Large Mediastinal Teratoma Research Articles

RUPTURED MEDIASTINAL TERATOMA

Introduction: Mediastinal teratomas are the most common type of mediastinal germ cell tumor. Most patients with mediastinal teratomas remain clinically silent. However, these teratomas occasionally rupture into the thoracic cavity, causing severe complications; surgical intervention is always required for ruptured teratomas. Herein, we report that case of a large anterior mediastinal teratoma that ruptured into the pleural cavity and caused a lung infection, pleural effusion, and subsequent mediastinitis. Case Report: A 20-year-old man presented with rapidly progressive dyspnea and chest pain. Chest radiography revealed a large opacity in the entire right hemithorax. A thoracostomy tube was introduced into the right pleural cavity, and 200 mL of purulent uid was evacuated. Thoracic computed tomography (CT) revealed a mass in the right hemithorax compressing the adjacent structures. The patient underwent total resection of the mediastinal mass via right posterolateral thoracotomy. Intraoperatively, the chest cavity was lled with adhesions and pus. The teratoma ruptured and adhered to surrounding structures. Postoperatively, the patient recovered completely. Microscopy revealed a mature teratoma. Rupt Conclusion: ured mediastinal mature teratoma is a serious complication. Once it is diagnosed, early surgical excision should be performed to reduce rupture-related complications.

A large ruptured mediastinal teratoma

Introduction: Mediastinal teratomas are the most common type of mediastinal germ cell tumor. Most patients with mediastinal teratomas remain clinically silent. However, these teratomas occasionally rupture into the thoracic cavity, causing severe complications; surgical intervention is always required for ruptured teratomas. Herein, we report that case of a large anterior mediastinal teratoma that ruptured into the pleural cavity and caused a lung infection, pleural effusion, and subsequent mediastinitis. Case Report: A 29-year-old man presented with rapidly progressive dyspnea and chest pain. Chest radiography revealed a large opacity in the entire right hemithorax. A thoracostomy tube was introduced into the right pleural cavity, and 200 mL of purulent fluid was evacuated. Thoracic computed tomography (CT) revealed a mass in the right hemithorax compressing the adjacent structures. The patient underwent total resection of the mediastinal mass via right posterolateral thoracotomy. Intraoperatively, the chest cavity was filled with adhesions and pus. The teratoma ruptured and adhered to surrounding structures. Postoperatively, the patient recovered completely. Microscopy revealed a mature teratoma. Conclusion: Ruptured mediastinal mature teratoma is a serious complication. Once it is diagnosed, early surgical excision should be performed to reduce rupture-related complications.

Rare Case of Mediastinal Compressive Teratoma in a Child

Benign teratomas of the mediastinum are rare tumors that represent 5 to 10% of mediastinal tumors. They remain asymptomatic for a long time and their discovery often reveals their bulky size. They occur most often in young subjects. We report the observation of a 6-year-old patient with a large mediastinal teratoma revealed by rest dyspnea and chest pain in a context of asthenia who was referred to our pediatric imaging department for a thoracic CT scan. Although benign mediastinal teratomas are slow growing, they can rarely become complicated and cause symptoms. Imaging is essential to make the diagnosis and to look for possible complications. The gold standard treatment is complete surgical resection.

Mediastinal teratoma in a second trimester fetus

А case of a large mediastinal teratoma in a fetus with a large pleural effusion at 21 weeks of gestation is presented. Detailed sonographic examination showed a large, complex cystic and solid mass posterior to the sternum, in the upper anterior mediastinum, measuring 35 31 22 mm. The lungs were visualized without morphological changes or pulmonary arterial tree abnormalities, but they were relatively small. The couple opted for pregnancy termination at 23 weeks of gestation. Histological examination revealed an encapsulated immature teratoma.

A teenager with recurrent supraventricular tachycardia and a giant mediastinal mass

We describe a unique case of a teenager with past medical history of anxiety, dysmenorrhea and one year of recurrent symptomatic palpitations who was found to have an exceptionally large mediastinal teratoma which was compressing the right atrium, after evaluation for recurrent symptomatic supraventricular tachycardia. Our case adds new perspectives on the evaluation of what may seem to be an indolent arrhythmia. Her symptoms were initially thought to be secondary to her treatment with fluoxetine and oral combined contraceptives, which were discontinued but her symptoms persisted. A follow-up 12-lead electrocardiogram revealed normal sinus rhythm for which a 48-h Holter monitor was placed and yielded multiple episodes of overt AV node reentrant supraventricular tachycardia (SVT). She was referred to our center for evaluation for ablation for which she underwent routine pre-ablation echocardiography and was found to have an exceptionally large mediastinal mass consistent with a cystic teratoma significantly compressing the right atrium causing partial obstruction of the tricuspid annulus. The mass was successfully excised, and the pathology report revealed a 16cm cystic teratoma arising from thymic tissue. The mediastinum is the second commonest site to find a teratoma. These are congenital masses thought to arise from a defect in embryonal cell migration and by definition include all three embryonal cell layers, thus potentially may differentiate any kind of tissue. We emphasize the importance of pre-ablation imaging studies to evaluate for secondary causes of SVT, as catheter manipulation of the endocardium could have resulted in devastating consequences such as atrial rupture. • Mediastinal cystic teratomas are congenital tumors that may grow to a large size and compress vital adjacent structures. • Prompt workup of cardiac-related symptoms should be done to discard dangerous secondary causes. • Cardiac imaging should be considered before attempting a catheterization procedure of the heart.

Клінічний випадок ведення новонародженого з тератомою переднього середостіння, не виявленою пренатально, в умовах міського пологового будинку

Teratomas are tumors which are composed of tissues derived of more than one germ cell layer; they appear between 3-6 weeks of pregnancy and are present more often in females. A prognosis for life depends on the timely diagnosis of the mass and a possibility of surgical treatment. An article presents a case of a female neonate born with severe respiratory insufficiency. Antenatal ultrasound at 19-20 and 30-31 weeks exposed the myoma of the uterus and a probability of large birth weight. Immediately after birth a neonate requested urgent intubation, artificial lung ventilation, intensive therapy for hemodynamic stabilization. The thoracic surgeon suspected the presence of cystic adenomatous malformation upon the chest X-ray and clinical observation data and defined expectant management and prolongation of intensive therapy. Autoptical evidence is a large mediastinal teratoma 10×8×5 cm, weight 135.0 gram, moderate secondary hypoplasia of lungs. Histological processing revealed mass lesion of the anterior mediastinum in a capsule, which was presented with immature discohesive mesenchyme with lymphoid assembly, brain tissue and multiple cysts of different size with inclusions of cartilage tissue. Effective correct and precise antenatal visualization, which can defined the type of maternity hospital, postnatal MRT and timely provided therapy intervention surgical mass removal including — these are key factors of successful management newborns suffering from anterior mediastinal teratomas. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: newborn, mediastinal teratoma, diagnostics, therapy.

Mediastinal Mature Teratoma Revealed by Empyema.

Teratomas are germ cell tumors, manifested with a great variety of clinical features; the most common extragonadal site is the anterior mediastinum. In this case, we report the patient with a large mature mediastinal teratoma with several components of ectodermal and endothermal epithelium. A 24-year-old female patient presented with history of persistent chest pain and progressively aggravating dyspnea for the previous 3 months. A chest X-ray showed a large opacity of the entire left hemithorax. Transcutaneous needle aspiration revealed a purulent fluid. The tube thoracostomy was introduced and the effusion was evacuated. Some weeks later, patient was seen in emergency for persistent cough and lateral chest pain. CT scan revealed a mass of the left hemithorax. The mass showed heterogeneous density, without compressing mediastinum great vessels and left hilar structures. Lipase value was elevated in needle aspiration. The patient underwent a total resection of the mediastinum mass via a left posterolateral thoracotomy. Microscopy revealed a mature teratoma with cystic structures. The patient subsequently made a full recovery. This case provide benign mediastinal teratoma with total atelectasis of left lung and elevated lipase value in needle transcutaneous aspiration; this event is explained by pancreatic component in the cystic tumor. Total removal of the tumor is adequate treatment for this type of teratoma and the prognosis is excellent.

Large Thoracic Teratoma with Gastro-intestinal Presentation

We report the case of a 27-year-old woman with a large mediastinal teratoma presenting with vague abdominal pain and diarrhea; she was erroneously suspected of having coeliac disease. This is the first such presentation of a mediastinal teratoma. We describe the endoscopic and radiologic presentation, the surgical management, and histologic characteristics.

Large mediastinal teratoma causing recurrent pericarditis (RCD code: VI)

The mediastinal tumors are rare but potentially fatal diseases. Teratomas are derived from multipotent germ-line cells. In majority of cases mediastinal tumours are incidentally detected on chest X ray. We present 19-year-old patient with recurrent pericarditis recurrent pericarditis. After comprehensive diagnostic process it was figured out that the reason for recurrent pericarditis was large mediastinal teratoma. Once the correct diagnosis has been made, the patient could have been completely cured. JRCD 2014; 1 (6): 29–32

Salvage resection of a large chemorefractory mediastinal germ cell tumor

Immature mediastinal teratomas refractory to chemotherapy are very rare and require management by an aggressive surgical approach. We describe resection of a large mediastinal teratoma in a 23-year-old man, with a satisfactory early result.

Mediastinal teratoma in a neonate with acute respiratory failure

Abstract Background: While teratomas account for the leading cause of germ cell tumors, the mediastinal teratomas represent one of the infrequent types of congenital germ cell tumors. Neonates with large mediastinal teratomas generally show severe respiratory distress, and the immediate surgical treatment is needed to alleviate their problems. Objectives: Report clinical symptoms, diagnostic procedures, treatment option, and outcomes after the treatment for a neonate with a large mediastinal teratoma. Methods: A 2-day-old female infant presented with acute respiratory failure diagnosed as mediastinal teratoma. It was followed with surgical treatment. The removed tissues were examined pathologically. Results: The girl suffered an acute respiratory failure two days after birth. The chest radiography, echocardiography, and chest computerized tomography results showed the considerable size of the mediastinal teratoma. A median sternotomy was performed on the third day of infant life to remove the tumor without rupturing the capsule. Pathological diagnosis was germ cell tumor. Clinical follow-ups reported no complication. Conclusion: The successful management of a neonate with large mediastinal teratomas was presented. Immediate detection and proper treatment of the large mediastinal teratoma in a neonate was most important to decrease the morbidity and mortality of the infant.

Successful management of a large fetal mediastinal teratoma complicated by hydrops fetalis

This report describes a case of fetal mediastinal teratoma complicated by hydrops fetalis managed successfully by aspiration of the tumor cyst fluid. Fetal mediastinal teratomas are rare tumors that cause hydrops fetalis or fetal demise in the prenatal period and respiratory distress in the neonatal period. The patient presented with a large cystic mass in the thoracic cavity complicated by hydrops fetalis. The hydrops resolved after fetal aspiration of the tumor cyst fluid. The infant was born without respiratory distress, and tumor resection was performed at the age of 30 days. The postoperative course was uneventful, and the patient was in good health 6 months postoperatively.

Life-threatening giant mediastinal cystic teratoma in a 4-month-old male baby

Cystic teratomas of the mediastinum are rare and present with severe respiratory distress during childhood. Aspiration of the cyst is indicated to reduce the cyst volume, alleviate the patient's symptoms, and secure an operative field. This report describes a 4-month-old male baby with a large anterior mediastinal teratoma presenting with severe respiratory distress. The cystic teratoma was large enough to cause pectus carinatum. Respiratory distress secondary to airway obstruction was markedly reduced by percutaneous aspiration of the cyst. Surgical excision is indicated for a malignant or benign well-demarcated mass in any part of the mediastinum. In our patient, total surgical excision was performed. Preoperatively, percutaneous aspiration was performed twice, with the symptoms being reduced after each aspiration. Surgical excision is the best means of diagnosing and treating a benign teratoma. Percutaneous cyst aspiration not only improved ventilation but also facilitated easy excision of the cyst during surgical management.

Giant mediastinal teratoma—bull in a china shop: Management strategies

Large thoracic tumors behave in a similar manner to an enraged bull in a china shop when they grow, despite treatment with neoadjuvant chemotherapy (NACT). Management strategies should be tailored to meet the challenges posed by the rapidity of growth and enormity of size of these giants. We report a case of a patient with large and heavy malignant mediastinal teratoma, in which the intensity of compressive features caused by spiraling growth, despite NACT, necessitated urgent surgery using a combination of incisions that were individually inadequate and perilous for safe tumor removal.

Superior Mediastinal Syndrome in an Infant Caused by Mediastinal Teratoma: Case Report

A 3-month-old male infant presented with superior mediastinal syndrome due to a large mediastinal teratoma. The child suffered from severe cardiorespiratory compromise that required emergency treatment. Mediastinal teratomas are potentially life-threatening in infancy. Close cooperation among pediatric oncologists, surgeons, anesthesiologists, intensivists, and radiologists is crucial in the management of these rare tumors.

Acute respiratory failure associated with intrathoracic masses in neonates

Background : Intrathoracic masses are uncommon in children. Occasionally, they present with acute respiratory failure in the neonatal period. Although emergency resection usually is the treatment of choice, other modalities are sometimes necessary to stabilize the patient. Methods : Seven neonates with intrathoracic masses were treated. Five had congenital cystic adenomatoid malformations (CCAM), 1 had a mediastinal teratoma, and 1 had a pneumatocele. These cases were reviewed retrospectively. Results : Four of the 7 infants had respiratory failure in the neonatal period. A patient with a large mediastinal teratoma and 1 with a CCAM that increased rapidly after presentation underwent emergency operation, relieving respiratory distress. The other 2 large CCAMs presented with severe respiratory distress immediately after birth because of pulmonary hypoplasia. One neonate with a Stocker-I CCAM died after emergency resection. One more recent patient with a Stocker-III CCAM survived after successful treatment with delayed resection, performed 3 days after birth. Nitric oxide (NO), and extracorporeal membrane oxygenation (ECMO) were instituted as supportive care because of profound persistent fetal circulation (PFC). Conclusions : Acute respiratory failure associated with intrathoracic masses in neonates may be managed in 1 of 2 ways. A small mass that increases rapidly should be resected soon after presentation. In neonates with large masses with associated PFC, surgery can be delayed until the patient is stable. ECMO, NO, and high-frequency oscillation (HFO) can be used aggressively for stabilizing such neonates.

A CASE OF LARGE MEDIASTINAL TERATOMA RESECTED BY THORACOSCOPIC SURGERY WITH COLLAR INCISION OF THE NECK

Indications of thoracoscopic surgery has been increasingly extended with the improvement in the instrument and operative procedure. Recently we successfully resected a large mediastinal teratoma which extended to the neck by thoracoscopic surgery with collar incision of the neck. A 35-year-old man was admitted to the hospital because of a tumor shadow on a chest X-ray film. Computed tomography and magnetic resonance imaging revealed that the tumor was a large mediastinal teratoma extending to the neck. Aiming at a minimally invasive surgery, we performed a thoracoscopic surgery combined with collar incision of the neck. After the upper portion of the tumor extending to the neck was divided by the transcervical approach, the tumor was extirpated by the thoracoscopic procedure. It is thought that the method is safe and minimally invasive even for large mediastinal benign tumors.

Acute thoracic distress in childhood due to spontaneous rupture of a large mediastinal teratoma

We have presented what we believe to be the first report of a mediastinal teratoma which ruptured into the pleural cavity of a child. The patient presented as an acute thoracic catastrophy with respiratory distress and severe chest pain. Despite extensive diagnostic procedures, the true nature of the lesion was not determined until a thoracotomy was performed. A review of the English literature pertinent to mediastinal tumors disclosed 120 teratomas in children, 23 per cent of which were malignant. Complications of mediastinal teratomas, including rupture into the pleural space, pericardium, tracheobronchial tree, great vessels, and esophagus, are discussed and diagnostic procedures are reviewed.