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Malignant teratoma of the mediastinum

Teratoma - MRI scaTeratoma - MRI scan
Malignant teratomaMalignant teratoma

Dermoid cyst - malignant; Nonseminomatous germ cell tumor - teratoma; Immature teratoma; GCTs - teratoma; Teratoma - extragonadal

Definition

A teratoma is a type of cancer that contains one or more of the three layers of cells found in a developing baby (embryo). These cells are called germ cells. A teratoma is one type of germ cell tumor.

The mediastinum is located inside the front of the chest in the area that separates the lungs. The heart, large blood vessels, windpipe, thymus gland, lymph nodes and esophagus are found there.

Causes

Malignant mediastinal teratoma occurs most often in young men in their 20s or 30s. Most malignant teratomas can spread throughout the body, and have spread by the time of diagnosis.

Blood cancers are often associated with this tumor, including:

Acute myelogenous leukemia (AML)
Myelodysplastic syndromes (group of bone marrow disorders)

Symptoms

Symptoms may include:

Chest pain or pressure
Cough
Fatigue
Limited ability to tolerate exercise
Shortness of breath

Exams and Tests

The health care provider will perform a physical exam and ask about the symptoms. The exam may reveal a blockage of the veins entering the center of the chest due to increased pressure in the chest area.

The following tests help diagnose the tumor:

Chest x-ray
CT, MRI, or PET scans of the chest, abdomen, and pelvis
Nuclear imaging
Blood tests to check beta-HCG, alpha fetoprotein (AFP), and lactate dehydrogenase (LDH) levels
Mediastinoscopy with biopsy

Treatment

Surgical removal is the mainstay of treatment.

Chemotherapy is used to treat the immature teratoma. A combination of medicines (usually cisplatin, etoposide, and ifosfamide) is commonly used.

After chemotherapy is complete, CT scans are taken again to see if any of the tumor remains. Surgery may be recommended if there is a risk that the cancer will grow back in that area or if any cancer has been left behind.

Support Groups

There are many support groups available for people with cancer.

Outlook (Prognosis)

The outlook depends on the tumor size and location and the age of the patient.

Possible Complications

The cancer can spread throughout the body and there may be complications of surgery or related to chemotherapy.

When to Contact a Medical Professional

Contact your provider if you have symptoms of malignant teratoma.

References

Triplette M, Varghese TK, Cheng G-S. Mediastinal tumors and cysts. In: Broaddus VC, Ernst JD, King TE, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 115.

Wald O, Izhar U, Sugarbaker DJ. Lung, chest wall, pleura, and mediastinum. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. St Louis, MO: Elsevier; 2022:chap 58.

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Review Date: 8/15/2022

Reviewed By: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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