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Teratoma of Mediastinum

A mature teratoma of the anterior mediastinum came to light as an incidental finding of a Chest X–ray, taken on a presumably healthy 25–yo male non–smoker. The patient was not complaining of any symptoms whatsoever! There was a Past Medical History of ear cholesteatoma resected 7 years before.

PreOp investigations revealed a marked elevation of the Ca 19.9* cancer antigen ( patient's serum level of Ca 19.9 was 101.1 U/mL, instead of < 37.0 )

VIDEO :

Photographs :

Figures 1–2:
PreOp CXRs. There was a slight elevation of the right hemidiaphragm.


Figures 3–6:
PreOp CTs

Figures
7–12:
IntraOp findings, as via a right Limited thoracotomy through the bed of the 5th rib (i.e. the 4th interspace). The teratoma was abutting the right phrenic nerve along its course on the pericardium; the nerve was dissected free from the tumour and spared.

PostOp:

Histopathology findings: a benign, mature cystic teratoma, measuring 5.2 cm (maximal dimension) and arising from thymus. There were elements of skin and adipose tissue as well as sebaceous glands, columnar ciliated epithelium as well as islets of pancreas* tissue and keratin inside the tumour. There were focal degenerative changes. There were no abnormalities within the thymus specimen, measuring 11 cm.

* The presence of islets of pancreas tissue within the resected tumour interprets the preoperatively elevated Ca 19.9 levels on this case (Ca 19.9 was postoperatively measured within the normal range)
  • Preoperative CXR of the case mediastinal teratoma

    1. Preoperative CXR (posteroanterior) of the incidental finding. The teratoma is shown by GREEN arrows. There is minimal elevation of the right hemidiaphragm.

  • Preoperative lateral CXR of the case mediastinal teratoma

    2. Preoperative CXR (lateral) of the incidental finding. The teratoma is shown by GREEN arrows.

  • Preoperative CT of mediastinal teratoma

    3. Preoperative CT (mediastinal window). GREEN arrows show the teratoma

  • Preoperative CT of mediastinal teratoma

    4. Preoperative CT (mediastinal window). GREEN arrows show the teratoma

  • Preoperative CT of mediastinal teratoma

    5. Preoperative CT (mediastinal window). GREEN arrows show the teratoma

  • Preoperative CT of mediastinal teratoma

    6. Preoperative CT (mediastinal window). GREEN arrows show the teratoma

  • Intraoperative photograph of a mediastinal teratoma

    7. Intraoperative findings
    via a right limited thoracotomy through the bed of the 5th rib (i.e. the 4th interspace) :

    • GREEN arrows show the tumour (the teratoma)
    • WHITE arrows show remnants of Thymus
    • YELLOW arrows show the right lung, partly deflated and retracted towards the right side
    • BLUE arrows show the pericardium

  • Intraoperative photograph of a mediastinal teratoma

    8. Intraoperative findings
    via a right limited thoracotomy.
    Same colours as used on photo № 7 :

    • GREEN arrows show the tumour (the teratoma)
    • WHITE arrows show remnants of Thymus
    • BLUE arrows show the pericardium

  • Intraoperative photograph of a mediastinal teratoma

    9. Intraoperative findings
    via a right limited thoracotomy.
    Same colours as used on photo № 7 :

    • GREEN arrows show the tumour (the teratoma)
    • WHITE arrows show remnants of Thymus

  • Intraoperative photograph of a mediastinal teratoma

    10. Intraoperative findings
    via a right limited thoracotomy.
    Same colours as used on photo № 7 :

    • GREEN arrows show the tumour (the teratoma)
    • WHITE arrows show remnants of Thymus

  • Intraoperative photograph of a mediastinal teratoma

    11. Intraoperative findings
    via a right limited thoracotomy.
    Same colours as used on photo № 7 :

    • GREEN arrows show the tumour (the teratoma)
    • WHITE arrows show remnants of Thymus

  • Intraoperative photograph of a mediastinal teratoma

    12. Intraoperative findings
    via a right limited thoracotomy.
    Same colours as used on photo № 7 :

    • GREEN arrows show the tumour (the teratoma)
    • WHITE arrows show remnants of Thymus
    • BLUE arrows show the pericardium

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