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Rare Case of Mediastinal Teratoma Masquerading as Loculated Pleural Effusion FREE TO VIEW

A.P. Kansal, MD; Gopal Chawla, MBBS; Parul Mrigpuri, MBBS; Naresh Kumar, MBBS; Bidhi Chand, MBBS; Shiyas Mohammed, MBBS
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Govt. Medical College, Patiala, India

Chest. 2013;144(4_MeetingAbstracts):950A. doi:10.1378/chest.1704504
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SESSION TITLE: Miscellaneous Global Case Reports

SESSION TYPE: Global Case Report

PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM

INTRODUCTION: Benign mediastinal teratomas are uncommon germ cell tumors often discovered while still asymptomatic. Almost all arise in the anterosuperior mediastinal compartment, and most symptoms, when present, result from compression of adjacent structures. We report a case of a large teratoma arising from the anterior mediastinum that presented a confusing clinical picture of loculated pleural effusion which was successfully diagnosed and treated by surgical excision, with no recurrence.

CASE PRESENTATION: A 17 year old girl with no complaints or co-morbid conditions presented to our hospital with trivial breathlessness. A chest X-ray revealed right sided homogenous opacity with regular margins widening the cardiac shadow. There was no previous chest X-ray. Her physical examination revealed that she was apyrexial and eupneic. Her thyroid, lymph node, chest and abdominal were normal. Her chest X-ray showed a mass in the right side of 18 x 11 cm well delineated margin continuous to cardiac shadow. The clinical suspicion was a pericardial or bronchogenic cyst or massive loculated effusion. Radiologically suspicion of same was made as homogenously opaque mass was seen involving whole right hemithorax with obscuration cardiophrenic angle, dome of diaphragm and right cardiac border with slight mediastinal shift towards left. However CT scan showed large well defined mass, which was low attenuating with focal areas of fat and calcification, areas of cystic degeneration also seen showing enhancing septa, very specific for a germ cell tumor. Surgical and anatomo-pathologic findings led to the diagnosis of a mature cystic teratoma with components of three germ layers. Gross examination showed a rounded tumor measuring 18x11.5x7.8cm and weighing 300gm. The tumor was predominantly cystic, with thin, sharply delineated wall filled with sebaceous material and hair. Microscopically,the cyst wall was lined by epidermis and some are lined by tall columnar epithelium with lobules of mature adipose tissue, brain tissue and nerve twigs. Post operative follow ups were uneventful.

DISCUSSION: A teratoma of the mediastinum is an uncommon germ cell tumor, principally .Five percent of germ cell tumors are extragonadally located, They occur more frequently in young adults. Most are asymptomatic and are incidentally discovered, but large tumors may cause chest pain, dyspnea, cough, or other symptoms of compression. (1)

CONCLUSIONS: Thus one should always be cautious while reaching to diagnoses as rare cases are not that rare and sometimes present with trivial symptoms.

Reference #1: Lewis BD, Hurt RD, Payne WS, Farrow GM, Knapp RH, Muhm JR. Benign teratomas of the mediastinum. J Thorac Cardiovasc Surg 1983;86:727-31.

DISCLOSURE: The following authors have nothing to disclose: A.p. Kansal, Gopal Chawla, Parul Mrigpuri, Naresh Kumar, Bidhi Chand, Shiyas Mohammed

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