A symptomatic anterior mediastinal mass with a simultaneous Haemophilus influenzae infection.

Surgical resection remains the treatment of choice for mature mediastinal teratoma, and the operation itself is sometimes complicated or life-threatening, especially when it ruptures into adjacent vital structures. We describe a rare case of unanticipatedly delayed complete resection of a symptomatic teratoma with simultaneous Haemophilus influenzae infection, followed by extended rupture into the pleural space, lung, and bronchus. The clinical presentation and the microbiological and radiologic features may lead to the impression of a lung abscess until it can be proven otherwise pathologically after an initial thoracic aspiration. Accordingly, surgical intervention through a minimal approach, such as video-assisted thoracoscopic surgery, might be considered a strategy after the initial extended rupture.

Metastatic mediastinal mature teratoma with malignant transformation in a young man with an adenocarcinoma in a Klinefelter's syndrome: Case report and review of the literature.

Malignant transformation of mediastinal mature teratoma is extremely rare and worsens the prognosis of the disease. Transformation can appear synchronously to or several years after the initial diagnosis. Clinical and radiological signs can orientate the clinician but the definitive diagnosis is obtained thanks to histology. An 11 year-old boy presented with a mediastinal mature teratoma and bone and pulmonary metastases. He received six cycles of chemotherapy combining etoposide, ifosfamide, cisplatin, followed by resection of a 16×14×9cm mediastinal mass. Karyotype analysis revealed the presence of an additional sex chromosome X (47 XXY) pathognomonic of Klinefelter's syndrome. Ten years later, sciatalgia revealed malignant transformation of a pre-existing sacral bone metastasis into gastrointestinal adenocarcinoma. The patient received four cycles of chemotherapy combining oxaliplatin, 5-fluorouracil and cetuximab. This treatment was followed by a complete resection of the sacral metastasis and completed with adjuvant irradiation of 54Gy in 30 daily fractions. Twelve months after the diagnosis of relapse, the patient remained alive without disease. To our knowledge, this is the first case of adenocarcinoma developed in bone metastases of a mediastinal mature teratoma in a boy with a Klinefelter's syndrome. We propose a review of the literature and an analysis of 20 others published cases of mediastinal teratoma with malignant transformation into adenocarcinoma.

Mediastinal Mature Teratoma With Malignant Carcinomatous Transformation (Somatic-Type Malignancy) With Metastatic Course.

We report the case of a 76-year-old patient presenting with an anterior mediastinal heterogeneous mass. Surgical biopsy revealed a solid and cystic lesion filled with hair. Pathological examination showed an atypical papillary epithelial lining without other germ cell tumor or immature teratoma associated. The final diagnosis was a mature teratoma of the mediastinum with somatic-type malignancy (carcinomatous transformation). After 8-month follow-up, subcutaneous and lymph node metastatic lesions of the carcinomatous component were identified. Subtyping of the malignant component within germ cell tumors is an important challenge for therapeutic options and prognosis.