Life-threatening and Rapidly Growing Teratoma in the Anterior Mediastinum

Mature Cystic Teratoma of Anterior Mediastinum in a Child: A Case Report and Literature Review

Mediastinal mature cystic teratomas are rare benign germ cell tumors that predominantly affect children. Despite their low incidence, they present unique diagnostic and management challenges. Early recognition and appropriate surgical intervention are crucial for optimal outcomes. This case report aims to highlight the importance of prompt diagnosis and management of mediastinal mature cystic teratomas in pediatric patients. We present the case of a 10-year-old female patient who presented with persistent chest pain and dyspnea. Imaging studies, including a chest X-ray and contrast-enhanced chest CT scan, revealed a large, well-circumscribed anterior mediastinal mass with calcifications. The patient underwent a right thoracotomy, resulting in the excision of a 6 × 5 × 5 cm mature cystic teratoma. Histopathological examination confirmed the diagnosis. The patient had an uneventful recovery and was discharged in stable condition. Mediastinal mature cystic teratomas pose diagnostic challenges due to their nonspecific symptoms and heterogeneous imaging characteristics. Differential diagnosis includes other mediastinal masses containing fat and calcifications. Surgical excision is the preferred treatment, although complete removal can be challenging due to adhesions to neighboring structures. Close follow-up is necessary to monitor for recurrence and complications. Mediastinal mature cystic teratomas are rare tumors with variable clinical presentations. Early detection and surgical intervention are crucial for optimal outcomes. These tumors should be included in the list of differential diagnoses for mediastinal masses in pediatric patients.

Large mediastinal/thoracic benign teratoma presenting with haemoptysis: Report of a case and review of the literature

The mediastinal teratomas can grow to a large size before becoming symptomatic. The symptoms are usually due to the compression of adjacent structures. A computed tomographic scan of the chest is the investigation of choice for making a provisional diagnosis and planning for further management. Removal of large mediastinal/thoracic teratoma can be associated with various intraoperative and postoperative complications, which can be life-threatening sometimes. We operated on a patient with a large mediastinal mass extending into the right thoracic cavity up to the costo-phrenic angle. The postoperative period was eventful and required judicious intensive care. The patient eventually recovered with conservative treatment. A literature search was done on PubMed using the keywords benign mediastinal teratoma. Case series/original articles published in the last two decades, that is, after the year 2000, were evaluated. As per the review of the literature, the prevalence of benign mediastinal teratoma may be higher in eastern countries. Thoracoscopic surgery is the preferred modality except for cases with adhesions or infiltration into surrounding structures.

Mediastinal mature cystic teratoma in a child: A case report study

INTRODUCTION

A mediastinal teratoma is a very rare disease, in which a relatively large mass grows in the space between the two lungs. Although it is a congenital abnormality, it is diagnosed late in the second or third decade. It could be benign or malignant, symptomatic or asymptomatic.

PRESENTATION OF CASE

A five-year-old child presented with an acute respiratory distress episode due to an acute infection, unresponsive to first-line antibiotics and had a history of similar recurrent pulmonary infections. On imaging, the patient showed an abnormal mediastinal mass which was speculated to be a hydatid cyst or abscess; however, it was later diagnosed during surgery as a mature mediastinal cystic teratoma.

DISCUSSION

Mediastinal tumors are slow-growing tumors that are mostly benign and asymptomatic, but sometimes they may grow, reaching a state where they can affect the neighboring anatomical structures, causing symptoms, which may lead to misdiagnosis.

CONCLUSION

Teratomas, as a differential diagnosis, should be considered in children with recurrent pulmonary infection and radiological findings that resemble masses in the chest. This emphasizes on the importance of performing detailed radiological and lab investigations to set an appropriate diagnosis to ensure a better treatment and prognosis.

18F-FDG PET/CT Showing Rare Mediastinal Growing Teratoma Syndrome Following Chemotherapy

Growing teratoma syndrome (GTS) is a condition in which poorly differentiated cells in a mixed-germ cell tumor (GCT) regress after chemotherapy, and the number of well-differentiated components increases. A 60-year-old man had an 8.0 cm mediastinal tumor with strong ¹⁸F-fluorodeoxyglucose (FDG) uptake [maximum standardized uptake value (SUV_max): 9.2], which was diagnosed as a GCT. After chemotherapy, serum alpha fetoprotein, beta-human chorionic gonadotropin, and tumor ¹⁸F-FDG uptake decreased (SUV_max: 3.9), but the tumor volume increased. The tumor was completely resected, and pathology confirmed the diagnosis of GTS. ¹⁸F-FDG positron emission tomography after chemotherapy reflects the proliferation of highly differentiated tumor components with poor ¹⁸F-FDG uptake.

Trends, Symptoms, and Outcomes of Resectable Giant Mediastinal Tumors

Describing the changes in surgical procedures and factors affecting the surgical outcome of patients who have undergone complete resection of giant mediastinal tumors (GMTs, diameter ≥ 10 centimeters) could improve preoperative decision-making and prognostic evaluations. We accessed data from three sources, which are case reports on surgical treatment of GMTs from PubMed, Web of Science, and EMBASE until June 1, 2019; patients with resected GMT from the Surveillance, Epidemiology, and End Results (SEER) database; and retrospective review of medical records in our institution from 2000 to 2019. The worldwide distribution, clinicopathological characteristics, symptom profile, prognosis of patients with GMT resection, and nomogram for surgical outcome prediction are reported. A total of 242 rare GMT cases from four continents (Asia, North America, South America, and Europe) were included. The median age of the patients was 40 (IQR: 27, range: 13–83) years, and the male-to-female ratio was 1.57:1. Dyspnea, shortness of breath, cough, and chest pain or discomfort were the major symptoms at presentation. The prognosis of benign and low-grade malignant GMTs was superior to that of high-grade malignant GMTs. Tumor malignancy played the most critical role in predicting postoperative survival, followed by longest tumor diameter and a posterior mediastinum location. The findings of this study suggest that the number of successful GMT surgeries has increased over the last decade and describe clinical features of GMTs. Physicians should prioritize tumor malignancy as a leading factor in predicting outcome rather than tumor size.

Mature mediastinal teratoma with somatic type malignancy including neuroblastoma and intestinal type of adenocarcinoma: A Case Report

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Mediastinal tumours may cause non-specific symptoms, associated with tumour growth.

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Mediastinal teratoma is uncommon finding and most often present in young adults.

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Total surgical excision is the treatment of choice for mediastinal teratoma.

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Imaging study appears to be a sufficient tool to diagnose mediastinal teratoma.

Introduction and importance

The majority of mediastinal tumours develop asymptomatically and are often detected incidentally on a chest X-ray performed for another reason. Mediastinal tumours, although mostly asymptomatic, may cause non-specific symptoms associated with advanced tumour growth.

Case presentation

We present a case of a 30-year-old woman who presented with exhaustion and lower back pain accompanied by severe headaches with symptoms of visual disturbances, followed by the typical Horner syndrome. Computed tomography revealed a tumour measuring 12 × 11 × 10 cm in the right cavity with features suggestive of teratoma. The patient underwent mediastinal tumour resection and thymectomy. The pathomorphological examination confirmed the primary diagnosis of mediastinal teratoma, but rare somatic type malignancy was detected. Therefore, the patient was referred for further oncological treatment.

Discussion

Mediastinal teratoma is an uncommon finding and usually asymptomatic. Despite its slow growth, it can grow enough to compress adjacent structures, causing symptoms similar to those presented in our patient.

Conclusion

Radiologic imaging proves diagnostic in most cases. Despite the somatic type malignancy, surgical excision of the tumour using the en-bloc technique seems to be a sufficient option for the patient, and further oncological treatment is not always obligatory.

Surgical treatment of giant mediastinal tumors

Background

This study aims to evaluate the surgical treatment outcomes of giant mediastinal tumors.

Methods

Between July 2013 and July 2018, medical data of a total of 31 patients (26 males, 5 females; mean age 27.7±8.2 years; range, 18 to 56 years) who underwent radical surgery for a giant mediastinal tumor in our center and 47 cases (26 males, 21 females; mean age 45.4±16.7 years; range, 19 to 62 years) of giant mediastinal tumors retrieved from the National Center for Biotechnology Information database were retrospectively reviewed. Two-year overall survival and disease-free survival rates of the patients were evaluated.

Results

All patients underwent radical surgery (R0 resection). Symptoms caused by giant mediastinal tumors were relieved after radical surgery during follow-up. The two-year overall survival and disease-free survival rates were 100% and 86.7%, respectively, indicating a good prognosis. The surgical procedures for malignancies were more difficult than those for benign pathologies.

Conclusion

Radical surgery is the mainstay for treatment of giant mediastinal tumors to relieve symptoms in a short period of time and to achieve a good prognosis for up to two years, regardless of adjuvant therapy. The surgical route should be cautiously planned before radical surgery to reduce complications.

Rapid growth of a mature mediastinal teratoma in a middle-aged woman: A case report

A mediastinal mass was incidentally detected in a 42-year-old Japanese woman during a routine medical checkup. Computed tomography revealed a 7-cm, well-circumscribed multilocular cystic mass consistent with a mature cystic teratoma; however, no solid or cystic lesion had been detected at a voluntary complete medical checkup 1.5 years earlier. An anterior mediastinal tumor resection was performed, and the histopathological findings were compatible those of a mature teratoma. Although the mechanisms that underlie rapid growth of all tridermic components in a mature teratoma remain unclear, it is presumed that the mechanisms involve hemorrhage, rupture, inflammation caused by pancreatic enzymes, and estrogen hormone activity. We presented a rare case of a rapid formation of a mediastinal teratoma, which revealed that a mediastinal teratoma with all tridermic components could develop in a relatively short period.

A rapidly growing mature mediastinal teratoma with a testicular epidermoid cyst and familial Mediterranean fever

Anterior mediastinal teratomas are common and are generally characterized as slow growing tumors. Very few reports documenting rapidly growing tumors exist. Here, we describe a case of a mature teratoma showing rapid growth in 1 year treated with complete surgical resection.

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A 25-year-old man was diagnosed with teratoma in the anterior mediastinum.

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Additionally, he had testicular epidermoid cyst and familial Mediterranean fever.

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Both tumors were surgically resected.

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The postoperative course was uneventful with no evidence of recurrence.

A case of mediastinal teratoma with pancreatic islets accompanied by discontinuation of insulin treatment in insulin-dependent diabetes mellitus

A 74-year-old woman of insulin-dependent diabetes mellitus presented with gradually improvement of blood glucose control and finally discontinuation of insulin therapy, for some unknown reason. During follow-up period, she was admitted with hemoptysis. CT imaging showed a heterogeneous enhancement mass in the middle mediastinum with cyst and calcification, suggesting the diagnosis of mediastinal teratoma. Immediately after excision of the tumor, her plasma glucose levels again increased, and she required insulin therapy for glycemic control. Immunohistochemical examination showed that the tumor contained pancreatic tissue with both exocrine and endocrine components consisted with the islet cells of Langerhans with insulin-positive cells. Accordingly, we diagnosed insulin-producing mediastinal teratoma. Although hypoglycemic agents are the commonest cause of hypoglycemia in diabetic patients, an insulin-producing tumor should be considered in the patients who have dramatic improvement of diabetes mellitus, particularly after withdrawal of all hypoglycemic treatment. Mediastinal teratomas should be considered in differential diagnosis as etiology in undiagnosed case of hypoglycemia or blood glucose fluctuations.

Giant mature teratoma in the mediastinum presenting with rapid growth

Teratomas are primary germ-cell tumours in the mediastinum. Although they are generally slow-growing and asymptomatic, rapid growth causing life-threatening complications can occur. Sebaceous secretion, insulin production, chorionic gonadotropin secretion and pancreatic enzyme secretion are the presumptive causes of tumour progression. Only few cases of rapidly growing teratomas have been reported previously. Here, we present a case of a giant mature teratoma in the mediastinum that presented with rapid growth and compare the characteristics of this case with those of previous cases.