Mediastinal Teratoma

MAULIDYA AYUDIKA DANDANAH, DR

THORACIC, CARDIAC AND VASCULAR SURGERY DIVISION
Introduction

 Mediastinal tumors are benign or cancerous growths

that form in the area of the chest that separates the
lungs.
 This area, called the mediastinum, is surrounded by the
breastbone in front, the spine in back, and the lungs on
each side. The mediastinum contains the heart, aorta,
esophagus, thymus and trachea.
Introduction

 Mediastinal germ cell tumors are broadly classified as

benign or malignant
 Benign tumors include mature teratomas and mature
teratomas with an immature component of <50%
 Usually, mediastinal teratomas are the most frequent
mediastinal germ cell tumors, while immature teratomas
are very rare

Dulmet EM, Macchiarini P, Suc B, et al. Germ cell tumors of the mediastinum: a 30 year experience. Cancer 1993;72:1994.
Epidemiology

 Mediastinal teratomas are the most common extra-gonadal germ cell

tumours.
 They account for approximately 15% of anterior mediastinal masses in
adults and approximately 25% of anterior mediastinal masses in children.
 They are by far the most common mediastinal germ cell tumour,
accounting for 50-70% of such tumours
 The age of presentation is wide, but typical presentation in adults is in the
third or fourth decade (20s and 30s).
 In children below 1 year of age, immature teratomas are common (40%)
and may be detected antenatally
 No definite gender predilection for mature teratomas has been identified
(at most there is a slight female predilection). Immature teratomas
however, occur almost exclusively in males

Travis WD. Pathology and genetics of tumours of the lung, pleura, thymus and heart. Iarc. (2004) ISBN:9283224183
  Histologically, teratomas may be solid or cystic in appearance and are
often referred to as dermoid cysts if unilocular  The majority of
mediastinal teratomas is composed of mature ectodermal, mesodermal,
and endodermal elements and exhibits a benign course
Moeller KH, Rosado-de-Christenson ML, Templeton PA. Mediastinal mature teratoma: imaging features. AJR Am J Roentgenol 1997;169(4):985-990.

 Determination of serum tumor markers (α-fetoprotein AFP and human

beta-choriogonadotropin HCG) is important in the diagnosis and follow-up
of mediastinal germ cell tumors.
 Differently from immature teratomas, patients with benign teratomas have
normal markers.

Taniyama K, Ohta S, Suzuki H, Matsumoto M, et al. Alpha-fetoprotein-producing immature mediastinal teratoma showing rapid and massive recurrent
growth in an adult. Acta Pathol Jpn 1992;42(12):911.
Clinical presentation

 The majority of patients are asymptomatic, with the mediastinal mass

discovered incidentally when the thorax is imaged for another reason
 Masses that become symptomatic can do so in a variety of ways:
 mass effect
 respiratory distress (infants)
 respiratory failure
 superior mediastinal syndrome
 neck mass
 Horner syndrome
 endocrine function
 hormone production, e.g. beta-HCG, insulin

Travis WD. Pathology and genetics of tumours of the lung, pleura, thymus and heart. Iarc. (2004) ISBN:9283224183
Treatment

 For mature and differentiated teratomas the radical surgical removal is the
only curative treatment, because unnecessary delay may result in the
rupture of tumors or in malignant degeneration.
 The prognosis after surgical removal of the tumor is good and there is no
recurrence of tumor after complete excision
Smahi M, Achir A, Chafik A, et al. Mature teratoma of the mediastinum. Ann Chir 2000;125(10):965-971.

 For immature teratomas the main options are primary resection and
chemotherapy
THANK YOU…
Non surgical vs operabilitas
(TNM/evaluasi struktur)