Uniportal video-assisted thoracoscopic surgery for complex mediastinal mature teratoma:A case report

BACKGROUND Mediastinal mature teratoma is the most common histological type of primary extragonadal germ cell tumor.In this report,we describe a rare case of giant mature teratoma located primarily in the anterior mediastinum and causing partial atelectasis of the upper and middle lobes of the right lung,as well as extrinsic compression of the right atrium.CASE SUMMARY A 31-year-old male with a giant mediastinal mature teratoma presented with progressive exertional dyspnea and chest pain for 1 mo.Computed tomography of the chest indicated the diagnosis of anterior mediastinal teratoma.The patient underwent right uniportal anterior approach video-assisted thoracoscopic surgery(VATS).En bloc resection of the giant teratoma,wedge resection of the upper and middle lobes of the right lung,resection of the thymus and partial excision of the pericardium were successfully performed.The pathological diagnosis revealed a mature cystic teratoma with foreign-body reaction that was closely related to the right lung,atrium dextrum,superior vena cava and ascending aorta.An atrophic thymic tissue was also discovered at the external teratoma surface.The patient was discharged on postoperative day 7.CONCLUSION This is the first report of the use of uniportal VATS for complete resection of a teratoma in combination with wedge resection of the right upper and middle lung lobes and partial resection of the pericardium.

Rare primary mature teratoma of the liver:A case report

BACKGROUND Primary liver teratoma is an extremely rare tumor usually affecting children under the age of 3 years.Specific signs of teratoma on ultrasound,computed tomography(CT)or magnetic resonance imaging are lacking,which makes morphology the only diagnostic tool.Misdiagnosis of a mature teratoma may lead to excessive liver resection,whereas misdiagnosis of an immature teratoma may result in spread,causing a life-threatening condition.Consequently,a careful tumor examination is important,and the rarest types of tumors must be accounted for.CASE SUMMARY We describe a 52 years old female who presented with a solid mass in the left liver lobe.Contrast-enhanced CT and magnetic resonance imaging(MRI)revealed a round,heterogeneous lesion containing a number of fluid areas and areas of calcification in the middle,and the provisional diagnosis was cholangiocarcinoma.The patient underwent resection of liver segment I.Immunohistochemistry analysis of the resected lesion indicated thyroid follicular epithelium;however,the thyroid gland was intact.10 years prior to presentation the patient underwent a surgery due to mature teratoma of the right ovary,nevertheless the tumor was benign and could not spread to the liver,in addition teratoma of the liver was also benign.This led to the final diagnosis of primary mature liver teratoma.CONCLUSION Primary hepatic teratoma,including heterotopia of the thyroid gland in the liver,is an extremely rare condition in adults that needs to be considered in the differential diagnosis of solid-cystic neoplasms in the liver and cholangiocarcinoma.This case adds to the limited literature on the patient presentation,clinical workup and management of liver teratomas.

Malignant transformation of primary mature teratoma of colon:A case report

BACKGROUND Mature teratoma is a common benign ovarian germ cell tumor,accounting for about 20%of ovarian tumors.The malignant transformation of this tumor is less than 2%.The most common type is squamous cell carcinoma,followed by adenocarcinoma.Malignant transformation of colonic mature teratoma is extremely rare.We here report a case of malignant transformation of primary mature teratoma of the colon.The type of malignant transformation was adenocarcinoma.CASE SUMMARY A 63-year-old woman was admitted to our hospital due to persistent pain in her right lower abdomen for 1 mo,and she had no nausea,vomiting,blood in the stools,or other symptoms.Preoperative colonoscopy showed uplift of the sigmoid colon mucosa and submucosa.The biopsy showed squamous epithelium.However,contrast-enhanced computed tomography of abdomen and pelvis showed a localized thickening of the sigmoid wall,suggesting colon cancer.Endoscopic ultrasonography(EUS)revealed that the structure of the intestinal wall at the base of the lesion was destroyed,and the boundary between the lesion and the surroundings was unclear.According to the findings of the EUS,the patient did not undergo endoscopic submucosal dissection,but underwent radical resection of the tumor.Histologically,squamous epithelium was seen on the mucosal surface of the colon wall,cartilage and glands were seen under the epithelium,and adenocarcinoma was seen on the muscular layer and serous surface.The final pathological diagnosis was malignant teratoma of the colon.We have followed up the patient for 2 mo since the operation,and the patient recovered well.CONCLUSION This case suggests the possibility of mature teratoma in the colon and recognition of malignant types,and it should not be considered as an exclusively ovarian tumor.

Rectal mature teratoma:A case report

BACKGROUND Rectal mature teratoma is rare and has been reported as a case report in this study.Herein,clinical presentation,magnetic resonance imaging findings,and immunohistochemistry showed a pelvic rectal mature teratoma.The case report and the surgical treatment procedure have been discussed below.CASE SUMMARY A 29-year-old Chinese female showed up with over a 1-mo history of perianal mass that emerged after defecation.Physical examination indicated that the mass was 4 cm×3 cm×3 cm.The intraoperative procedure involved ligation of the sigmoid colon 10 cm above the upper edge of the tumor,followed by ligation of the rectum 3.5 cm above the upper edge of the tumor,and subsequent complete removal of the mass.The histopathology confirmed the mature teratoma.CONCLUSION The tumor can be completely removed using surgery to prevent its recurrence.

Mature Teratoma Revealed by an Encysted Pleural Effusion

A 32-year-old patient with no previous history was admitted for chest pain, dyspnea, appetite and weight loss. Chest X-ray revealed an opacity involving the lower two-thirds of the right hemithorax, suggestive of a pleural effusion. Because of the absence of fluid return even after ultrasound-guided thoracentesis, a Chest Computed tomography was required showing a heterogeneous anterior mediastinal mass with soft tissue, fat, fluid and calcifications associated with extensive encysted fluid collection in the right hemithorax. A video-assisted mini-thoracotomy revealed a mediastinal tumor firmly attached to the thymus with a cystic wall lined by squamous epithelium and sebaceous gland composed of respiratory tissue, adipose tissue, cartilage, smooth muscle fibers, and well-differentiated pancreatic tissue. These findings led to the diagnosis of a mature thymic teratoma. The patient was discharged 7 days after surgery, with no recurrence on follow-up.

Spinal intradural mature teratoma in an elderly patient

Spinal intradural mature teratomas are rarely encountered in adults.In this report,one of the oldest patients ever reported to harbor an intradural mature teratoma of the conus medullaris is presented,and the relevant literature concerning the teratoma’s origin,clinical presentation,radiological features,and treatment modalities is reviewed.A previously healthy 70-year-old woman presented with a 2-month history of left sciatica.Her neurological examination was normal and the magnetic resonance imaging of the thoracolumbar spine showed an intradural,partially cystic mass extending from T12 to L3 level.The patient underwent a T11-L4 laminectomy.After opening the dura,a yellowish vascular tumor attached to the conus medullaris came into view.Meticulous dissection allowed for subtotal tumor removal.Only a thin part of the tumor wall,tightly attached to the conus medullaris,was left.The tumor was diagnosed as mature teratoma by histological study,and no adjunctive therapy was administered.The pain experienced by the patient disappeared postoperatively.Her condition remained unchanged with no radiological recurrence through the most recent follow-up examination,3 years after surgery.The present study outlines that mature teratoma can arise from the conus medullaris,even in older adult patients.Functional preservation is of utmost importance,and long-term follow-up is mandatory to spot recurrences early.

Mature Cystic Teratoma of the Suprasternal Fossa in an Adult: Report of Case

Teratomas have been reported to occur in multiple organ regions, and are less common in non-gonadal regions, such as the neck and chest, than in gonadal and midline regions of the body, such as ovaries and testis. Cases have been reported of a large teratoma of the anterior mediastinum extending to the neck, causing symptoms such as dyspnea, which can be quickly detected by Ultrasound, and patients can be quickly treated. In adults, primary teratoma at the suprasternal foss that not accumulate thyroid gland upward and not invade the mediastinum are rare, usually have no obvious clinical symptoms and are found in most patients by chance. In this literature, we report a rare case of mature cystic teratoma in the suprasternal fossa of a 33-year-old male. Preoperative ultrasonography showed a superior sternal fossa tumor with less calcification and more adipose tissue. The final pathologic diagnosis was mature cystic teratoma through open surgery of the suprasternal neck incision. The patient was followed up for 9 months and there was no recurrence. We believe that the suprasternal notch approach is a safe and effective method for the treatment of mature teratoma without protruding into the superior mediastinum.

Retroperitoneal Teratoma in Infants: About a Case in the Medical Imaging Department of the Mother and Child Hospital Center “Luxembourg”

Introduction: Retroperitoneal teratoma is a rare congenital tumour, representing only 1% to 10% of primary retroperitoneal tumors in children, far behind ovarian and testicular locations. There is a clear female predominance with a sex ratio of 3.4/1. The purpose of this study is to review the clinical manifestations, the mode of revelation of retroperitoneal teratoma, the diagnostic means and the anatomopathologic aspect of retroperitoneal teratoma, then to show the contribution and the limits of the various imaging examinations: ultrasound, CT and MRI in the diagnosis of retroperitoneal teratoma. Observation: We report the case of a mature retroperitoneal teratoma discovered in a 10-month-old male infant. The diagnosis evoked by ultrasound and abdominal CT was confirmed by histological study of the excised specimen. The postoperative evolution after 3 months was favorable in particular with no signs of recurrence. Conclusion: Retroperitoneal teratoma is a rare congenital tumour. The complete imaging assessment including ultrasound and computed tomography is necessary preoperatively in order to make the diagnosis and to clearly determine the relationship with the various organs. The anatomopathological study confirms the diagnosis of retroperitoneal teratoma. Tumor excision must be radical to avoid recurrence, which readily occurs in a malignant form. Even if the tumor appears benign, postoperative monitoring based on clinical, biological and radiological examination is essential.

A Case of Benign Mature Cystic Teratoma of Left Fallopian Tube Along with Right Endometrial Ovarian Cyst

Objective To report a case of benign mature cystic teratoma of fallopian tube along with endometrial ovarian cyst, occasionally found during the operation. Methods A 30-year-old patient complained of mild dysmenorrhea and gradual enlargement of bilateral adnexal cysts in the past one year. At the age of 27 she had undergone a laparoscopic right ovarian endometrial cyst ablation. Before the second operation, pelvic ultrasound revealed recurrence of bilateral cysts in the adnexal regions, as well as serum concentrations of CA19-9 and CA125 above normal limits. Laparotomy revealed a 7 cm cystic mass of the right ovary, tightly adhesive to the lateral pelvic; a 10 cm-large mass on the left adnexal region embedded among intestines. The left adnexal mass appeared to be attached to the fimbriated end of the left fallopian tube with the ipsi-lateral ovary. However the left fallopian tube was obscure because of severe synechia. After separating the adhesion, we found the left hydrosalpinx. Results During laparotomy, both the cyst on the right ovary and the left fallopian tube were removed. Grossly, it revealed enlargement of the left fallopian tube in diameter 1.3 cm, with 2 neoplasms, in diameter 0.6 cm and off-white and smooth appearance. This mass was considered to be a mature solid teratoma arising in the left fallopian tube. At the same time it indicated left hydrosalpinx. Conclusion Although mature cystic teratomas are derived from ovarian germ cells （in proportion of 16%-20%）, mature teratoma of the fallopian tube is very rare. Once diagnosis, the operation will be recommended. This case was revealed during the laparotomy accidentally. The prognosis was good.