- Email: [email protected]
Mediastinal teratoma: Simplicity in diagnosis and therapy
Accepted Manuscript Mediastinal teratoma: Simplicity in diagnosis and therapy Pravin Kammar, MS, Sajid S. Qureshi, MS, DNB, FICS, FAIS PII:
S2468-1245(17)30023-2
DOI:
10.1016/j.phoj.2017.03.002
Reference:
PHOJ 32
To appear in:
Pediatric Hematology Oncology Journal
Received Date: 5 March 2017 Accepted Date: 7 March 2017
Please cite this article as: Kammar P, Qureshi SS, Mediastinal teratoma: Simplicity in diagnosis and therapy, Pediatric Hematology Oncology Journal (2017), doi: 10.1016/j.phoj.2017.03.002. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Mediastinal Teratoma: Simplicity in diagnosis and therapy Pravin Kammar MS, Sajid S Qureshi, MS, DNB, FICS, FAIS * Division of Pediatric Surgical Oncology, Department of Surgical Oncology, Tata
RI PT
1
Memorial Centre, Bombay, India.
*
SC
E-mail: [email protected], [email protected]
Correspondence to:
M AN U
Sajid S Qureshi, MS, DNB, FICS, FAIS. Division of Pediatric Surgical Oncology, Department of Surgical Oncology, Tata Memorial Centre, Ernest Borges Road, Parel. 400012. Bombay, India. Tel. No: +91-22-24177276 Fax: +91-22-24146937 E-mail: [email protected]
AC C
EP
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Running title: Mediastinal teratoma
ACCEPTED MANUSCRIPT Dear Editor,
A 6-year-old boy presented with complaints of chest pain since three months and had undergone a biopsy elsewhere three weeks before presentation to us. On
not
have
any
respiratory
distress.
A
RI PT
examination air entry was absent in the infraclavicular areas however, the patient did computed
tomogram
showed
gross hydropneumothorax with partial collapse-consolidation of the right lung and left shift.
A heterogeneous
predominantly
cystic
mass
SC
mediastinal
with fatty areas and solid component without any calcification occupied the anterior
M AN U
mediastinum. Serum alpha fetoprotein, beta human chorionic gonadotropin and lactate dehydrogenase levels were normal. Based on the characteristic radiological findings and normal tumor markers a diagnosis of mediastinal teratoma was established. Intraoperatively it was observed that the mass had ruptured and
TE D
contents of the mass had spilled into the pleural cavity. Meticulous dissection ascertained the mass arising from the thymus which was removed after securing the thymic veins. Histopathology confirmed a mature teratoma. A characteristic CT
EP
finding with normal tumor markers is diagnostic of pure teratoma at any site and this criterion was utilized for the diagnosis in the present case [1, 2]. Unfortunately,
AC C
despite the presence of the characteristic findings, our patient endured a biopsy and fluid aspiration which led to hydropneumothorax and the tumor rupture. Although the patient did not have an adverse event due to this, however, the spillage theoretically may increase the chance of relapse.
ACCEPTED MANUSCRIPT References
1. Franco A, Mody NS, Meza MP. Imaging evaluation of pediatric mediastinal masses. Radiol Clin North Am. 2005;43:325–53.
RI PT
2. Wright CD. Mediastinal tumors and cysts in the pediatric population. Thorac
AC C
EP
TE D
M AN U
SC
Surg Clin. 2009;19:47–61.
ACCEPTED MANUSCRIPT Legends to illustration
Figure 1: Computed tomogram showing [A] a mediastinal mass with collapse of the right lung and accompanying hydropneumothorax. [B] The mass showing mild
RI PT
peripheral enhancement, solid and cystic components within. The characteristic fat attenuation (solid white arrow head) can also be seen within the mass. The superior vena cava can be seen compressed by the mass (hollow arrow). [C] The mass is
SC
seen pushing the mediastinal structures to the left side and stretching the right pulmonary vessels (white arrow) and the right main bronchus (black arrow). It closely
M AN U
abuts the right atrium (hollow circle) and ventricle (solid black dot).
Figure 2: Intraoperative image showing ruptured mediastinal mass with extravasation
AC C
EP
TE D
of sebaceous material into the thoracic cavity.
AC C
EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
AC C
EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
S2468-1245(17)30023-2
DOI:
10.1016/j.phoj.2017.03.002
Reference:
PHOJ 32
To appear in:
Pediatric Hematology Oncology Journal
Received Date: 5 March 2017 Accepted Date: 7 March 2017
Please cite this article as: Kammar P, Qureshi SS, Mediastinal teratoma: Simplicity in diagnosis and therapy, Pediatric Hematology Oncology Journal (2017), doi: 10.1016/j.phoj.2017.03.002. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Mediastinal Teratoma: Simplicity in diagnosis and therapy Pravin Kammar MS, Sajid S Qureshi, MS, DNB, FICS, FAIS * Division of Pediatric Surgical Oncology, Department of Surgical Oncology, Tata
RI PT
1
Memorial Centre, Bombay, India.
*
SC
E-mail: [email protected], [email protected]
Correspondence to:
M AN U
Sajid S Qureshi, MS, DNB, FICS, FAIS. Division of Pediatric Surgical Oncology, Department of Surgical Oncology, Tata Memorial Centre, Ernest Borges Road, Parel. 400012. Bombay, India. Tel. No: +91-22-24177276 Fax: +91-22-24146937 E-mail: [email protected]
AC C
EP
TE D
Running title: Mediastinal teratoma
ACCEPTED MANUSCRIPT Dear Editor,
A 6-year-old boy presented with complaints of chest pain since three months and had undergone a biopsy elsewhere three weeks before presentation to us. On
not
have
any
respiratory
distress.
A
RI PT
examination air entry was absent in the infraclavicular areas however, the patient did computed
tomogram
showed
gross hydropneumothorax with partial collapse-consolidation of the right lung and left shift.
A heterogeneous
predominantly
cystic
mass
SC
mediastinal
with fatty areas and solid component without any calcification occupied the anterior
M AN U
mediastinum. Serum alpha fetoprotein, beta human chorionic gonadotropin and lactate dehydrogenase levels were normal. Based on the characteristic radiological findings and normal tumor markers a diagnosis of mediastinal teratoma was established. Intraoperatively it was observed that the mass had ruptured and
TE D
contents of the mass had spilled into the pleural cavity. Meticulous dissection ascertained the mass arising from the thymus which was removed after securing the thymic veins. Histopathology confirmed a mature teratoma. A characteristic CT
EP
finding with normal tumor markers is diagnostic of pure teratoma at any site and this criterion was utilized for the diagnosis in the present case [1, 2]. Unfortunately,
AC C
despite the presence of the characteristic findings, our patient endured a biopsy and fluid aspiration which led to hydropneumothorax and the tumor rupture. Although the patient did not have an adverse event due to this, however, the spillage theoretically may increase the chance of relapse.
ACCEPTED MANUSCRIPT References
1. Franco A, Mody NS, Meza MP. Imaging evaluation of pediatric mediastinal masses. Radiol Clin North Am. 2005;43:325–53.
RI PT
2. Wright CD. Mediastinal tumors and cysts in the pediatric population. Thorac
AC C
EP
TE D
M AN U
SC
Surg Clin. 2009;19:47–61.
ACCEPTED MANUSCRIPT Legends to illustration
Figure 1: Computed tomogram showing [A] a mediastinal mass with collapse of the right lung and accompanying hydropneumothorax. [B] The mass showing mild
RI PT
peripheral enhancement, solid and cystic components within. The characteristic fat attenuation (solid white arrow head) can also be seen within the mass. The superior vena cava can be seen compressed by the mass (hollow arrow). [C] The mass is
SC
seen pushing the mediastinal structures to the left side and stretching the right pulmonary vessels (white arrow) and the right main bronchus (black arrow). It closely
M AN U
abuts the right atrium (hollow circle) and ventricle (solid black dot).
Figure 2: Intraoperative image showing ruptured mediastinal mass with extravasation
AC C
EP
TE D
of sebaceous material into the thoracic cavity.
AC C
EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
AC C
EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT