INTRODUCTION: Intrapulmonary teratomas are exceedingly rare. Fewer than fifty cases have been reported in literature. We describe a case of intra-pulmonary cystic teratoma (IPCT) that presented closely mimicking a malignant pulmonary neoplasm.
CASE PRESENTATION: A 39-year-old Hispanic male immigrant from Mexico presented with two-year history of intermittent cough, recent onset hemoptysis, fullness in his chest and ten-pound weight loss in seven months. He was an ex-smoker who had a recent Mantoux test that was negative. On exam, breath sounds were reduced in right upper chest, along with egophony and dullness to percussion. Chest radiograph showed right upper lobe (RUL) opacity and CT Chest confirmed large intra-pulmonary mass (8.5 X 8.9 cm) with multiple cavitations & evidence of infiltration of adjacent mediastinal and vascular structures. Bronchoscopic and CT guided biopsies were inconclusive. Thoracotomy revealed a large mass in the RUL surrounding the bronchus and extending into the mediastinum, which contained hair and particulate matter. Right upper and middle lobectomy was performed along with mediastinal lymph node dissection. Pathology On gross exam there was a mass of dull gray-tan rubbery tissue with attached hair. Microscopy revealed ectodermal components such as sweat, sebaceous glands and hair follicles along with multiple cystic areas consistent with a diagnosis of IPCT. Multiple sections failed to reveal any dysplasia or metaplasia. There was evidence of organizing pneumonia with dense fibrosis in the surrounding lung tissue and intra alveolar hemorrhage secondary to disruption of the blood vessels around the alveoli with evidence of blood in the airways, which caused the patient to have episodes of hemoptysis.
DISCUSSION: Teratomas are tumors consisting of tissues derived from more than one germ cell line. Typically, cystic teratomas are found in the body’s midline such as gonads and the mediastinum. Intra-pulmonary cystic teratoma is an extremely rare tumor, and only few cases have been reported in literature since its first description by Mohr in 1839(1). This tumor most commonly occurs in females and left upper lobe of the lung(2). Our patient was unique as he was a male with RUL mass. Diagnosis is often missed until thoracotomy and resection is usually curative. As seen in our case, they gradually invade the surrounding vascular tissue or bronchus and may cause life-threatening complications.
CONCLUSIONS: IPCT is a rare benign pulmonary tumor. Clinical presentation is myriad and may closely mimic malignant pulmonary neoplasm and needs to be considered in the differential diagnosis when evaluating a pulmonary mass in the young.
Reference #1 Teratoma of the lung. Collier FC, Dowling EA, Plot D, Schneider H. Archives of pathology. 1959; 68:138-142.
Reference #2 Intrapulmonary teratoma: A case report and review of literature. Desiree E. Morgan at al. J Thorac Imaging 1992; 7(3): 70-77.
DISCLOSURE: The following authors have nothing to disclose: Abhishek Sawant, Narinder Gill, Vijay Balasubramanian
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