Aleksic I Intrapulmonary Cystic Benign Teratoma a Case Report and Review of the Literature
Cureus. 2019 Jan; 11(1): e3834.
A Case Report of Intrapulmonary Teratoma in the Right Upper Lung Zone in a 35-year-sometime Female Patient
Monitoring Editor: Alexander Muacevic and John R Adler
Ahmed A Bawazir
1 Internal Medicine, Alfaisal University, Riyadh, SAU
Naif M Alrossais
ane Internal Medicine, Alfaisal University, Riyadh, SAU
Yara BinSaleh
ii Surgery, Alfaisal University, Riyadh, SAU
Abdulhadi A Alamodi
2 Surgery, Alfaisal University, Riyadh, SAU
Abdullah Alshammari
2 Surgery, Alfaisal University, Riyadh, SAU
Received 2018 Nov 21; Accustomed 2019 January 7.
Abstract
Teratomas are rare germ prison cell tumors usually institute in the gonads. Extra-gonadal teratomas are specially rare, mostly occurring in the thorax. Merely a few cases of intrathoracic teratomas have been reported in medical literature and nigh reported were located in the mediastinum. An additional intrathoracic location for teratoma occurrence is in the pulmonary system, most usually in the upper lobe of the left lung. In this report, we describe a instance of a 35-year-old woman diagnosed with an intrapulmonary mature teratoma plant in the right upper lobe. A 35-yr-old Saudi female presented with a chief complaint of a iii-week history of dry cough. Chest X-ray revealed a right-sided para-pericardial mass in the anterior mediastinum and a significant decrease in the size of the correct middle lobe opacity. Subsequently, a chest computed tomography (CT) was performed and revealed a cystic mass in the right lung, which required removal by surgical intervention. The surgery was performed via a thoracoscopic approach and the tumor was excised with no complications. Intrapulmonary teratomas (IPT) unremarkably nowadays with vague and not-specific symptoms such as cough, hemoptysis, and chest hurting. It is a rare condition without diagnostic features detected preoperatively, save for trichoptysis which is reported in approximately 13% of the cases. We study a rare advent of mature IPT in the right upper lung zone which is an unusual location.
Keywords: intrapulmonary, teratoma, mature teratoma
Introduction
Teratomas are rare germ prison cell tumors composed of 1 or multiple tissues, such as hair, sebaceous glands, teeth and other tissues derived from germ cells. They are generally beneficial and occur nearly often in gonadal organs, namely the ovaries and testicles. However, they tin can also be plant in extra-gonadal areas, specially the thorax [1-2].
Intrathoracic teratomas are ordinarily seen in the mediastinum. Withal, in some extremely rare cases, intrathoracic teratomas occur inside the parenchyma of the lungs [3]. Since its beginning clarification by Mohr in 1839 in the literature, only a few cases of intrapulmonary teratomas (IPT) have been reported. It is believed that IPTs are derived from the third endodermal pharyngeal pouch, from which the thymus develops embryonically [iii-4]. IPTs usually involve the upper lobe of the lung, for reasons nonetheless unidentified; patients with IPT ordinarily present with not-specific symptoms such as breast pain, persistent cough, and/or hemoptysis [1-4]. All the same, in approximately thirteen% of the cases, patients nowadays with trichoptysis (expectoration of hair) which signifies communication of the teratoma with the bronchus. Surgical resection is currently the sole management method of IPTs and holds a good prognosis in almost patients [five].
Case presentation
A 35-year-quondam Saudi female person presented to her local hospital complaining of a iii-calendar week history of dry cough. Her past medical history was unremarkable. Breast imaging revealed a mass in the anterior mediastinum. The patient was referred to King Faisal Specialist Hospital (KFSH) for further workup.
Repeated breast X-ray revealed a right-sided para-pericardial mass in the anterior mediastinum and a meaning decrease in the size of the correct centre lobe opacity (Figure 1). No other focal opacities were identified. The cardiac silhouette appeared unremarkable. In that location was no pleural effusion or pneumothorax.
Chest X-ray revealed a right-sided para-pericardial mass in the anterior mediastinum and a significant decrease in the size of the right middle lobe opacity
A breast computed tomography (CT) was ordered for the patient, which revealed a cystic mass for which surgical resection was indicated (Figure 2).
Computed tomography (CT) of the breast revealed a cystic mass in the correct upper lung zone
The patient was admitted and through a right thoracoscopic approach, the cyst was excised. Intraoperatively, there was significant adhesion of the right lung to the anterior breast wall surrounding the cyst. Dissection was fabricated using diathermy claw and blunt dissection until the lung became almost completely free mainly in the inductive and mediastinal aspect of the pleura. A thick cyst at the inductive segment of the right upper lobe was identified. The cyst was and then excised completely past wedge resection and modest oozing around the hilum was encountered simply controlled by clips. A minor incision was made in the anterior chest wall and inside was constitute cheese-similar fabric. A breast tube was inserted in the apex and the anesthetist was asked to inflate the lung, which was done well. The wound was closed in layers, the patient was awoken, and she was sent to the recovery room in good condition. Her postoperative catamenia was uneventful. The retrieved specimen consisted of 64.4 thousand of lung tissue measuring 14.5 x half dozen.0 x 3.0 cm. There was a mass opened on the pleural surface measuring 6.0 ten 5.0 x two.five cm containing soft xanthous textile. The diagnosis of mature teratoma was and so established. The chest tube was removed on the postoperative day ii. The patient was discharged on postoperative day 3 in a good shape. The patient was given a follow-up date to the thoracic surgery clinic.
Discussion
In general, germ cell tumors in the thorax are either secondary tumors, metastasized from the gonads, or developed de novo at the thorax. The virtually mutual actress gonadal germ prison cell tumors in adults are located in the mediastinum [iv-6]. IPTs are a very rare germ-prison cell tumor. Past 1996, only 65 cases had been reported in English and Japanese literature, with the first study in 1939. Most IPTs reported are located in the upper left lobe. However, in this case, the IPT was found to exist in the upper right lung lobe [4-6].
Most teratomas are beneficial and grow slowly. Although teratomas may be nowadays in any age group, IPTs commonly affect patients in their first and second decades of life. IPTs can be nowadays in males and females equally, unlike malignant mediastinal germ jail cell tumors, which affect males more than females [4-8]. Symptoms of IPTs vary according to multiple factors, including their size, location, and tissue blazon of which they are comprised [7]. The patient, in this case, complained of dry cough, considered the virtually common symptom of IPTs, alongside hemoptysis and chest pain. Other symptoms of IPTs include trichoptysis, pneumonia, fever, bronchiectasis, abscess, and infection [1-3]. There is no relationship betwixt the size of the teratoma and malignancy [5-half dozen].
Cancerous teratomas take a poor prognosis [i-3]. One major complication of IPTs is rupture of the tumor, which some believe to be caused by digestive or proteolytic enzymes secreted by the tumor itself [5-8]. Rupture of the teratoma into the pericardium may cause cardiac tamponade, a medical emergency [iv].
The recommended management of beneficial teratomas is consummate surgical excision. Failure to surgically remove the tumor tin lead to serious complications including excessive hemoptysis, tumor enlargement, adult respiratory distress syndrome and eventual demise [1-2,5,viii].
Conclusions
IPTs usually present with vague and not-specific symptoms such as coughing, hemoptysis, and chest pain. It is a rare condition without diagnostic features detected preoperatively, save for trichoptysis which is reported in approximately 13% of the cases.
Notes
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Human Ethics
Consent was obtained by all participants in this report
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6411339/