1995 Volume 9 Issue 7 Pages 879-884
An anterior mediastinal tumor (6×5×4 cm) was removed from a 47-year-old female. The biochemical examination of the liquid contents obtained from the cystic part of the tumor demonstrated low protein concentration (0.3g/dl) but a high concentration of amylase (429 IU/l), CEA (62.7ng/ml), and CA 19-9 (greater than 240U/ml). Amylase isozyme analysis by electrophoresis showed that three pancreatic types of amylase comprised at least 65% of the total amylase. The tumor was believed to originate from the left thymus and strong adhesions to the left lung were found. The tumor and the part of the lung were removed en bloc. Pathological examination showed a mature teratoma and pancreatic tissue with Langerhans' islands. Early fibrosis and tissue lysis between the tumor and the lung, and inflammatory cell infiltration, accumulation of histiocytes and formation of lymphoid follicles in the lung were also observed. These findings suggested an early perforation in a mediastinal teratoma into the lung. In this patient the early process of perforation into the lung could be seen because the operation could remove the tumor en bloc with the lung within two months of the onset of left chest pain before the tumor could have perforated into the free thoracic cavity.
The pancreatic tissue and the high value of amylase (429IU/l), including mostly three pancreatic types of amylase, in the tumor suggested the mechanism of perforation by a mediastinal teratoma. The teratoma of this patient would have perforated completely into the lung or the bronchus later. This case illustrates the importance of the early removal of mediastinal teratomas.
