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Management of
Mediastinal Teratoma

Ulfah Wisdayanti
17100129019

Pembimbing: dr Ivan, Sp. BTKV

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Introduction

 Mediastinum is a space in the central of the thoracic cavity between

the pleural cavities that contain all the thoracic viscera except the
lungs

 Boundaries
 Anterior: sternum
 Posterior: column vertebra
 Superior: thoracic inlet
 Inferior: diaphragm
 Lateral: parietal pleura
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DIVISION OF MEDIASTINUM

Superior mediastinum

Inferior mediastinum:
 Anterior mediastinum
 Middle mediastinum
 Posterior mediastinum
+ DIVISION OF THE MEDIASTINUM
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The contains
Superior mediastinum:
• Trachea
Anterior mediastinum:
• Oesophagus
• Thymus gland
• Blood vessels
• Lymph nodes
• Nerves
• Fat
• Thymus
• Lymph nodes

Posterior mediastinum:
Middle mediastinum:
• Oesophagus
• Heart
• Arteries
• Arteries
• Veins
• Veins
• Nerves
• Nerves
• Thoracic duct
• Tracheobronchial lymph
• Lymph nodes
nodes
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MEDIASTINAL MASSES
(Anterior mediastinal masses)

GERM CELL TUMOR

• Teratoma (mature or immature)

• Nonteratomatous carcinoma
 Seminoma
 Non seminomatous Germ Cell

THYMUS: Mediastinal Lymphoma

• Thymoma • Hodgkin’s lymphoma

• Thymic carcinoma • Non-hodgkin’s lymphoma
• Thymic cyst
• Thymolipoma
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Germ Cell Tumors

 Teratoma

• Teratoma matur

• Teratoma immatur

 Nonteratomatous germ cell carcinoma

• Seminoma

• Nonseminomatous germ cell tumor

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Germ Cell Tumor

 Mediastinum is the extragonadal location, which is germ cel tumours

are most commonly found

 About 5-10% of all germ cell tumors are found in the mediastinum

 Germ cell tumors can be benign or malignant

 Mediastinal Teratoma
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Epidemiology

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

tumors

 Approximately 15% in adults, 25% im children of anterior

mediastinal masses. About 50-70% of mediastinal germ cell tumor

 Age adult: third or fourth decade (20s or 30s), Children: < 1 year
 Mediastinal Teratoma
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Clinical Presentation

 The majority of patients are asymptomatic  Rupture

 Mass effect: • Chest pain

• Respiratory distress (infants) • Haemoptysis

• Respiratory failure • Respiratoty distress
• Superior mediastinal syndrome • Cardiac temponade
• Neck mass • Pleural effusion
• Horner syndrome

 Endocrone function

• Hormone production (beta HCG, insulin)

 Mediastinal Teratoma
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Planning Diagnostic

 Laboratory (B h-CG dan AFP)

 Imaging:

• Radiography thorax

• CT Scan thorax

• MRI

• Radionuclide scanning

• Echocardiograpy and ultrasonography

• Positron emission tomography (PET)

• Arteriography
 Planning diagnostic: imaging
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Radiography thorax

 The PA view allows for determination of bilaterality and superior or

inferior location, while the lateral chest radiograph determines the
specific compartment.
 Planning diagnostic: imaging
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CT Scan thorax

 CT is the test of choice for mediastinal masses. This test can greatly
assist in determining the exact location of the mediastinal tumor

 Shows therelationship to adjacent structures.

 It also is useful in differentiating masses that originate in the

mediastinum from those that encroach upon the mediastinum from
the lung or other structures.

 The CT scan is very useful in differentiating tissue densities

 Planning diagnostic: imaging
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MRI
 Magnetic resonance imaging (MRI) is not routinely used to
investigate germ cell neoplasms

 It can be used when iodinated contrast cannot be administered

 MRI is more useful than CT in the evaluation of invasion or

extension of tumors, especially tumors closely associated with the
heart

 MRI is more useful than CT in the evaluation of invasion or

extension of tumors, especially tumors closely associated with the
heart

 CT is superior in detecting pulmonary metastasis, spatial relationship

to other mediastinal structures, and bony destruction
 Planning diagnostic: imaging
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Radionuclide scanning

 The iodine-131 (I-131) or iodine-123 (I-123) scans are not indicated

specifically for the identification of germ cell tumors, but they are
used to identify thyroid tissue

 Radionuclide scanning as a tool that can be used to distinguish the

nature of an unknown anterior mediastinal mass

 Because germ cell tumors and abnormalities of the thyroid (eg,

ectopic thyroid) present as anterior mediastinal masse
 Planning diagnostic: imaging
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Echocardiograpy and ultrasonography

 Ultrasonographic methods have been used to differentiate solid from

cystic mediastinal masses

 In general, given the accuracy and detail provided by CT , MRI, and

selected radionuclide scans, ultrasound techniques generally are not
used as primary tools in the evaluation of mediastinal tumors and
cysts
 Planning diagnostic: imaging
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Positron emission tomography (PET)

 For the evaluation of neoplasms, such as lung, colorectal, breast,

lymphoma, and melanoma.
 Planning diagnostic: imaging
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Arteriography

 Conventional angiography has been used to differentiate mediastinal

masses from vascular abnormalities

 As well as to exhibit the relationship between known masses and

adjacent vascular structures.
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Diagnostic Procedures

 Transthoracic needle biopsy

 Cevical mediastinoscopy and substernal extended mediastinoscopy

 Anterior mediastinotomy

 VATS

 Sternotomy and thoracotomy

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Histologic Findings

 Teratoma

• Mature teratomas commonly are cystic and well differentiated tissues

from 3 germinal cell layers

• Immature teratomas

• Teratomas with malignant components (germinal cell tumor type,

adenocarcinoma, squamous cacinoma, mesenchymal or sarcomatous
type, or combination
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Treatment

 Surgical resection is the treatment of choice for most neoplasms that

occur in the mediastinum, except for malignant germ cell neoplasms

 Benign teratomas are tumors for which surgical excision is adequate

therapy

 VATS techniques have been introduced in teratoma resection with

promising results.
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THANK YOU