Benign mediastinal teratoma with intrapulmonary and bronchial rupture presenting with recurrent hemoptysis

Abstract

Mediastinal teratomas are usually asymptomatic tumors, located most commonly in the anterior mediastinum. Very rarely, such tumors may rupture into the tracheobronchial tree, lung, pleura or pericardium. Computed Tomography (CT) is helpful in the diagnosis and differentiation of ruptured and unruptured tumors. We report a case of ruptured anterior mediastinal teratoma in a 20-year-old female presenting with recurrent hemoptysis and cough; thus, mimicking a lung malignancy or tuberculosis. CT demonstrated a heterogeneous fat containing lesion in the anterior mediastinum with extension into the lingular lobe. Subsequent fine needle aspiration cytology (FNAC) yielded plenty of anucleate squames and debris, and a clear cut diagnosis could not be made. Total excision of the tumor was performed and histopathology of the surgically excised mass confirmed the CT diagnosis.

Keywords: Hemoptysis; Mediastinal Teratoma; Rupture; Tomography, X-Ray Computed.

Figure 1. Chest radiograph three years prior to admission shows a large ill-defined opacity with multiple lucencies adjacent to the left heart border

Figure 2. Contrast enhanced axial CT of thorax A, Heterogeneous mass containing fat (arrow), soft tissue, and gas, involving the mediastinum and lingular lobe B, Consolidation and ground-glass opacities seen in lingular lobe adjacent to the tumor

Figure 3. Teratoma gross-cut surface showing predominantly solid and few cystic areas and a bunch of hairs

Figure 4. Teratoma tissue section A, Mixture of gland, cartilage, and mesenchymal tissue B, Another area showing ectodermally derived tissue (skin and adnexa) (H & E × 200)