Spontaneous rupture of mediastinal cystic teratoma into the pleural cavity: report of two cases and review of the literature

Mediastinal cystic teratoma misdiagnosed as pleural tuberculosis: A case report and review of 53 cases revealed by pleural effusion

Mediastinal teratoma (MT) can be misdiagnosed for a long period and revealed by fatal pleural effusion at any age. In high burden tuberculosis settings, it is important to consider MT for extra-pulmonary tuberculosis not responding to medical treatment.

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.

Mediastinal mature teratoma with rupture into pleural cavity due to blunt trauma

We report a rare case of mediastinal mature teratoma with rupture due to blunt trauma. A 15-year-old boy had received a strong head-butt in the left upper chest wall and was admitted with the sudden onset of left-sided severe chest pain and dyspnea. Chest computed tomography (CT) scan on admission revealed a heterogeneous mass lesion in the anterior mediastinum. The contrast-enhanced CT scans obtained 2 days after admission showed not only mediastinal mass lesion but also left pleural effusion. On the radiologic finding at 5 months later, the lesion became larger and was thought to be a typical mediastinal mature teratoma. The patient underwent extirpation of the tumor. Microscopically, the tumor was typically composed of adult-type tissues and was confirmed to be mature teratoma.

What could hemoptysis hide in an otherwise healthy child?

We describe a previously healthy 12-year-old boy who attended our Department after a sudden episode of hemoptysis and recurrent consolidation. CT-scan revealed a mediastinal tumor. The biopsy specimens taken from the mass showed a mature teratoma. Hemoptysis is an unusual presenting symptom in an otherwise healthy child with a well capsulated, unruptured mature mediastinal teratoma. In this report, hemoptysis prompted us to undertake the diagnostic work-up that eventually disclosed the tumor.

Giant mediastinal mature teratoma with increased exocrine pancreatic activity presenting in a young woman: a case report

Introduction

Mediastinal mature teratoma is a benign, slow-growing tumor typically affecting 20- to 40-year-old adults. Fluid examination from the cystic masses rarely shows enzymatic activity as we describe in this report.

Case presentation

We report a case of a giant mediastinal germ cell tumor (measuring 15 cm × 14 cm × 8 cm) detected in a 35-year-old Caucasian woman. Microscopic examination showed that the lesion resembled a mature cystic teratoma with areas of pancreatic tissue with mature ductal and acinar structures intermixed with islets of Langerhans. Fluid from the cysts in the mass was examined after removal showed amylase activity of 599 U/l despite normal serum levels. The post-operative period was free of complications, and the patient was discharged on post-operative day 10.

Conclusion

Complete surgical removal is the treatment of choice for mature cystic teratomas, with optimal results and acceptable surgical risk. Exocrine pancreatic function may be an aid to pre-operative or intra-operative diagnosis; however, these findings have no impact on survival or the therapeutic pathway.

Spontaneous rupture of benign ovarian cystic teratoma in a premenarcheal girl

BACKGROUND

Spontaneous rupture of benign cystic ovarian teratoma is an unusual occurrence.

CASE

A 9-year-old girl presented with acute onset of abdominal pain. Under a radiological diagnosis of cystic ovarian teratoma, she underwent laparoscopic cystectomy, preserving as much ovarian tissue as possible. Direct observation of a defect on the tumor surface and the presence of keratinized squamous cells in the ascites were important clues for intraperitoneal rupture. Pathologically, the defect was surrounded by inflamed tissues adjacent to the gastric mucosa, suggesting that autolysis of the wall by proteolytic enzymes induced the spontaneous rupture.

SUMMARY AND CONCLUSION

We present the youngest and first premenarcheal case of spontaneous rupture of cystic ovarian teratoma. Early diagnosis and minimally invasive surgical procedure are essential to preserve future fertility.

Presentation and management of benign mediastinal teratomas

Mediastinal teratomas are uncommon, making up only about five to ten percent of all mediastinal tumors and are thought to occur in approximately 1 in 3400 hospital admissions. There are many names for this tumor, but the term "benign teratoma" is fitting. The word "teratoma" is derived from the Greek word "teras", meaning monsters. They have been defined as "tumors that are composed of tissue that is foreign to the organ or anatomic site in which they arise" Alternatively, mediastinal teratomas may arise from cells adjacent to the third or fourth brachial cleft. Whatever the cell of origin, these tumors have potential to express all three of the germ cell layers, ectoderm, mesoderm and neuroderm.