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Weekly Chest CasesArchive of Old Cases

Case No : 1417 Date 2024-12-16

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  • Courtesy of Sang Young Oh / Asan medical center
  • Age/Sex 28 / F
  • Chief ComplaintAbnormal findings on chest X-ray
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Mature cystic teratoma
Radiologic Findings
Fig1. Posteroanterior chest radiograph shows anterior mediastinal mass.
Fig2~3. Contrast-enhanced chest CT scan show heterogenous mass. The mass contains foci of fat density and foci of water density area.
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.

Mature mediastinal teratomas are usually encapsulated tumors with a mean diameter of 10 cm (range 3-25 cm). There can be adhesions to the surrounding structures, such as lung or great vessels. The cut surface shows cystic spaces containing fluid, hair, fat, flecks of cartilage, and occasionally teeth and bone.
References
1. Jeung MY, et al. Imaging of cystic masses of the mediastinum. Radiographics. 2002;22:S79-S93.
2. Imaging of the chest, 1496~1498
Keywords

No. of Applicants : 62

▶ Correct Answer : 43/62,  69.4%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - , Japan SUZUNE TSUKAMOTO
  • - None , Ethiopia ABEL GIRMA GMARIAM
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - Oita university , Japan AYUMI KAMEI
  • - Kyoto City Hospital , Japan YUSUKE UTSUNOMIYA
  • - Seoul National University Hospital , Korea (South) HYUNGIN PARK
  • - , Korea (South) DONG-HO BANG
  • - Healthy Longevity Medical Center , Japan SHIN-ICHI CHO
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Other , Korea (South) SEONGSU KANG
  • - , Korea (South) JIN YOUNG LEE
  • - Secomedic Hospital , Japan FUMINORI MIYOSHI
  • - Oita University, Faculty of Medicine , Japan FUMITO OKADA
  • - University of Yamanashi , Japan TAKAAKI HASHIMOTO
  • - Osaka University , Japan AKINORI HATA
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - , Japan YOSHIKI ISHII
  • - University of Yamanashi , Japan HIROAKI WATANABE
  • - Nankai medical center , Japan NORITAKA KAMEI
  • - , Japan KENTARO KOTANI
  • - Other , Korea (South) CHAEHUN LIM
  • - Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
  • - , Japan SHUNJIRO NOGUCHI
  • - , Korea (South) HEONSEOK LEE
  • - Jichi Medical University, School of Medicine , Japan MITSURU MATSUKI
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Shiga General Hospital , Japan YUSAKU MORIBATA
  • - Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
  • - The First Affiliated Hospital of Nanjing Medical University , China TENG ZHANG
  • - , Japan SHUHEI NORIMOTO
  • - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
  • - Fukuoka university , Japan KEISUKE SATO
  • - Kantou Rousai Hospital , Japan KAORU SUMIDA
  • - Other , Korea (South) DONG HAN SHIN
  • - Matsunami General Hospital , Japan TARO TAKEDA
  • - Toyota Kosei Hospital , Japan YUKI HAYASHI
  • - The Catholic University of Korea Yoeuido St. Mary , Korea (South) CHAWOONG JEON
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - University of Yamanashi , Japan KOJIRO ONOHARA
  • - Jiangsu province hospital , China WANGJIAN ZHA
  • - , China ZHOU GANG
▶ Correct Answer as Differential Diagnosis : 11/62,  17.7%
  • - medical scanning , Japan HIROAKI ARAKAWA
  • - ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
  • - Kyoto University , Japan AKIHIKO SAKATA
  • - Other , Korea (South) DOWOO KIM
  • - Seoul Medical Center , Korea (South) HYUK GI HONG
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - Osaka metropolitan university Hospital , Japan TATSUSHI OURA
  • - Mie university , Japan SHIKO OKABE
  • - Kyoto University , Japan SHO KOYASU
  • - , Japan JUN YOSHIDA
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