2017 Volume 31 Issue 6 Pages 784-788
A 40-year-old male had a 2-week history of fever and left chest pain prior to consultation. Pneumonia with pleuritis was suspected based on a chest radiograph. Chest CT and MRI showed a polycystic mass in the superior anterior mediastinum.
Therefore, intrathoracic perforation by a mature mediastinal teratoma was suspected.
Operation was performed with a median sternotomy. The intra-operative histopathological diagnosis showed no malignant findings.
The adhesion of the mass and the left lung was marked because of inflammation, and we removed the mass and resected part of the left upper lobe of the lung.
The final pathological diagnosis was a mature mediastinal teratoma.
The cause of this perforation was most likely to be histolysis with pancreatic enzymes in the tumor. We considered that the autolysis with pancreatic enzymes was the cause of this perforation, because there was pancreatic tissue based on pathologic findings and no other potential cause present, although amylase of the pleural effusion did not show a high level.
Perforation caused by a mature mediastinal teratoma can cause a variety of complications. Because a mature mediastinal teratoma can show malignant transformation, we should resect it completely.
