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Weekly Chest CasesArchive of Old Cases

Case No : 1024 Date 2017-06-12

  • Courtesy of Jin Joo Kim, Geewon Lee, Ji Won Lee, Yeon Joo Jeong / Pusan National University Hospital
  • Age/Sex 19 / M
  • Chief ComplaintChest discomfort
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6

Diagnosis With Brief Discussion

Diagnosis
Mature cystic teratoma
Radiologic Findings
Chest radiograph shows a mediastinal mass manifesting as bulging of right cardiac border with right pleural effusion. MR images show a multiloculated cystic mass with heterogeneous high-signal-intensity areas on T1- and T2-weighted images. Diffusion weighted MR images show no diffusion restriction. Contrast-enhanced T1-weighted images with fat saturation show peripheral and septal enhancement. Chemical shift images show an area of signal drop on opposed phase images. The patient underwent mediastinal mass excision. Photomicrograph of the surgical specimen shows a mature cystic teratoma containing skin, cartilage, fat tissue, and salivary gland. Preoperative CT images show a heterogeneous anterior mediastinal mass with areas of fat, fluid attenuation, and thin soft-tissue septae.

Opposed phase

Brief Review
Mature cystic teratoma is the most common benign mediastinal germ cell neoplasm (60-70%). It is composed of well-differentiated benign tissue from at least two of the three germ cell layers, which are ectoderm (skin and hair), mesoderm, and endoderm. Cyst formation is typical, and cysts are usually lined by tall, mucus-secreting epithelial cells. Patients with mediastinal mature cystic teratoma are ususally asymptomatic, but large size and malignant component can cause symptoms, such as cough, dyspnea, chest pain, upper respiratory complaints, and fever.
On radiography, mature cystic teratomas usually appear as sharply marginated, round or lobulated anterior mediastinal mass that may extend to one side of the midline. Calcification, ossification, or even teeth may be visible. At CT, these tumors appear as heterogeneous and well-defined masses with walls of variable thickness that may enhance. In 15% of cases, teratomas consist of only cystic portion that contains neither fat nor calcification. A fat-fluid level within the tumors is seen less frequently, but it is a highly specific finding. On MR, mature cystic teratomas appear as heterogeneous mediastinal mass containing a variable proportion of fat, fluid, soft tissue, and calcification. A fat-saturation MR imaging technique (phase-shift gradient-echo imaging or proton-selective fat-saturation imaging) can be used to detect fat.
References
1. Jeung MY, et al. Imaging of cystic masses of the mediastinum. Radiographics. 2002;22:S79-S93.
2. Choi SJ, Lee JS, Song KS et al. Mediastinal teratoma: CT differentiation of ruptured and unruptured tumors. AJR Am J Roentgenol. 1998;171 (3): 591-4.
Keywords
Mature Cystic Teratoma , anterior mediastinum,

No. of Applicants : 112

▶ Correct Answer : 72/112,  64.3%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - Hyogo Prefectural Amagasaki General Medical Center , Japan TOMOAKI OTANI
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Higashi-Ohmi General Medical Center , Japan AKITOSHI INOUE
  • - Chungbuk National University Hospital , Korea (South) YEONGTAE PARK
  • - Chonbuk National University Medical School , Korea (South) HYEJIN YANG
  • - King Abdulaziz University Hospital , Saudi Arabia Amr M. Ajlan
  • - Chonbuk National University Hospital , Korea (South) MINGI SHIN
  • - Chonbuk National University Hospital , Korea (South) JINHEE YOU
  • - IRSA LA ROCHELLE , France, Metropolitan BIGOT
  • - Korea University Guro Hospital , Korea (South) PARK SOYEON
  • - The University of Tokyo Hospital , Japan Yusuke Watanabe
  • - Chonbuk National University Hospital , Korea (South) EUN HA JUNG
  • - Chungbuk National University Hospital , Korea (South) SOOJUNG LEE
  • - Busan National University Hospital , Korea (South) ILWAN SON
  • - Other , Korea (South) SEONG SU KANG
  • - Madeira Medical center , Portugal Duarte Rufino Nascimento
  • - Asan Medical Center , Korea (South) HYUN JUNG KOO
  • - Busan National University Hospital , Korea (South) LEE YOU JIN
  • - Pusan national university hospital , Korea (South) MIRI JEONG
  • - Soonchunhyang University Hospital Seoul , Korea (South) SUNG HWAN BAE
  • - 罹…stanbul , Turkey AYHAN YILMAZ
  • - Amagasaki General Medical Center , Japan GENKI FUKUMOTO
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - privato , Italy VINCENZO ENZO GENCHI
  • - Samsung Medical Center , Korea (South) JUHYUN KIM
  • - The Jikei university , Japan TAKU GOMI
  • - Pusan national university hospital , Korea (South) SeungHyun Lee
  • - Asan Medical Center , Korea (South) HONG SANG HYUP
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Yonsei University, Wonju Severance Christian Hospital , Korea (South) JUYEON LEE
  • - Chonnam National University Hospital , Korea (South) JONG HYEON KIM
  • - Seoul National University Hospital , Korea (South) JI EUN KIM
  • - Chonnam National University Hospital , Korea (South) YOUNSU AHN
  • - Asan Medical Center , Korea (South) JIHYE KWON
  • - Chung buk national university hospital , Korea (South) hong gwon Byun
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Chungbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - Samsung Medical Center , Korea (South) MIN YEONG KIM
  • - Samsung medical center , Korea (South) Ran Kim
  • - Samsung Medical Center , Korea (South) KYOWON GU
  • - Medicheck health care , Korea (South) Chae hun Lim
  • - Chungbuk National University Hospital , Korea (South) LEE JUNG HWAN
  • - Mallinckrodt Institute of Radiology , United States Naganathan BS Mani
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - Kyeongpook National University Hospital , Korea (South) MIN A LEE
  • - Other , Korea (South) HAYEON LEE
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Kyeongpook National University Hospital , Korea (South) SUNGJUN MOON
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - Azienda Ospedaliera di Cremona , Italy Pietro Sergio
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - The University of Tokyo Hospital , Japan TAKU TAJIMA
  • - Other , Korea (South) MAERAN KIM
  • - Other , Korea (South) DONGHWAN KIM
  • - MBAL BURGAS , Bulgaria VLADISLAV BOYANOV RUSINOV
  • - Korea University Guro Hospital , Korea (South) JINWOO HAN
  • - Fortis hospital , Mohali , India SHALEEN RANA
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
  • - Korea University Guro Hospital , Korea (South) SUN HONG
  • - Teikyo University Hospital , Japan KAORU SUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - MCI , India TARUN KUMAR BAID
  • - Seoul National University Hospital , Korea (South) YONSUB SONG
  • - University of Tsukuba , Japan Toshitaka Ishiguro
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Chungbuk National University Hospital , Korea (South) HYEONMI RYU
  • - Korea University Guro Hospital , Korea (South) HWANSEOK YONG
  • - Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
  • - Korea University Guro Hospital , Korea (South) Yoonmi Choi
▶ Correct Answer as Differential Diagnosis : 18/112,  16.1%
  • - Niigata University , Japan ATSUSHI UEHARA
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - NIMS, HYDERABAD , India BHASKAR K
  • - consultant radiologist , India DEVINDERPAL SINGH DHANOTA
  • - Myongji Hospital , Korea (South) KYUNGHO KIM
  • - speciality medical officer , India DIVYESHKUMAR RAMNIKLAL DADHANIA
  • - The first affiliated Hospital of Xiamen University , China Qing Qiang Guo
  • - Other , Korea (South) SUNG HYUN YOON
  • - Dong-A University, College of Medicine , Korea (South) KI-NAM LEE
  • - Soonchunhyang University Hospital Seoul , Korea (South) BODA NAM
  • - GHICL , France MANUEL TOLEDANO
  • - Chonbuk National University Hospital , Korea (South) WEON JANG
  • - Yujin Yamazaki Hospital , Japan MASASHI TAKAHASHI
  • - The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
  • - Kaohsiung Veterans General Hospital , Taiwan MING-TING WU
  • - University of Utah , United States AKIHIKO SAKATA
  • - Pusan national university hospital , Korea (South) So min Park
▶ Semi-Correct Answer : 1/112,  0.9%
  • - university of montreal , Canada Andrei Bogdan Gorgos I
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