Giant Mediastinal Teratoma in the Left Hemithorax - A Case Report
Keywords:
Teratoma, Germ cell tumor, Posterior mediastinum.Abstract
Background: Teratomas are rare germ cell tumors and the mediastinum is one of the areas they occur. They are composed of tissues derived from more than one germ cell line. Majority of the tumors are benign and they present with different clinical manifestations; and, very interesting radiologic features. However, many cases are diagnosed incidentally.
Methods: We used the case records of the patient managed for a giant mediastinal teratoma in the left hemithorax and reviewed relevant literature.
Results: A 33-year-old male was admitted with a two - year history of chest pain; chronic cough with associated occasional hemoptysis; easy fatigability. Clinical signs of unexplained mediastinal shift to the contralateral side, and diminished vesicular breath sounds on the affected side were present. Radiologic studies (CXR & Chest CT); 2D echocardiography was carried out. The CXR and Chest CT showed a large tumor compressing the left lung with calcified deposits seen in different parts of the tumor and pericardial attachment. The ECG showed minor left axis deviation while the echocardiography was suggestive of a posterior mediastinal mass, an ejection fraction of 60% with normal cardiac chamber dimensions. A clinical diagnosis of a teratoma arising from the mediastinum was made. Through a posterolateral thoracotomy the tumor located in the posterior mediastinum was excised. Histopathology confirmed benign mediastinal teratoma. The patient has been followed up for 2 years without any signs or symptoms of recurrence.
Conclusion: Patients with mediastinal teratoma are without symptoms generally but some become symptomatic from pressure effect as the tumor increases in size. This case report highlights the huge size of the tumor, the posterior mediastinal location which is rare, with involvement of the pericardium and the near total atelectasis of the left lung. Surgical excision is the treatment of choice for benign mediastinal teratomas with acceptable surgical risk and optimal long term results.
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