CTICasesLarge Cystic Mediastinal Teratoma
Imaging findings
Chest radiograph and lateral view demonstrate a very large anterior mediastinal mass with a well-defined smooth portion of its margin visible where it contacts the lung but fading margins elsewhere. CT from an outside institution demonstrates a large predominantly cystic mass compressing the left ventricle, left atrium inferior vein, and left lower lobe, arising from or contiguous with the mediastinum. A small band of calcium is identified within the mass, and a small crescent of fat is seen on careful review, separate from the normal mediastinal and thymic fat. MRI confirms a predominantly cystic mass with fluid-fluid level, septations, and minimal solid component with some capsular enhancement. Surgery found a mature cystic teratoma containing hair, milky sebum-like liquid, and mature tissue elements with no malignant or immature components on pathology.
Key takeaways
Cystic mediastinal teratomas can be very large yet predominantly cystic with minimal solid components, making malignant or immature elements difficult to detect radiographically. The presence of any fat (even a small crescent) and calcium within a cystic anterior mediastinal mass in a young male should suggest germ cell origin. MRI is the optimal modality to characterize the cystic, solid, and fluid components. Even in males, a large cystic teratoma may be fully mature with excellent prognosis after complete surgical resection. The gross surgical description of hair and milky liquid in the operative specimen is characteristic.
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