Correct!
2. Teratoma
All are causes of an anterior mediastinal mass. However, given the heterogenous radiographic appearance, the slow progression and the patient’s age, the most likely diagnosis is a teratoma (4).
Teratomas are the most common germ cell tumors, occur equally in males and females and usually present at 20 to 40 years of age. About 80% are benign. A third have symptoms due to compression and obstruction of surrounding organs including chest pain, cough, or dyspnea. They may cause bronchial obstruction and post-obstructive pneumonia. Expectoration of hair (trichoptysis) or sebaceous debris is pathognomonic of benign teratoma, and results from erosion into an adjacent bronchus.
Chest x-rays may demonstrate an anterior mediastinal mass, with calcification seen in 26% of benign teratomas. Teeth or bone can be seen on plain chest x-rays and thoracic CT scans or MRI can characterize densities within the lesion suggestive of fat, sebaceous material, or cystic elements.
Our patient underwent resection of the mass which was a typical benign teratoma (Figure 5).
Figure 5. Gross pathology of the resected anterior mediastinal mass showing a heterogenous mass sebaceous and fatty areas.
She made an uneventful recovery and is doing well on follow-up.
References