Mediastinal mature teratoma with chest pain onset and subsequent perforation: A case report

Abstract

Highlights Ruptured mediastinal teratomas (RMTs) may lead to mediastinitis. RMTs may also cause the rupture of adjacent tissues. Immediate resection of RMTs should be performed once perforation is confirmed. Radiography and MRI may provide useful information for RMT diagnosis.

A large ruptured mediastinal teratoma

“…There are several explanations for the tendency of some teratomas to rupture. These include autolysis by digestive enzymes, chemical inflammation, ischemia, pressure necrosis, and infections [7,9]. In this case, we speculate that the pleural effusion had high cancer antigen 19-9 levels and pathological examination revealed pancreatic and intestinal tissues, the rupture was probably caused by the digestive enzymes secreted by these tissues.…”

“…They often contain variable amounts of fat, soft tissue density, cystic areas, calcification, and bone or teeth [5]. Up to 36% of mediastinal teratomas rupture, most frequently into the lung and bronchial tree, followed by into the pleural space, pericardial space, or great vessels [4,6,7]. Rupture into the lungs may cause pneumonia, and the patient may present with cough, fever, chest pain, and dyspnea.…”

“…Rupture into the lungs may cause pneumonia, and the patient may present with cough, fever, chest pain, and dyspnea. Rupture into the pleural cavity produces chemical pleuritis, and the usual complaint is chest pain [4,[6][7][8]. Computed tomography characteristics of ruptured versus unruptured teratomas have been reported; 90% of unruptured teratomas exhibit homogeneity of their internal components, whereas most ruptured teratomas tend to have inhomogeneous densities of internal components in each compartment.…”

“…Inhomogeneity of an unruptured tumor should raise suspicion of a malignant component in the cystic teratoma. Other findings suggesting rupture include pleural effusion, observed in 57% of CT scans in ruptured mediastinal teratomas, or pericardial effusions when the tumor is adherent to the pericardium [7]. There are several explanations for the tendency of some teratomas to rupture.…”

The Key Role of Lung Ultrasound in the Diagnosis of a Mature Cystic Teratoma in a Child with Suspected Difficult to Treat Pneumonia: A Case Report

“…In addition, the clinical scenario may be complicated by intracapsular hemorrhages, pleural or pericardial effusion with a case of difficult diagnostic interpretation that can easily be mistaken for infectious diseases [12,13].…”