Soumyodhriti Ghosh1, Hari Ignatius Pandey1, Shabnam Kumari2, Sunaram Majhi3, Abhijit Kundu4, Pradeep Singh5, Abhishek Kumar5.
1Department of Pediatric Surgery, Abhishek Child Care hospital, Jamshedpur,
2Department of Obstetrics & Gynecology, Abhishek Child Care hospital, Jamshedpur,
3Department of Anesthesiology, Abhishek Child Care hospital, Jamshedpur,
4Department of Surgery, Tata Main Hospital, Jamshedpur,
5Department of Pediatrics, Abhishek Child Care hospital, Jamshedpur.
ADDRESS FOR CORRESPONDENCE
Soumyodhriti Ghosh, Department of Pediatric Surgery, Abhishek Child Care Hospital. Jamshedpur- 831001, Jharkhand.
Email: drsghosh.surg85@gmail.com | | Keywords | | thorax, mediastinal mass, surgery | | | Mediastinal mass, particularly teratoma is extremely uncommon in infancy. The incidence is around 1 in 4000 live births with mediastinum being one of the least reported sites in pediatric age groups.1,2 The mentioned case underlines the high degree of dilemma in diagnosis and management of children presenting with such rare thoracic mass.
A three months infant presented to the pediatric emergency with respiratory distress, persistent non productive cough, poor appetite and poor weight gain. The patient was sick looking, dyspneic with mild intercostal retractions. Blood parameters had elevated leukocytes and high alpha fetoprotein levels. Chest xray suggested a large mediastinal shadow more to the left. CECT was done suggestive of anterior mediastinal mass lesion with compression of great vessels, abutting the pericardium and left pleura projecting towards the left hemithorax. Left anterolateral thoracotomy was done with findings of the heterogenous mass densely adherent to the superior vena cava, innominate vein, phrenic nerve, pericardium and left pleura. The mass was excised in totality. All major vessels and nerves were preserved. The post operative period was uneventful. The patient was discharged home after seven days of stay. The biopsy was suggestive of mature teratomatous component.
Mature teratoma in the mediastinum is a rare tumor. It accounts for only 1 percent of all mediastinal tumors.1,3 The most common reported sites of teratoma are sacrococcygeal (40%), ovary (25%), testicle (12%), brain (5%) and others including neck and mediastinum (18%). The child presents with compression symptoms lading to progressively severe respiratory compromise, low weight gain and poor appetite.3,4,5 Most of such patients are diagnosed incidentally on chest x ray. Confirmation of diagnosis and extent of disease needs a CT scan. The standard treatment for any such compressing mass is urgent surgical excision. Surgery offers the best outcome although surgicalexcision across all planes may be challenging due to the abutment of the mass close to great vessels, nerves and vital structures. Post surgery, the histology determines the need for adjuvant therapy.1,5 For cases like ours, that are mature and benign histologically, surgery is the curative treatment and there is no role of chemoradiation.
A mature mediastinal teratoma is a potential surgical emergency due to its inherent closeness to vital structures and ability to compress them. Surgery is life saving and the patient recovers markedly with respect to respiratory function. We present this rare case to highlight its importance of a proper diagnosis and urgent operative intervention to avoid a potential catastrophe in a child. | | | | Compliance with Ethical Standards | | Funding None | | | | Conflict of Interest None | | |
- Safadi S, Timsahi W, Saadoune M, Khayi FE, Daoudi A, Daoudi Sr A. Mature Teratoma of Posterior Mediastinum in a Newborn: A Case Report. Cureus. 2025 Apr 23;17(4). [CrossRef] [PubMed] [PMC free article]
- Nusjirwan R, Hermawan K, Dewi M, Nugraha HG, Dewayani BM, Nataprawira HM. Mediastinal teratoma in children: A case series of misdiagnoses in a high-endemic tuberculosis setting. International Journal of Surgery Case Reports. 2024 Mar 1;116:109307. [CrossRef] [PubMed] [PMC free article]
- Anusha CL, Gopal PS. Mature cystic teratoma of anterior mediastinum: a case report. Int J Res Med Sci. 2024 Apr;12:1303-5. [CrossRef]
- Piber N, Weichert W, Hörer J, Ono M. Life-Threatening Mediastinal Teratoma of Infant Requiring Emergency Surgical Removal. The Thoracic and Cardiovascular Surgeon Reports. 2022 Jan;11(01):e7-10. [CrossRef] [PubMed] [PMC free article]
- Meghana P, Pradhan A, Dash M, Mohapatra D. A Rare Case of Anterior Mediastinal Mature Teratoma. Research and Reviews in Pediatrics. 2022 Jan 1;23(1):26-8.
DOI: https://doi.org/10.7199/ped.oncall.2026.60
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| Cite this article as: | | Ghosh S, Pandey H I, Kumari S, Majhi S, Kundu A, Singh P, Kumar A. Mediastinal teratoma in a three months infant- an unforeseen emergency. Pediatr Oncall J. 2025 Nov 29. doi: 10.7199/ped.oncall.2026.60 |
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