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Cardiothoracic Surgery |

A Case of a Large Pericardial Teratoma of the Anterior Mediastinum in an Adult

Larysa Sanchez, MD; Narjust Duma, MD; Martin Gutierrez, MD
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Rutgers New Jersey Medical School, Newark, NJ


Chest. 2015;148(4_MeetingAbstracts):35A. doi:10.1378/chest.2260749
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Abstract

SESSION TITLE: Cardiothoracic Surgery Student/Resident Case Report Posters

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: Extragonadal germ cell tumors are rare, representing 1-3% of all germ cell tumors. The most common location of extragonadal germ cell tumors is in the anterior mediastinum. Of all types of anterior mediastinal neoplasms in adults, mediastinal germ cell tumors represent about 15% of cases and are usually benign teratomas.[1]

CASE PRESENTATION: A 36-year-old Columbian man with no past medical history presented with right (R.) shoulder and R.-sided chest pain for two days. The pain was sharp, constant, pleuritic, and non-radiating. He denied fever, night sweats, weight loss, dyspnea, cough, hemoptysis, palpitations, or any other symptoms. CT Chest showed a well-circumscribed mass along the R. heart border. Further imaging with cardiac MRI delineated a large R. anterior mediastinal mass measuring 8.2 x 9.0 x 6.1 cm arising from the R. pericardium (Fig. 1), without intracardiac extension, imposing on the SVC and R. atrium (Fig. 2). The mass enhanced heterogeneously, showing calcification and fat signal consistent with a teratoma. CT Abdomen/Pelvis, testicular ultrasonography, alpha-fetoprotein and beta-HCG levels were normal. The patient underwent median sternotomy; pericardial and pleural spaces were both entered, revealing tumor arising from the fibrous pericardium without invasion of the serous pericardial surface. Adhesions between the tumor and right lung were present. The excised mass grossly appeared solid and cystic, tan-pink with fragments of hair and histology revealed a benign mature teratoma with margins free of tumor. Post-operative course was uncomplicated and patient was seen in follow-up 2 months later doing well.

DISCUSSION: Mediastinal germ cell tumors of cardiac origin are exceedingly rare, with reported incidence of cardiac teratomas less than 1%. Cardiac teratomas predominantly occur in children and young adults and peak incidence is in the second and third decades of life. The majority of cardiac teratomas arise from the pericardium and are usually R.-sided masses. Generally, mediastinal teratomas are asymptomatic and found incidentally due to the nature of their slow growth, although large tumors may cause symptoms such as chest pain related to mechanical effect. MRI is sensitive in defining the spatial relationship of mediastinal teratomas to structures such as the pericardium and great vessels. Surgical resection of these tumors is usually through median sternotomy or posterolateral thoracotomy with careful surgical technique so as not to injure vital mediastinal structures.[2]

CONCLUSIONS: This case reports a very rare occurrence of a pericardial mature teratoma in a patient of adult age and although uncommon, complete surgical resection is curative with good prognosis.

Reference #1: Shameem, M. et al. Mature mediastinal teratoma in adult. Respiratory Medicine CME. 2010; 3:116-117.

Reference #2: Cohen, R. et al. Mature cardiac teratoma in an adult. Cardiology Research. 2012; 3(3):97-99.

DISCLOSURE: The following authors have nothing to disclose: Larysa Sanchez, Narjust Duma, Martin Gutierrez

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