Tuberc Respir Dis.  2009 Feb;66(2):127-131.

A Case of Mediastinal Teratoma Associated with Elevated Tumor Marker in Chronic Empyema

• Um SJ
• Yang DK
• Lee SK
• Son C
• Roh MS
• Kim KN
• Lee KN
• Choi PJ
• Bang JH

Abstract

Most mediastinal teratomas are histologically well-differentiated tumors and benign. The majority of patients with a mediastinal teratoma are asymptomatic and their tumors are usually discovered incidentally on chest radiography. On rare occasions this tumor will rupture spontaneously into the adjacent organs. A 72-year-old female patient was admitted for dyspnea and she had a multiloculated pleural effusion in the left lung field. Although repeated pleural biopsy and pleural fluid cytology did not prove the presence of malignancy, we assumed that this was a malignant effusion because it revealed consistently high levels of carcinoembryonic antigen and carbohydrate antigen 19-9, and the chest CT scan did not show typical fat or bone density in the mass. Secondary infection and an uncontrolled septic condition due to pleural empyema finally compelled the patient to undergo a surgical operation. Mature teratoma was the final diagnosis and she has done well without recurrence for 2 months.

Keyword

Teratoma; Pleural effusion; Carcinoembryonic antigen

MeSH Terms

Aged
Biopsy
Bone Density
Carcinoembryonic Antigen
Coinfection
Dyspnea
Empyema
Empyema, Pleural
Female
Humans
Lung
Pleural Effusion
Recurrence
Rupture
Teratoma
Thorax
Carcinoembryonic Antigen

Figure

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  Figure 1 Chest radiograph on admission (A) shows large amount of left pleural effusion, and improved finding 20 days after removal of mediastinal teratoma and effusion (B).

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  Figure 2 Chest computed tomography (CT) on admission (A) shows large amount of multiloculated left pleural effusion with atelectatic change of left lung. A lobulated soft tissue density lesion within mediastinal pleural effusion and diffuse pleural thickening are seen. Chest CT after 6 months (B) shows no interval change of multiloculated left pleural effusion with internal soft tissue density lesion, and pleural thickening. Note newly developed pericardial and right pleural effusion.

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  Figure 3 The histologic findings of specimens are consistent with teratoma. The cystic area (A) is lined by keratinized stratified squamous epithelium (H&E stain, ×20). The solid area (B) is composed of heterogeneous mature tissues and organized structures, including pancreas tissue, muscle, cartilage and dilated glandular structures (H&E stain, ×100). Immunohistochemical stains of solid area (C) demonstrate positive staining for carcinoembryonic antigen (CEA).

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