22 y/o woman, smoker, with chronic persistent cough and occasional wheezing
Chest: scattered wheezing
alpha Fetoprotein: 1.7
Pa/Lat Chest: demonstrate a well-circumscribed anterior mediastinal mass projecting over the left hemithorax, near the aorta. Two areas of calcification are seen within the mass.
Chest CT: demonstrates a large mass measuring 5.7 x 4.5 x 6 cm in size in the anterior mediastinum. This mass contains solid tissue components as well as fat and calcium. It is well circumscribed and has mass effect on adjacent structures, without evidence of occlusion.
-germ cell tumors (teratoma, seminoma, nonseminomatous germ cell tumor)
Treatment was complete surgical resection.
Teratomas account for over 60% of mediastinal germ cell tumors. They are common in children and young adults with no gender preference. Patients are usually asymptomatic. Occasionally rupture of tumor into a bronchus can cause expectoration of hair.
Teratomas are made up of tissues that arise from more than one of the three germ cell layers (endoderm, ectoderm, and mesoderm). Most are mature and contain well differentiated cells. Mature teratomas are encapsulated and can contain teeth, skin, hair, or bone. They also can contain bronchial, intestinal or pancreatic tissue. An immature teratoma contains fetal tissue and â€śmalignant teratomaâ€ť will contain a focus of carcinoma, sarcoma or malignant germ cells.
On chest radiographs, teratomas are rounded or lobular anterior mediastinal masses. They are well defined and can protrude to one side of midline. Twenty-six percent will contain calcification. CT will show a mass containing a combination of tissue, fluid, calcium or fat density. Surgical excision is curative accept in immature or malignant teratomas, which can recur or metastasize.
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