J Korean Soc Radiol.  2014 Feb;70(2):119-122. 10.3348/jksr.2014.70.2.119.

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

• Jun JS
• Park HJ
• Kim KJ
• You JY
• Jung WS
• Cho DG
• Kim HL

• KMID: 1839420
• DOI: http://doi.org/10.3348/jksr.2014.70.2.119

Abstract

Mature teratomas are rarely located in the posterior mediastinum, and most mature teratomas are asymptomatic. Teratoma rupture into the adjacent lung and esophagus is possible but considering the rare entity of posterior mediastinal teratomas and the perforation rate, it is extremely unusual. We report a case of ruptured mature cystic teratoma located in the posterior mediastinum, showing fistula formation to the adjacent lung and esophagus, which presented with hemoptysis.

MeSH Terms

Esophagus
Fistula
Hemoptysis
Lung
Mediastinum*
Rupture
Teratoma*

Figure

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  Fig. 1 Chest posteroanterior radiograph shows homogenous consolidation (arrows) in the right lower lung field. Note a curvilinear opacities along the lower thoracic spine superimposed on the right atrium and left heart border (arrowheads), finding suggestive of a posterior mediastinal mass.

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  Fig. 2 A 43-year-old man with ruptured mature cystic teratoma in the posterior mediastinum. A. Contrast-enhanced chest CT with mediastinal window setting shows a huge heterogeneous density mass (arrows) in posterior mediastinum, containing fat, soft tissue, and calcification (arrowhead). Note fat density lesions (circle) that measures -70 Hounsfield unit in density within the mass. B. Coronal reconstruction of contrast-enhanced chest CT reveals consolidation with air bronchogram and focal low density lesion in basal segment of right lower lobe. An air-containing fistulous tract (black arrow) is seen between the mediastinal mass (white arrows) and the consolidation (arrowhead). C. Another fistulous tract (white arrow) is observed between the esophagus (black arrow) and the mediastinal mass (arrowheads).

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  Fig. 3 Esophagography reveals contrast leakage (arrow) into the tumor, suggesting communication between the tumor and esophagus.

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  Fig. 4 Microscopic image of the mass shows sweat glands (large arrow), adipose tissue (small arrow), neural tissue (large arrowhead), and multiple cystic structures lined by columnar (small arrowhead) and squamous epithelium (hematoxylin and eosin stain, × 40).

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