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Teratoma of the mediastinum: a case report
© Vieira et al; licensee BioMed Central Ltd. 2011
Received: 16 June 2010
Accepted: 20 May 2011
Published: 20 May 2011
This case report illustrates a rare case of teratoma of the mediastinum which was continuous to the pericardium and caused extrinsic compression to the right atrium.
A 22-year-old Caucasian man with no complaints or comorbid conditions presented to our hospital with obliteration of the right cardiophrenic sinus by a mass. A non-invasive investigation demonstrated a tumoral mass which was continuous to the pericardium and caused extrinsic compression to the right atrium. The clinical suspicion was a pericardial or bronchogenic cyst. Surgical and anatomopathologic findings led to the diagnosis of a mature cystic teratoma with atrophic thymic tissue at the external teratoma surface.
We present an original report of a mature teratoma causing obliteration of the right cardiophrenic sinus with extrinsic heart compression. The diagnosis of this tumor is very difficult through non-invasive investigation.
A teratoma of the mediastinum is an uncommon germ cell tumor, principally when heart structures are involved . Five percent of germ cell tumors are extragonadally located, and men are affected more than women . Most mediastinal teratomas produce no symptoms, and they are more commonly associated with compression of adjacent structures, predominantly those of the respiratory system. Another signal is bleeding or rupture of the tumor into the bronchial tree, pleura, or pericardium. Digestive enzymes from pancreatic tissue or intestinal mucosa into the tumor produce this phenomenon. A rare finding associated with rupture is hair or sebaceous material expectoration [2, 3]. The most common tumors found in the anterior mediastinum are of thymic, thyroid, or lymphoid origin and of pericardium or bronchogenic cyst or fat pad [4, 5].
Surgical excision was accomplished via a median sternotomy. This surgical access was chosen because of clinical suspicion that superior vena cava invasion would necessitate extracorporeal circulation. The tumoral mass was continuous to the right parietal pleura and pericardium. There was no cardiac, pulmonary, or vascular invasion. The surgical approach was successful.
This case report illustrates the accuracy of complementary examinations. All the investigations suggested a cystic tumor, probably of pericardial origin. Sometimes it is hard to diagnose a teratoma on the basis of imaging examinations. To make the diagnosis of teratoma, it is mandatory to find at least two of three germ layers [2, 3]. The ectoderm tissue generally is predominant and is composed of neural tissues, skin, hair, and teeth. Mesodermic tissues such as fat, cartilage, or bone and endodermic tissue are less common. The endoderm layer is characterized by respiratory or intestinal epithelia. The complementary examinations' diagnostic accuracy is high if the characteristics of fat and teeth are identified in the tumor at the same time. The presence of just calcification, as in this case report, is not sufficient to characterize a teratoma, because calcification can also be found in tumors other than germ cell tumors [2, 3].
We relate an original report of a mature teratoma causing obliteration of the right cardiophrenic sinus with extrinsic heart compression. The correct diagnosis was made by using a surgical approach.
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
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