Large Mediastinal Teratoma Originating from the Aortic Adventitia
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Many mediastinal tumors do not cause local symptoms, so they are discovered incidentally upon thoracic imaging. We present the case of a patient who had a large, mature, cystic, mediastinal teratoma. The primary tumor arose from the ascending aortic adventitia and was in a highly unusual location—the medial mediastinum. The teratoma, which was diagnosed in our patient on thoracic computed tomography for follow-up evaluation of empyema, was resected completely. To our knowledge, such a teratoma, arising from the adventitia of the ascending aorta in the medial mediastinum, has not previously been reported in the English medical literature.
We review diagnostic methods and therapeutic approaches to such mediastinal tumors. We conclude that surgical resection is the method of choice for treating these tumors, because it enables radical therapy and tissue diagnosis after extirpation.
Key words: Magnetic resonance imaging, mediastinal cyst, mediastinal neoplasms/diagnosis/surgery, radiography, thoracic, surgical resection, teratoma/diagnosis/surgery, tomography, X-ray computed, tumor markers, biological/blood/diagnostic use
Many different tumors and cysts can arise from mediastinal anatomic structures. Most of these primary mediastinal masses are diagnosed incidentally during routine chest radiography. Early diagnosis and therapy is rare, because mediastinal masses are generally diagnosed only after they begin to compress the adjacent structures. At that point, these masses can become malignant, and surgery provides the only chance for a cure. We report the case of a patient who had a large, mature, cystic teratoma of the medial mediastinum that arose from the ascending aortic adventitia. We present our diagnostic methods and our techniques for successful resection of the teratoma.
Case Report
In March 2003, a 19-year-old man was referred to our clinic after a mediastinal cystic lesion was found on a routine, follow-up, thoracic computed tomographic (CT) scan. Six months before admission to our clinic, the patient had undergone an appendectomy and retroperitoneal abscess drainage at another institution. He had then been hospitalized elsewhere on the 17th postoperative day, and was given medical therapy for right pleural empyema. When he was discharged, he was advised to return for a 3-month follow-up thoracic CT scan. It was this CT scan that revealed the lesion and led to a consultation at our clinic.
The thoracic CT scan showed a mediastinal, cystic lesion, 8 cm in diameter, with smooth borders. The mass extended from the upper mediastinal area, in front of the aorta and pulmonary artery, to the right atrium. The CT scan was examined for mediastinal cystic lesions such as pericardial or hydatid cysts. Echocardiography showed a paracardiac mass compressing the right ventricular base, the right atrium, and the aorta (the aortic root and ascending aorta). The mass surrounded the proximal part of the ascending aorta. It was encapsulated and contained homogenous granular tissues. We did not see any flow within the mass, and there was no agitated fluid passing to the mass from the heart; therefore, we determined this to be a paracardiac mass compressing the right atrium. On a thoracic magnetic resonance image (MRI), we found a smooth, contoured, cystic lesion beginning in the right ventricle and extending to the right atrium, invading the anterior mediastinum; its dimensions were 8.5 × 6.5 cm. The lesion occupied a large portion of the anterior mediastinum and displaced the main vascular structures and the heart to the left. No disease was evident on complete abdominal ultrasonography, computed brain tomography, or whole-body bone scintigraphy. Thyroid scintigraphic results were normal, as were the levels of serum α-fetoprotein, human chorionic gonadotropin-β subunit (β-HCG), and other tumor markers. The patient underwent surgery for removal of the cystic mass.
Large Mediastinal Teratoma Originating from the Aortic Adventitia
Ufuk Yetkin, MD, Aylin Orgencalli, MD, Gokhan Yuncu, MD, and Ali Gurbuz, MD
Izmir Ataturk Education and Research Hospital, Department of Cardiovascular Surgery, Izmir, Turkey
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