ABSTRACT

Some cases with giant mature mediastinal teratomas occupies most of one or another pleural cavities. Objective: To describe three cases with giant thoracic teratomas, occupying most of the right hemithorax. Presentation of the cases: We describe three patients with giant thoracic teratomas surgically treated between 2011 y 2017. Age was 22, and 37 years old. There were one male and two females. Main symptoms were thoracic pain and moderate dyspnea to physical efforts (patient 1), thoracic pain, moderate dyspnoea and fever (patient 2) and thoracic discomfort and light dyspnoea (patient 3). Patient two was submitted three times to thoracoscopy with the diagnosis of pleural empyema. Fever could have influenced to pose this diagnosis. Pus was not obtained, but some small whitish clots floating in a dark liquid, result observed in the material obtained with US guided puncture. This finding made us to pose the diagnosis of mediastinal teratoma. CT showed a cystic image in the right hemithorax, without calcifications in patients one and two and small parietal calcifications in patient three. Surgical cysts removal was satisfactory in all patients. At the end of the study patients were asymptomatic with no evidence of recurrence eight years, 17 months and seven months, after operation, respectively. Diagnosis was confirmed by anatomopathological study. Conclusions: Giant thoracic teratomas produce symptoms associated to their volume as: pain, cough, dyspnea and adjacent organ compression. Surgical treatment yield excellent results.

KEYWORDS

Teratoma, giant teratoma, thoracic teratoma.

REFERENCES

1. Lakhotia S, Dewan RK. Benign cystic teratoma of mediastinum. Indian J Surg 2008;70(5):244-246. doi: 10.1007/s12262-008-0070-4.

2. de Castro MA, Rosemberg NP, de Castro MA, de Castro AP, Wietzycoscki C, Mespaque C. Mediastinal teratoma mimicking pleural effusion on chest X-rays. J Bras Pneumol 2007;33(1):113-115.

3. Gupta N, Shah D, Singh U, Tiwari A. Antenatal diagnosis of large sacro-coccygeal teratoma with foetal cardiomegaly and hydrops. Kathmandu Univ Med J (KUMJ) 2008;6(23):383-385.

4. Ram D, Sharma DK, Darlong LM, Rajappa SK, Bhakuni YS. Mediastinasl teratoma with pulmonary parenchyma fistula: a rare diagnostic endeavour. J Clin Diagn Res 2017;11(8):XD03-XD04. doi: 10.7860/JCDR/2017/28238.10438.

5. Mitra A, Sarma MK, Das AK. Curious case of a black pleural effusion: Mediastinal teratoma presenting as massive pleural effusion. Lung India 2018;35(1):87-89. doi: 10.4103/lungindia.lungindia_253_17.

6. Zisis C, Rontogianni D, Stratakos G, et al. Teratoma occupying the left hemithorax. World J Surg Oncol 2005;3:76-81.

7. Oomman A, Santhosham R, Vijayakumar C, Jayaraman S, Ramachandran P, Kumar S. Anterior mediastinal teratoma presenting as cardiac tamponade. Indian Heart J 2004;56(1):64-66.

8. Serraj M, Lakranbi M, Ghalimi J, Ouadnouni Y, Smahi M. Mediastinal mature teratoma with complex rupture into the lung, bronchus and skin: a case report. World J Surg Oncol 2013;11:125-127. doi: 10.1186/1477-7819-11-125.

9. Zhao H, Zhu D, Zhou Q. Complete resection of a giant mediastinal teratoma occupying the entire right hemithorax in a 14-year-old boy. BMC Surgery 2014;14:56-58. doi: 10.1186/1471-2482-14-56.

10. Chow MB, Lim TCh. Massive mediastinal teratoma mimicking a pleural effusion on computed tomography. Singapore Med J 2014;55(5):e67-e68. doi: 10.11622/smedj.2013211.

11. Montebello A, Mizzi A, Cassar PJ, Cassar K. Benign cystic mediastinal teratoma presenting as a massive pleural effusion in a 17-year-old boy. BMJ Case Rep 2017;2017. pii: bcr2016217439. doi: 10.1136/bcr-2016-217439.

12. Kuroda H, Hashidume T, Shimanouchi M, Sakao Y. Resection of a ruptured mature cystic teratoma diagnosed two years after the onset of perforation. World J Surg Oncol 2014;12:321-323. doi: 10.1186/1477-7819-12-321.

13. Yang M, Shen C, Du H, Wang Y, Che G. A huge neoplasm occupying the right hemithorax in a pregnancy. J Thorac Dis 2014;6(10):E237-E241. doi: 10.3978/j.issn.2072-1439.2014.08.46.

14. Allen MS, Trastek VF, Pairolero PC. Benign germ cells tumor of the mediastinum. In: Shields ThW, LoCicero III J, Reed CE, Feins RH, editors. General thoracic surgery. 7th ed. Chicago: Lippincott Williams & Wilkins; 2009. p. 2390-2395.