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Eur J Cardiothorac Surg 2001;20:650-651
© 2001 Elsevier Science NL

Letter to the Editor

Mediastinal cystic teratoma associated with a Hodgkin's lymphoma

^a Department of General and Digestive Surgery, Virgen de la Arrixaca University Hospital, 30120 El Palmar, Murcia, Spain
^b Department of Thoracic Surgery, Virgen de la Arrixaca University Hospital, 30120 El Palmar, Murcia, Spain

Received 18 April 2001; received in revised form 21 May 2001; accepted 23 May 2001.

Corresponding author. Av/. Libertad no. 208, CP 30007 Casillas, Murcia, Spain. Tel.: +34-968-23-07-48; fax: +34-968-36-97-16
e-mail: arzrios{at}teleline.es

Key Words: Mediastinal cystic teratoma • Hodgkin’s lymphoma • Surgery

The finding of a mediastinal cystic teratoma has no prognostic implications as it is a benign lesion and surgical removal is curative [1]. However, it is important that the finding of this lesion does not cover up other pathologies in which an adequate treatment has major implications in the prognosis of the disease. We present a benign cystic teratoma associated with a lymphoma.

A 16-year-old male, following a cranio-encephalic traumatism, was admitted to the emergency room. Physical exploration, blood cell count and biochemistry profile were normal. Chest X-ray detected a mediastinal tumour. Chest computerized tomography (CT) scan informed us of a mass in the antero-superior mediastinum, with smooth edges and a diameter of some 10 cm, low density and no apparent infiltration of neighbouring structures. It also revealed mediastinal nodular images suggesting adenopathies (Fig. 1 ). Mediastinal magnetic resonance imaging (MRI) showed a localized thoracic mass in the anterior-superior part of the mediastinum, polylobulate in appearance, with a low-signal central area and lateral masses suggesting adenopathies. The vessels were rejected but not infiltrated.

View larger version (97K): [in this window] [in a new window]   Fig. 1. Computed axial tomography of the thorax. Note the mass in the antero-superior mediastinum, polylobulate in appearance, with a low-signal central area. Lateral to this tumour are masses suggesting adenopathies.

CT is the test of choice for studying mediastinal tumours [2], and in cases like ours, where lesions not justified by the teratoma are detected, such as the presence of mediastinal adenopathies, one should be cautious when justifying all the symptoms by this lesion. In the literature there are cases reported of association between mediastinal germ cell tumours and haematological neoplasms, which although uncommon are not exceptional [3]. In these cases of doubt, MRI is an imaging technique that allows a greater definition of the lesions and which may provide data for a differential diagnosis.

In these cases it is essential to perform a biopsy or removal of the adenopathies for the anatomopathological study to rule out or confirm associated pathology, in this case a lymphoma. We must remember that lymphomas, unlike benign cystic teratomas, are malignant neoplasms in which treatment (chemo- and radiotherapy) influences the evolution of the disease. Factors of poor prognosis in Hodgkin's disease are large tumour size, systemic involvement (more than three sites), presence of constitutional symptoms and age over 50 years; all these factors usually occur with the evolution of the disease and are therefore favoured by a late diagnosis [4].

References

1. Moran C.A., Suster S. Primary germ cell tumors of the mediastinum: I. Analysis of 322 cases with special emphasis on teratomatous lesions and a proposal for histopathologic classification and clinical staging. Cancer 1997;80:681-690.[Medline]
2. Moeller K.H., Rosado de Christenson M.L., Templeton P.A. Mediastinal mature teratoma: imaging features. Am J Roentgenol 1997;169:985-990.[Abstract/Free Full Text]
3. DeMent S.H., Eggleston J.C., Spivak J.L. Association between mediastinal germ cell tumors and hematologic malignancies. Report of two cases and review literature. Am J Surg Pathol 1985;9:23-30.[Medline]
4. Kennedy B.J., Fremgen A.M., Mench H.R. The national cancer data base report on Hodgkin's disease for 1985–1989 and 1990–1994. Cancer 1998;83:1041-1047.[Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Zambudio, A. R. Articles by Paricio, P. P. Search for Related Content PubMed PubMed Citation Articles by Zambudio, A. R. Articles by Paricio, P. P. Related Collections Mediastinum