Journal List > Tuberc Respir Dis > v.60(3) > 1000928

TOOLS
Ha, Hur, Jung, Lee, Jo, Lee, Kim, Lee, Shin, Shim, In, Kang, and Yoo: Teratoma Presenting as An Unilateral Mediastinal Mass with Contralateral Pleural Effusion
Case Report
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2006; 60(3): 347-352.

Published online: 31 March 2006

DOI: https://doi.org/10.4046/trd.2006.60.3.347

Teratoma Presenting as An Unilateral Mediastinal Mass with Contralateral Pleural Effusion

Eun Sil Ha, M.D., Gyu Young Hur, M.D., Ki Hwan Jung, M.D., Sung Yong Lee, M.D., Won Min Jo, M.D.1, Sang Yeub Lee, M.D., Je-Hyeong Kim, M.D., Eung Seok Lee, M.D.2, Chol Shin, M.D., Jae Jeong Shim, M.D., Kwang Ho In, M.D., Kyung Ho Kang, M.D., Se Hwa Yoo, M.D.

Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea.

1Department of Thoracic and Cardiovascular Surgery, College of Medicine, Korea University, Seoul, Korea.

2Department of Pathology, College of Medicine, Korea University, Seoul, Korea.

Address for correspondence: Je-Hyeong Kim, M.D., Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Korea University, Ansan Hospital 516, Gojan-1-dong, Danwon-gu, Ansan, 425-707 Korea. Phone: +82-31-412-5950, Fax: +82-31-413-5950, chepraxis@korea.com

Received 23 January 2006       Accepted 9 March 2006

Copyright © 2006 The Korean Academy of Tuberculosis and Respiratory Diseases

Abstract

A teratoma is the most common benign germ cell tumor that develops in the mediastinum. Patients with a mediastinal teratoma are usually asymptomatic. However, a spontaneous rupture of a mediastinal teratoma into the pleural cavity or adjacent organs can cause severe chest pain, hemoptysis, acute dyspnea, etc. Complications such as recurrent pneumonia, pericardial effusion, pleural effusion and great vessel invasion can sometimes occur. We encountered a case of a patient with an abrupt onset of dyspnea after persistent shoulder pain for one month. The X-ray examinations revealed a unilateral mediastinal mass with contralateral pleural effusion. Subsequent evaluations confirmed a spontaneous rupture of the teratoma into the contralateral pleural cavity.

Keywords: Mediastinal neoplasms Teratoma pleural effusion

Figures and Tables

Figure 1
Chest radiography shows a huge mass lesion in right hilar area (A), blunting of left costophrenic angle with fluid shifting (B) on admission, and near-normal findings 2 months later after surgical resection (C).
trd-60-347-g001
Figure 2
Chest computed tomography shows a 6×7 cm sized, septated cystic mass, containing a fat-like low density component in the anterior mediastinum, which insinuates between superior vena cava and ascending aorta (A). The wall of mass is enhanced and no calcification is visible. Left pleural effusion and passive atelectasis are also noted (B).
trd-60-347-g002
Figure 3
Intraoperative photographs of excised specimen (A, B) showed several fragments of yellow to brown soft tissue, measuring 4.7×3×3 cm in the largest one. The histologic findings of specimens are consistent with ruptured teratoma, and reveal adipose tissue (C), formation of pancreatic acini and islet-like stucture (D). (hematoxylin and eosin, C:×100, D:×200)
trd-60-347-g003

References

1. Cancer principles & practice of oncology. 2001. 6th ed. Wilkins & Wilkins.
2. Moeller KH, Rosado-de-Christenson ML, Templeton PA. Mediastinal mature teratoma: imaging features. AJR Am J Roentgenol. 1997. 169:985–990.
3. Gunes S, Varon J, Walsh G. Mediastinal teratoma presenting as massive hemoptysis in an adult. J Emerg Med. 1997. 15:313–316.
4. Oomman A, Santhosham R, Vijayakumar C, Jayaraman S, Ramachandran P, Kumar S. Anterior mediastinal teratoma presenting as cardiac tamponade. Indian Heart J. 2004. 56:64–66.
5. Sasaka K, Kurihara Y, Nakajima Y, Seto Y, Endo I, Ishikawa T, et al. Spontaneous rupture: a complication of benign mature teratomas of the mediastinum. AJR Am J Roentgenol. 1998. 170:323–328.
6. Cheung YC, Ng SH, Wan YL, Pan KT. Ruptured mediastinal cystic teratoma with intrapulmonary bronchial invasion: CT demonstration. Br J Radiol. 2001. 74:1148–1149.
7. Ozergin U, Gormus N, Aribas OK, Durgut K, Yuksek T. Benign mature cystic teratoma of the anterior mediastinum leading to heart failure: report of a case. Surg Today. 2003. 33:518–520.
8. Pack HM, Kim ES, Kang JH, Jee HO. Anterior mediastinal teratoma which complicated empyema. Korean J Thorac Cardiovasc Surg. 1988. 21:535–540.
9. Lee TH, Lee SE, Baik JJ, Chung Y. A case of mediastinal teratoma complicated by spontaneous ruptured into pleural cavity. Tuberc Respir Dis. 1999. 47:265–271.
10. Jeon JB, Chung CH, Moon TH, Cho W, Ryu JS, Kwak SM, et al. Spontaneuos rupture of mediastinal teratoma into adjacent tissue. Tuberc Respir Dis. 1999. 47:400–405.
11. Choi SJ, Lee JS, Song KS, Lim TH. Mediastinal teratoma: CT differentiation of ruptured and unruptured tumors. AJR Am J Roentgenol. 1998. 171:591–594.
12. Goldstraw P. Spontaneous intrapleural rupture of mediastinal teratoma. Respir Med. 1993. 87:399–400.
13. Ege G, Akman H, Cakiroglu G, Kalayci G. Spontaneous rupture of mediastinal cystic teratoma with high levels of amylase, lipase, CA 19-9, CA 125 and CEA in cystic fluid: a case report. Acta Radiol. 2004. 45:111–112.
14. Kimura C, Kamiyoshihara M, Sakata K, Itoh H, Morishita Y. Mediastinal mature teratoma perforating Into the lung with elevated serum carbohydrate antigen 19-9 (CA19-9) levels: report of a case. Kyobu Geka. 2003. 56:247–250.
15. Cho JH, Son HS, Jo WM, Min BJ, Lee IS, Shin JS. Treatment of mediastinal growing teratoma syndrome. Korean J Thorac Cardiovasc Surg. 2005. 38:729–732.
TOOLS
Similar articles