Case Report (Looks Can Be Deceiving): Adrenal Teratoma Causing Diagnostic Difficulty Mehwash Nadeem, 1 Muhammad Hammad Ather, 1 M. Nasir Sulaiman, 1 and Shahid Pervez 2 1 Section of Urology, Department of Surgery, Aga Khan University, P.O. Box 3500, Karachi, Pakistan 2 Section of Histopathology, Department of Pathology, Aga Khan University, P.O. Box 3500, Karachi, Pakistan Correspondence should be addressed to Mehwash Nadeem; drmehwash7@gmail.com Received 30 September 2015; Accepted 19 November 2015 Academic Editor: Fumitaka Koga Copyright © 2015 Mehwash Nadeem et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Teratomas are unusual tumours that derived from totipotent cells with their origin from more than one or usually all three germ cells. Here authors are presenting a case of primary retroperitoneal tumour that is a rare clinical entity. A 19-year-old male presented with right lumbar pain and was found to have complex cyst with large calcifcation in right adrenal gland on imaging. Intraoperatively, he was found to have a solid mass with areas of sof consistency, which was excised en bloc. On gross examination, the cyst contained pieces of bone, few teeth, and hairs entangled in mucinous material. On histological evaluation, it was confrmed to be mature teratoma arising from the right adrenal gland. He made uneventful recovery and was kept well on annual follow-up. 1. Introduction Teratomas are rare tumours that shares radiological features with many other benign conditions. Although defnitive diagnosis is possible on histopathological evaluation only, pertinent radiological fnding mentioned in this report can help others to suspect this rare yet important clinical entity. Tis case highlights the importance of correct and metic- ulous interpretation of the radiological investigation. 2. Result 2.1. Case Presentation. A 19-year-old male with no prior health issues presented with complaint of vague pain in right fank for the past 9 months. He described the pain as intermit- tent, nonradiating with no specifc aggravating or relieving factors. Past history was unremarkable. On examination, he appears healthy with normal blood pressure and pulse rate. Abdominal and rest of the systemic examinations did not reveal anything signifcant. 2.2. Investigations. His baseline workup including complete blood count, renal profle, and liver function tests was within normal limits. His haemoglobin was 128 g/L (normal: 121– 160 g/L) and serum creatinine was 0.8 mg/dL (normal: 0.7– 1.2 mg/dL). Based on the fndings of imaging, investiga- tions were ordered to exclude functional adrenal tumour although the patient was completely asymptomatic. 24-hour urinary cortisol was 89 mic gm/24 hours (normal range: 55.5– 286 mic gram/24 hours) and serum cortisol (dexamethasone suppression) was 0.9 mic gram/dL (normal range: less than 2 mic gram/dL). Contrast enhanced computed topography (Figure 1) revealed a large cyst arising from right adrenal gland with mixed density that raised suspicion of malignant tumour. Other abdominal structures were normal and there was no evidence of distant metastasis although the right kidney was slightly displaced by the mass. 2.3. Diferential Diagnosis. Te most important diferential diagnosis based on the imaging could be teratoma, angiomy- olipoma, or myelolipoma that shares few radiological features and causes diagnostic difculty. Confrmation of diagnosis in this case is only possible by histopathological evaluation of resected tissue; however, in this particular case the presence of large calcifcation (which was actually a piece of bone) on Hindawi Publishing Corporation Case Reports in Urology Volume 2015, Article ID 232591, 4 pages http://dx.doi.org/10.1155/2015/232591