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Weekly Chest CasesArchive of Old Cases

Case No : 1274 Date 2022-03-21

  • Courtesy of So Hyeon Bak, Heon Han / Kangwon National University Hospital
  • Age/Sex 67 / M
  • Chief ComplaintIncidental radiographic abnormality
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Mature cystic teratoma
Radiologic Findings
Fig 1-5. CT scans show a thin-walled cystic mass with internal fat attenuation in the visceral compartment.
Brief Review
Mature cystic teratomas (dermoid cysts), the most common type of mediastinal germ cell neoplasms, contain well-differentiated tissues derived from at least two of the three germ cell layers (ectoderm, mesoderm, and endoderm). These lesions most commonly occur in young adults and are usually detected in the anterior mediastinum, with only 3–8% observed in the posterior mediastinum. They are histopathologically characterized by the formation of cysts, which are usually lined by tall, mucus-secreting epithelial cells.
A large anterior mediastinal mass with a well-defined wall and predominant cystic component is highly suggestive of a mature cystic teratoma. Radiographically, a mature cystic teratoma usually presents as a sharply marginated, round, or lobulated anterior mediastinal mass that extends toward one side of the midline. On computed tomography imaging, the tumor appears as a heterogeneous and well-defined mass with variable wall thickness that may show enhancement. Although they may contain all four tissue types, including soft tissue, fluid, fat, and calcium, fluid-containing cystic components are usually the most prominent. Teratomas present with an exclusively cystic component without fat or calcification in 15% of cases. A fat-fluid level within the mass is a highly specific finding, although it is less frequent. Most mature cystic teratomas are multilobular; however, unilocular cystic lesions are known to occur.
References
1. Jeung MY et al. Imaging of cystic masses of the mediastinum. Radiographics. 2002;22:S79-S93.
2. Kim JH et al. Cystic tumors in the anterior mediastinum. Radiologic-pathological correlation. J Comput Assist Tomogr. 2003;27(5):714-723
Keywords
mediastinal teratoma,

No. of Applicants : 119

▶ Correct Answer : 26/119,  21.8%
  • - Korea University Guro Hospital , Korea (South) SEOKYOUNG LEE
  • - , Italy PAOLO BALDASSARI
  • - Tiger Gate Hospital , Japan SHIN-ICHI CHO
  • - , Japan CHIAKI SATO
  • - Other , Korea (South) HWANGHEE JO
  • - Other , Korea (South) SEONGSU KANG
  • - Chonbuk National University Hospital , Korea (South) DAEUL LEE
  • - Chonbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - Ajou University Hospital , Korea (South) HAEIN LEE
  • - , Korea (South) SUNHYANG LEE
  • - , Korea (South) HYUNSEUNG LEE
  • - Chonbuk National University Hospital , Korea (South) HYUNSOO BAE
  • - , Qatar NABIL SHERIF MAHMOOD
  • - Osaka city university Hospital , Japan TATSUSHI OURA
  • - Dokkyo Medical University , Japan HIROAKI ARAKAWA
  • - , Korea (South) KIM HYE IN
  • - Kyoto University Hospital , Japan SATOSHI IKEDA
  • - Duncan Hospital, Raxaul , India SHYJUMON GEORGE
  • - Seoul National University Bundang Hospital , Korea (South) YOONAH DO
  • - , Korea (South) SUBIN LEE
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA
  • - , Japan KAZUMA TERAUCHI
  • - Chonbuk National University Hospital , Korea (South) YOUNG JU SONG
  • - Chonbuk National University Hospital , Korea (South) HYEONG RYUN CHO
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
▶ Correct Answer as Differential Diagnosis : 35/119,  29.4%
  • - , Japan HIROAKI ARAKAWA
  • - , Japan JUN KANZAWA
  • - , China XUFGENG ZHENG
  • - Mayo Clinic , United States AKITOSHI INOUE
  • - , France ANNE-LAURE LEJEUNE
  • - , United Kingdom SAMSON KADE
  • - Osaka Red Cross Hospital , Japan YUSUKE UTSUNOMIYA
  • - NIMS, HYDERABAD , India BHASKAR K
  • - IRSA LA ROCHELLE , France JEAN LUC BIGOT
  • - Ichinomiya Nishi Hospital , Japan CHIHIRO KIGUCHI
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Ajou University Hospital , Korea (South) KYUNGMIN LEE
  • - Scans world , India PHILSON JOSEPH MUKKADA
  • - Osaka University , Japan AKINORI HATA
  • - Wonkwang University Hospital , Korea (South) HYOJOO KIM
  • - Shimada General Medical Center , Japan HAYATO NOZAWA
  • - Ajou University Hospital , Korea (South) MINJI KIM
  • - Inje University Pusan Paik Hospital , Korea (South) JIYEON HAN
  • - , Korea (South) JAYOUNG MOON
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Kyoto University Hospital , Japan YASUHISA KURATA
  • - Ajou University Hospital , Korea (South) YOU NA KIM
  • - , Korea (South) YEONG UK HWANG
  • - , United States HIROAKI TAKAHASHI
  • - Other , Korea (South) MINSU KIM
  • - Eskisehir Sehir Hastanesi , Turkey MURAT SAHIN
  • - Other , Korea (South) SEONG WON JANG
  • - Osmania Medical College, Hyderabad , India PURUSHOTHAMA RAO TUMMALA
  • - Paras hospital, Panchkula , India SHALEEN RANA
  • - Chonbuk National University Hospital , Korea (South) MINJEE KIM
  • - Hanyang University Hospital , Korea (South) SUNJIN RYU
  • - Chonbuk National University Hospital , Korea (South) DONG HAN SHIN
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - , Japan YUKI HAYASHI
  • - , Korea (South) JIYOUNG PARK
▶ Semi-Correct Answer : 1/119,  0.8%
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
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