CASE 6173 Published on 06.06.2008
0

Malignant Teratoid Tumor

Section

Chest imaging

Case Type

Clinical Cases

Authors

Prepared by: 1. Dr Osama Ahmed Elzamazmi, FRCR in diagnostic radiology. Dubai Hospital. PO Box 7272. Dubai. UAE. Osam_zam@yahoo.com
2. Dr Jassem Salem. German board in diagnostic radiology. Dubai Hospital. PO Box 7272. Dubai. UAE. Email: jassem_ibrahim@hotmail.com

Connected authors
Patient

2 years, male

Download as PDF Print Show related cases Notify admin
Clinical History
A 2-year-old male patient presented with shortness of breath, cough and signs of SVC obstruction.
Imaging Findings
A 2-year-old male patient presented with shortness of breath, cough and signs of SVC obstruction. A CT scan of the chest with IV contrast showed a huge lobulated markedly necrotic and heterogeneously enhancing anterior mediastinal mass compressing and shifting the mediastinal structures towards the left side. The SVC was markedly compressed and slit-like explaining multiple mediastinal and chest wall
collaterals (SVC syndrome). Multiple small satellite lymph nodes were noted around the mass and in the supraclavicular and axillary regions. Bilateral pleural effusion was marked on the right side.The case was diagnosed by CT-scan guided biopsy.
Discussion
MALIGNANT TERATOID TUMOR:
Teratocarcinoma/ malignant teratoma.

1. Seminoma or germinoma:
most common mediastinal germ cell tumor. Most common primary malignant germ cell tumor of mediastinum! Incidence: 2-6% of all mediastinal tumors; 5-13% of all malignant mediastinal tumors. Age: 3rd-4th decade; Male> Female. Metastases: To regional lymph nodes, lung, bone, liver. Radiological appearance: large bulky well-marginated lobulated mass. Usually no calcification. Homogeneous soft–tissue density with slight enhancement.

2. Nonseminomatous Malignant germ cell tumor:
Age: During 2nd-4th decade. Male : Female = 9:1; in children Male=Female. Associated with: Klinefelter syndrome (in 20%), hematologic malignancy. Clinical presentation: Chest pain, dyspnea,cough, weight loss, fever SVC syndrome. Metastases to: lung, liver. Radiological appearance: Large tumor of heterogeneous texture with central hemorrhage / necrosis. Well circumscribed / with irregular margins and enhancement of tumor periphery. Lobulation suggests malignancy. Invasion of mediastinal structures (SVC obstruction is ominous). Pleural/pericardiacl effusion (from local invasion). Complication: (1) Hemorrhage (2) Pneumothorax (from bronchial obstruction with air trapping and alveolar rupture) (3) Respiratory distress (rapid increase in size from fluid production) with compression of traches/ SVC (SVC syndrome). (4) Fistula formation to aorta, SVC, esophagus (5) Rupture into bronchus (expectoration of oily substance /trichopytysis in 5-14%lipoid pneumonia). (6) Rupture into pericardium (pericardial effusion) or pleural cavity (pleural effusion). Differential diagnosis: thymoma, lymphoma.
Differential Diagnosis List
malignant tertoid tumor
Final Diagnosis
malignant tertoid tumor
Case information
URL: https://www.eurorad.org/case/6173
DOI: 10.1594/EURORAD/CASE.6173
ISSN: 1563-4086
Figure 1

Contrast enhanced CT-scan of the chest.

Contrast enhanced CT-scan of the chest.
showed huge lobulated markedly necrotic and heterogeneously enhancing anterior mediastinal mass compressing and shifting the mediastinal structures towards the left side. The SVC is markedly compressed and slit like hence the multiple mediastinal and chest wall collaterals (SVC syndrome). Multiple small satellite lymph nodes are noted around the mass and in the supraclavicualr and axillary regions .Bilateral pleural effusion which is marked on the right side.
Contrast enhanced CT-scan of the chest.
showed huge lobulated markedly necrotic and heterogeneously enhancing anterior mediastinal mass compressing and shifting the mediastinal structures towards the left side. The SVC is markedly compressed and slit like hence the multiple mediastinal and chest wall collaterals (SVC syndrome). Multiple small satellite lymph nodes are noted around the mass and in the supraclavicualr and axillary regions .Bilateral pleural effusion which is marked on the right side.
Contrast enhanced CT-scan of the chest.
showed huge lobulated markedly necrotic and heterogeneously enhancing anterior mediastinal mass compressing and shifting the mediastinal structures towards the left side. The SVC is markedly compressed and slit like hence the multiple mediastinal and chest wall collaterals (SVC syndrome). Multiple small satellite lymph nodes are noted around the mass and in the supraclavicualr and axillary regions .Bilateral pleural effusion which is marked on the right side.
Contrast enhanced CT-scan of the chest.
showed huge lobulated markedly necrotic and heterogeneously enhancing anterior mediastinal mass compressing and shifting the mediastinal structures towards the left side. The SVC is markedly compressed and slit like hence the multiple mediastinal and chest wall collaterals (SVC syndrome). Multiple small satellite lymph nodes are noted around the mass and in the supraclavicualr and axillary regions .Bilateral pleural effusion which is marked on the right side.
Contrast enhanced CT-scan of the chest.
showed huge lobulated markedly necrotic and heterogeneously enhancing anterior mediastinal mass compressing and shifting the mediastinal structures towards the left side. The SVC is markedly compressed and slit like hence the multiple mediastinal and chest wall collaterals (SVC syndrome). Multiple small satellite lymph nodes are noted around the mass and in the supraclavicualr and axillary regions .Bilateral pleural effusion which is marked on the right side.
Contrast enhanced CT-scan of the chest.
showed huge lobulated markedly necrotic and heterogeneously enhancing anterior mediastinal mass compressing and shifting the mediastinal structures towards the left side. The SVC is markedly compressed and slit like hence the multiple mediastinal and chest wall collaterals (SVC syndrome). Multiple small satellite lymph nodes are noted around the mass and in the supraclavicualr and axillary regions .Bilateral pleural effusion which is marked on the right side.
Contrast enhanced CT-scan of the chest.
showed huge lobulated markedly necrotic and heterogeneously enhancing anterior mediastinal mass compressing and shifting the mediastinal structures towards the left side. The SVC is markedly compressed and slit like hence the multiple mediastinal and chest wall collaterals (SVC syndrome). Multiple small satellite lymph nodes are noted around the mass and in the supraclavicualr and axillary regions .Bilateral pleural effusion which is marked on the right side.
Contrast enhanced CT-scan of the chest.
showed huge lobulated markedly necrotic and heterogeneously enhancing anterior mediastinal mass compressing and shifting the mediastinal structures towards the left side. The SVC is markedly compressed and slit like hence the multiple mediastinal and chest wall collaterals (SVC syndrome). Multiple small satellite lymph nodes are noted around the mass and in the supraclavicualr and axillary regions .Bilateral pleural effusion which is marked on the right side.