Mediastinal teratoma causing hemoptysis

Abstract

Benign mediastinal teratoma sometimes perforate adjacent organs. We report a case of benign mediastinal teratoma perforating the right lung. A 19-year-old female was admitted to our hospital exhibiting symptoms of hemoptysis 8 days before she was due to be admitted for an operation on a tumor that had been diagnosed from a tumor shadow in the anterior mediastinum 1 month previously by her physician. On admission, chest roengenogram revealed an abnormal shadow in the right hilum and middle lobe, and CT showed a right anterior mediastinal mass. It was speculated that the hemoptysis might have been caused by a perforation of the tumor into the lung, and she was operated on. The tumor was observed on the right side of the anterior mediastinum and adhered to the right middle lobe of lung so firmly that it was necessary to resect part of the right lung. The tumor and part of lung were removed en block. Pathological examination showed a mature teratoma and pancreatic tissue with Langerhans'islands. At 24 hours post-operatively, a bronchopleural fistula developed at the resection line of the right middle lobe. We performed emergency re-thoracotomy and right middle lobectomy. In conclusion, in a case of mature teratoma with hemoptysis, it is important in lobectomy or segmentectomy to completely close fistula.