Asymptomatic mature intrapericardial teratoma in an adult: a case report of a rare condition

Abstract

Background: Benign mature teratomas are the most common type of anterior mediastinal germ cell tumor. Mature intrapericardial teratomas are generally diagnosed during infancy because of symptoms of cardiac compression. In contrast, mature adult intrapericardial teratomas are extremely rare, accounting for less than 1% of mature intrapericardial teratomas. We describe herein a case of a mature intrapericardial teratoma in an asymptomatic adult.

Case presentation: A 52-year-old woman was found by computed tomography during a health checkup to have an anterior mediastinal mass. She was asymptomatic and hemodynamically stable with no evidence of heart failure. The preoperative provisional radiological diagnosis was a mature intrapericardial teratoma. A median sternotomy revealed an approximately 5-cm diameter protruding intrapericardial mass with a smooth surface. The mass was completely resected. Histopathological examination resulted in a diagnosis of a mature intrapericardial teratoma. The patient did well and has no evidence of recurrence 5 years after surgery.

Conclusions: Mature intrapericardial teratomas in adults are extremely rare. Given the risks of malignant transformation, rupture, compression of the heart, and infection, excision is indicated to prevent development of serious manifestations.

Keywords: Adult; Intrapericardial tumor; Mature teratoma; Surgery.

Fig. 1

a Chest computed tomography image showing a 50 × 45 × 40 mm mass in the anterior mediastinum with irregular marginal calcification. b Coronary CT shows no coronary aneurysm or feeding artery from the coronary artery

Fig. 2

Chest magnetic resonance images showing a mass in the anterior mediastinum on a T1-weighted and b T2-weighted sequences

Fig. 3

a Before the pericardiotomy. b Intraoperative photograph showing the tumor is attached to the adventitia of ascending aorta. c Surgical field after tumor resection. (*) Tumor and (★) aortic adventitia at the root of the ascending aorta

Fig. 4

a Gross specimen: a bosselated intrapericardial mass measuring 5.2 × 5.0 × 5.0 cm with a smooth external surface. b Macroscopic examination revealed a large cyst containing yellow cheese-like and tan-brown muddy material surrounded by calcification