and legs appeared thinner and her belly a little larger compared to the rest of her body. “She suggested we come in for another visit,” said Jenny.
So they did. When the nurse practitioner and physician touched the front of Corva’s belly, they thought they felt the edge of an internal organ pushing up against it. This combined with an abnormal blood test led the primary care physician to refer Corva to Children’s Hospital Central California for an ultrasound to get a better view of what was going on inside her abdomen.
“We were about to go on a five-day camping trip over the Labor Day weekend,” said Jenny. “Corva didn’t have a fever or any obvious pain, but like my dad said, ‘You’ll probably be glad you went to Children’s to get it checked.’”
Indeed, the visit to Children’s turned out to be well worth the effort. The ultrasound showed an unusual solid mass lodged in Corva’s abdomen. A CT scan followed and Children’s pediatric specialists determined the youngster likely had a massive abdominal teratoma.
“A what?” Jenny and Karl had asked.
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. All of the different specialized cells that make up the body come from one of these germ layers. Therefore teratomas can consist of any number of various tissue types. Present at birth, teratomas may contain hair, teeth, bone and very rarely, more complex organs such as eyes, torso, hands, feet or other limbs. Sometimes one or more fluid-filled cysts reside within the teratoma’s capsule. When a large cyst occurs, the teratoma may produce a structure within the cyst resembling a fetus.
While the exact cause of teratomas is not known, medical experts think it occurs during the cell differentiation process when the embryo begins to develop in the womb. Often the teratoma develops in the child’s ovary, testes, neck or torso and gradually grows to become a recognizable mass.
Preparing for surgery
In Corva’s case, the teratoma formed in the back of her abdominal cavity. It had grown so large that it pushed her pancreas all the way 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,” said Dr. Adam Gorra, a pediatric surgeon who recently joined Children’s. Dr. Gorra surgically removed Corva’s tumor with Dr. Michael Allshouse, Children’s medical director of pediatric surgery and trauma.
“Both doctors have a great demeanor and wonderful bedside manner,” said Jenny. “They explained everything to us and what to expect without sugarcoating anything. They inspired confidence. We knew we were in the right place.”
Usually benign, teratomas sometimes can be cancerous. To prepare the McColloms for that possibility, they met prior to the surgery date with Dr. Vonda Crouse, a pediatric oncologist at Children’s with nearly 35 years’ experience in her field. Of the 120 new cancer patients seen each year at Children’s Hospital Craycroft Cancer Center, only about one will involve a cancerous teratoma (teratocarcinoma).
“I explained that if Corva’s tumor is cancerous, the good news is there’s a 95 percent survival rate,” said Dr. Crouse. “We have very effective chemotherapy for this particular cancer.”
“Dr. Crouse was also very caring,” said Jenny. “She has a no-nonsense, straight-forward style, yet gentle at the same time.”
Removing the unusually large mass
Corva’s four-hour surgery went well, and the pediatric surgeons removed the entire tumor. The size of an eggplant, the mass weighed just over a pound. It was so big it represented 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,” said Dr. Allshouse, who has treated about 500 tumors during his more than 25-year career as a pediatric surgeon. Of the several dozen teratomas he has treated, most have been in the female ovary.
“Corva’s tumor wrapped 270 degrees around the abdominal aorta, the largest and most vital blood vessel in the body,” added Dr. Gorra. “In addition to the pancreas being pushed to the front, one of her kidneys was pushed out of place as well. We were thrilled we got the tumor out without sacrificing any other important organs.”
As teratomas do, the mass contained multiple types of tissue, including brain, retinal, fat, cartilage, lymphoid, stomach and more. Pathologists tested the tumor for cancer, which had been dissected into about 135 slides to ensure every element was carefully analyzed. “We were so relieved to learn none of it was malignant,” said Jenny.
During the surgery, hourly updates from the nurses especially comforted the McColloms as they anxiously waited. About halfway through, one of the nurses told them that the procedure continued to go well and that “They (the doctors) have a surprise for you!”
“We couldn’t imagine what that meant!” recalled Jenny with a smile.
Then they found out. Dr. Allshouse and Dr. Gorra removed a small triangular-shaped tooth from Corva’s tumor and gave it to her parents. “We kept it and show it to everybody now,” said Jenny with a chuckle. “It’s amazing that was in there.”
Jenny hates to think what could have happened if the tumor continued to grow. If left untreated, teratomas may become so large they burst, or put undue pressure on organs, arteries, vessels, etc.
“While we can usually remove teratomas, there is always the possibility that the tumor can’t be removed because doing so would result in harm to another vital structure,” said Dr. Gorra.
Thankfully, due to an astute nurse practitioner, concerned family and pediatric experts at Children’s Hospital, Corva’s story has a positive ending. While Corva has follow-up visits at Children’s to ensure the tumor doesn’t return, Children’s pediatric specialists don’t foresee any future complications. Her exciting life as a curious toddler continues, including learning to talk, climbing on furniture, playing with her dog, cat and chickens, and seeing the world with wondrous eyes.
“We’re just so happy that ‘monster’ is out! Now every time I drive by Children’s Hospital I think, ‘Thank goodness that’s there,’” said Jenny, who has another daughter, age 3. “We felt really cared for. I’m so glad there are people who have so much passion to help children.”