Mediastinal teratoma: CT differentiation of ruptured and unruptured tumors.

Abstract

OBJECTIVE. The purposeofthis studywasto differentiaterupturedfrom unrupturedme diastinal teratomas using CT.MATERIALSAND METHODS. CT findingsin 17casesof surgicallyresectedmediasti nal teratomas were reviewed retrospectively. Preoperative rapture was found in seven patients during surgery. We compared the clinical symptoms and CT findings of ruptured tumors with those of unruptured tumors. On CT, we evaluated size, wall thickness, location of the mass, presence or absence of internal septation, homogeneity of the internal components of each compartment, calcification or fat within the mass, and ancillary findings in adjacent structures. RESULTS. Severesymptoms(chestpain or hemoptysis)were more commonlyfound inruptured (71%) than in unruptured tumors. All ruptured mediastinal teratomas had a tendency to display inhomogeneityof the internal components, whereas90% of unrupturedmasses showedhomogeneous densitiesof internalcomponents in eachcompartment of themass. An cillary CT findings in ruptured tumors included fat-containing masses in adjacent lung paren chyma in two patients, consolidation or atelectasis in the adjacent lung in three patients, pericardial effusionin onepatient,andpleuraleffusionin four patients. CONCLUSION.In casesof mediastinalteratoma,CT findingsof inhomogeneityof the internal components and changes in the adjacent lung parenchyma, pleura, or pericardium can be used as signs of tumor rupture. Most common primary germ-cell tu mors in the mediastinum are cystic teratomas containing ectodermal, mesodermal, and endodermal derivatives [1]. [6,7,9]. In addition, surgical management of ruptured tumors often is more complicated than that of unruptured tumors because the in ternal components of the teratoma leak into the thoracic cavity, causing inflammation and adhesion. Therefore, preoperative diagnosis of ruptured teratoma is important for deciding the appropriate time for surgery and the plan of surgical approach. The purpose of this study was to differentiate ruptured from un ruptured mediastinal teratomas on CT. Materials and MethodsWe retrospectivelystudied 17 consecutivecases Choi et al.We compared the clinical symptoms and CT features of ruptured tumors with those of unrup tured tumors. Two radiologists who were unaware of the final results analyzed the CT findings with regard to the size, wall thickness, location of the mass, presence or absence of internal septation, ho mogeneity of internal components, and calcifica tion or fat within the mass. Ancillary CT findings in adjacent lung parenchyma, pleura, or pericar dium also were analyzed. The volume of the mass was determined by measuring its length, width, and height. The maximum wall thickness of themass was measured and divided into thin and thick groups; a thin mass was defined as having a thick ness of 1â€"5 mm, and a thick mass was defined as having a thickness equal to or greater than 6 mm.To analyze the CT features, the cases of ruptured and unruptured mediastinal teratomas were inter mixed randomly. The CT scans of both groups we...

Ruptured thymoma causing a hemothorax: A case report

“…The rupture of mediastinal teratomas has been recognized as a cause of chest pain and massive pleural effusion (7,8); however, the rupture of thymomas is rare. To the best of our knowledge, only six cases, including the present case, of ruptured thymic tumor have been reported.…”

Ruptured Mature Cystic Teratoma in the Posterior Mediastinum: A Case Report

“…Most mature teratomas are located in the anterior mediastinum, and only 3-8% of mature teratomas occur in the posterior mediastinum (1). Mature teratomas may rarely rupture into adjacent structures (2). Based on a review of the literature, ruptured mature teratomas in the posterior mediastinum have not been reported previously.…”

“…Based on a review of the literature, ruptured mature teratomas in the posterior mediastinum have not been reported previously. Ruptured teratomas with invasion of adjacent structures, such as the pleural space, pericardium, or lung parenchyma, have rarely been reported, but all reported mediastinal mature teratomas have been located in the anterior mediastinum (2).…”

The Retroconversion of Immature Mediastinal Teratoma with Chemothearpy: A Case Report

“…Mediastinal mature teratomas typically manifest on CT chest as a heterogenous sharply marginated spherical or lobulated mediastinal masses containing soft tissue, fat, fluid and calcium attenuation or any combination of the four. Fat fluid levels, considers highly specific for the diagnosis of the mediastinal mature teratoma, which are uncommon [7]. The mediastinal masses can give differential diagnosis like mediastinal fat pad, mediastinal lipomatosis, lipoma, omental herniation, thymolipoma and liposarcoma.…”

“…However, these radiographic features is not present in all cases and only 20-40% of cases give features of calcifications [2,6]. On the other hand, on CT mediastinal immature teratoma manifests as a heterogenous mediastinal mass containing soft tissue fluid, fat, calcification, or any combination of four [7]. Increasing value of tumor markers like alpha-fetoprotein and human chorionic gonadotropin hormone may suggest malignancy.…”