Anterior mediastinal mature teratoma in a 13-month-old girl: A case report

Abstract

Introduction

Mature teratomas in the anterior mediastinum are rare, making up only 1–5% of mediastinal tumors. While they are usually seen in adults, it is uncommon for toddlers to have such tumors, especially large ones with concomitant pericardial effusion.

Case presentation

A 13-month-old female toddler presented with a one-month history of dry cough, progressively worsening respiratory distress, low-grade fever, intermittent rapid breathing, and non-drenching night sweats. Despite multiple evaluations and treatments for presumed hyperactive airway disease with antibiotics and salbutamol inhalers, her symptoms persisted. There was no history of prior hospitalizations, and the child was fully vaccinated with normal growth and developmental milestones. On examination, she appeared in significant respiratory distress with tachypnea, nasal flaring, subcostal and intercostal retractions, and oxygen saturation of 85 % on room air. Respiratory examination revealed decreased air entry bilaterally. Other systemic examinations were unremarkable. A chest x-ray film at the referring center revealed a mediastinal mass with an associated pleural effusion. A chest ultrasound identified a multiseptated cystic anterior mediastinal mass. A contrast-enhanced CT confirmed a 13 × 12 × 8 cm heterogeneous mass with cystic, fatty, and calcified components compressing and displacing the superior vena cava, pulmonary artery, and aorta without invasion. The trachea and mainstem bronchi were narrowed and displaced posteriorly. Serum alpha-fetoprotein and beta-human chorionic gonadotropin levels were normal, favoring a benign diagnosis. Surgical excision was performed via clamshell thoracotomy, achieving complete resection of the solid portion and aspiration of the cystic components. Histopathology confirmed a mature cystic teratoma with no immature or malignant elements. The child recovered well postoperatively, was discharged home on postoperative day seven, and is in good health at five months of follow up.

Conclusion

Large anterior mediastinal mature teratomas in toddlers are rare but manageable with early diagnosis and complete surgical resection.