A Case Report of Intrapulmonary Teratoma in the Right Upper Lung Zone in a 35-year-old Female Patient

Abstract

Teratomas are rare germ cell tumors usually found in the gonads. Extra-gonadal teratomas are especially rare, mostly occurring in the thorax. Only a few cases of intrathoracic teratomas have been reported in medical literature and most reported were located in the mediastinum. An additional intrathoracic location for teratoma occurrence is in the pulmonary system, most commonly in the upper lobe of the left lung. In this report, we describe a case of a 35-year-old woman diagnosed with an intrapulmonary mature teratoma found in the right upper lobe. A 35-year-old Saudi female presented with a chief complaint of a three-week history of dry cough. Chest X-ray revealed a right-sided para-pericardial mass in the anterior mediastinum and a significant decrease in the size of the right middle lobe opacity. Subsequently, a chest computed tomography (CT) was performed and revealed a cystic mass in the right lung, which required removal by surgical intervention. The surgery was performed via a thoracoscopic approach and the tumor was excised with no complications. Intrapulmonary teratomas (IPT) usually present with vague and non-specific symptoms such as cough, hemoptysis, and chest pain. It is a rare condition without diagnostic features detected preoperatively, save for trichoptysis which is reported in approximately 13% of the cases. We report a rare appearance of mature IPT in the right upper lung zone which is an unusual location.

Aspergilloma or intrapulmonary teratoma - time to rethink

“…Teratomas are the most common mediastinal GCTs with 80% of mature type and are slow growing benign tumors. 1,3 IPTs are rare with only 65 cases reported till now. 3 They mostly involve the left upper lobe.…”

“…1,3 IPTs are rare with only 65 cases reported till now. 3 They mostly involve the left upper lobe. Only few cases have been reported with involvement of right upper lobe as seen in our case.…”

“…They are believed to arise from third pharyngeal pouch. 3,4 Derivatives from any of the three germinal layers can be found within the tumor mostly including hair, bone and teeth. Other tissues include respiratory epithelium, pancreatic or gastric tissues, cartilages and muscles.…”

“…1,2 Although rare trichoptysisis (expectoration of hair) is a characteristic feature of IPT and indicates communication with airway but is reported to occur in only 13% of cases. [1][2][3] Erosion of the tumor into bronchus can cause hemoptysis thus can be life threatening. 5 It is believed that the proteolytic or digestive enzymes secreted by intestinal mucosa or pancreatic tissue found in the teratoma can lead to enzymeinduced erosions causing rupture into airway, mediastinal structure and even through the skin to form draining fistulae.…”

“…They can occur at any age but mostly seen in the third decade of life with equal predilection for both genders. 2,3 In the lung, teratoma may present as metastasis from gonadal GCT such as seminoma, embryonal cell carcinoma, yolk sac cancers and choriocarcinoma. 1 We would like to report a case of IPT presenting as a cavitatory intraparenchymal lesion treated previously as aspergilloma lung.…”