Management of fetal mediastinal teratoma.

Chest masses present a common problem in the perinatal period. Advances in prenatal ultrasound, supplemented by fetal magnetic resonance imaging, now allow early detection and detailed characterization of many thoracic lesions in utero. As such, in asymptomatic infants, assessment with postnatal computed tomography or magnetic resonance imaging can often be delayed for several months until the time at which surgery is being contemplated. Bronchopulmonary malformations comprise most of the thoracic masses encountered in clinical practice. However, a variety of other pathologies can mimic their appearances or produce similar effects such as hypoplasia of a lung or both lungs. Understanding of the key differentiating clinical and imaging features can assist in optimizing prognostication and timely management.

Perinatal Thoracic Mass Lesions: Pre- and Postnatal Imaging

Immature mediastinal teratoma is very rare, found in only1% of all mediastinal teratomas. Raised serum alpha feto-protein acts as important surrogate marker for both diagnosis and follow up in such cases. Surgery and adjuvant chemotherapy are keys in the management, especially in patients older than 15 years of age. We present a 14 year boy presenting clinico-radiologically as left sided massive pleural effusion. Raised serum marker as well as excision biopsy of the mediastinal mass following thoracotomy were indicative of a diagnosis of immature teratoma.

Mediastinal Teratoma Mimicking Massive Pleural Effusion

A 42-hour-old male newborn was referred to our hospital with the complaints of life-threatening respiratory distress. A large mass was observed on posterior-anterior chest radiography. A 10 x 10 cm mass was completely excised from the anterior mediastinum and right hemitorax via right thoracotomy. Histopathologic examination of the mass revealed as immature teratoma. Mediastinal immature teratoma may cause life threatening respiratory obstruction and must be promptly diagnosed and treated.

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A Large Mediastinal Immature Teratoma Presenting with Life Threatening Respiratory Distress in a Newborn

Mediastinum is a common localization of extra gonadal teratoma. Mediastinal teratoma, which is comprising of 1-5% of all mediastinal tumors is an infrequent germ cell tumor. Immature mediastinal teratoma is a rare malignant neoplasm, which has an abilty to metastasize and recure and histologically resemble embryonal structures. There are few reports in literature, which show post chemotherapeutic retroconversion of immature teratoma; however, retroconversion of mediastinal teratoma into mature teratoma is not common. A 19-year-old boy was diagnosed a case of immature mediastinal teratoma by Computed tomography-guided FNA (Fine Needle Aspiration) and received 6 cycles chemotherapy by bleomycin, etoposide, and cisplatin regimen. After that, surgically total excision of tumor was done and histopathological report reveals mature teratoma, which is presented in this paper.

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Condon Richardson

Papers

Primary immature mediastinal teratoma in a newborn.