Germ cell tumors constitute 10% to 15% of anterior mediastinal neoplasms. Of these, mature teratoma is the most common. Somatic malignant transformation in mature teratoma is a very rare phenomenon. In the anterior mediastinum, few cases of malignant transformation in the form of carcinoma, sarcoma, or neuroendocrine tumors have been described. We present the case of a mature mediastinal teratoma in a 24-year-old female, diagnosed on computed tomography, where both carcinoid tumor and adenocarcinoma were seen. To the best of our knowledge, this is the first report of such a case. Malignant transformation in a mature teratoma confers a significantly worse prognosis and is difficult to diagnose only on clinical and radiological evaluation. As these lesions are so rare, the treatment options for these lesions are also not clearly defined. Extensive sampling and careful microscopic examination are needed when teratomas are submitted for pathological evaluation.
As a definite correlation between the ANA patterns and the group of antibodies was detected by line immunoassay, one could predict presence of certain specific auto antibodies for a particular ANA pattern identified. This may restrict one from requesting for line immunoassay, which is expensive and economizes on the cost of laboratory investigations in a developing country like India. Thus, screening of sera by ANA-IIF method alone may suffice and probably reduce the expense of detailed immunological work-up with minimal loss in diagnostic accuracy. This study, the first of its kind in India, provides database and reference for the Indian subpopulation.
Synovial sarcomas commonly occur in the extremities of young adults. A primary
occurrence in the mediastinum is very rare with only a few reported cases in the
world literature. This paper is about a 42-year-old male who presented with
chest pain and dyspnoea on exertion. Imaging showed an anterior mediastinal
mass with adhesions to the lung. Pathological examination of the resected mass
showed a biphasic neoplasm with a spindle cell component admixed with gland-like elements. The tumour showed positive staining with cytokeratin, epithelial
membrane antigen, and Bcl-2 confirming the diagnosis of a biphasic synovial
sarcoma. A wide range of neoplasms, both primary and metastatic, occur in the
mediastinum, which pose considerable diagnostic difficulties. A synovial sarcoma
should always be considered in the differential diagnosis, and
immunohistochemistry is an important adjuvant tool in this situation. This paper highlights the importance of recognizing an unusual presentation of this
aggressive neoplasm to aid appropriate clinical management.
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