Prenatal sonographic features of fetal mediastinal teratoma.

Mediastinal teratoma can cause severe hydrops fetalis, which worsens the effects of the mass compression on the vital mediastinal organs. A careful sonographic examination is mandatory to demonstrate the characteristic features suggestive of this congenital tumor. We describe these features at 20 weeks gestation. The most prominent finding was the heterogeneous echogenicity of a large cystic-solid mass with hyperechoic dots, seen as a part of the anterior mediastinum immediately posterior to the sternum. Additional diagnostic features included posterior displacement of the heart, low cardiac output, and hypoplasia of the normally structured heart and lungs due to the direct mass compression. These sonographic findings were confirmed at autopsy which confirmed a nonmetastatic immature teratoma. Sonography may enable accurate diagnosis of mediastinal teratoma considering the anterior location and heterogeneous appearance of the mass, posterior displacement of the heart, normal lung morphology, and compression effects on these organs.

Fetal mediastinal teratoma: Misinterpretation as congenital cystic lesions of the lung on prenatal ultrasound.

Congenital mediastinal teratoma can lead to development of hydrops fetalis and may be misinterpreted on ultrasound. In this case report, ultrasound revealed severe fetoplacental hydrops, moderate posthemorrhagic hydrocephalus, and multiple pulmonary cysts suggesting cystic adenomatoid malformation and displacement of the heart to the left side. Autopsy of the hydropic 24-weeks male fetus showed a large cystic-solid mediastinal mass that was consistent with nonmetastatic immature teratoma. It also demonstrated thymic, cardiac and pulmonary hypoplasia, and confirmed the germinal matrix-intraventricular hemorrhage. Accurate prenatal diagnosis of mediastinal teratoma may be achieved by a careful Doppler ultrasound assessment that also allows evaluating the fetal outcome.

Mediastinal masses: a case of fetal teratoma and literature review.

Fetal mediastinal masses are rare congenital formations that could complicate pregnancy. They are usually discovered as space occupying lesions in the fetal chest during routine ultrasound scan. The most important prognostic factors of mediastinal masses are mass location, compressing effect causing pulmonary hypoplasia and/or heart failure, and the presence or absence of hydrops. We report a case of fetal mediastinal teratoma and a review of the literature. A 32-year-old woman carrying a fetus with hydrops due to a mediastinal mass underwent cesarean section at 32 1/7 weeks' gestation. A well encapsulated tumor was excised by surgery at one day of life. The baby is now eight months old without respiratory difficulty. To our knowledge, this is the fourth case report of a mediastinal teratoma associated with nonimmune hydrops in a fetus that survived the neonatal period. Fetal mediastinal teratoma requires close surveillance and multidisciplinary management by obstetricians, neonatologists, and pediatric surgeons.

Successful management of a large fetal mediastinal teratoma complicated by hydrops fetalis.

This report describes a case of fetal mediastinal teratoma complicated by hydrops fetalis managed successfully by aspiration of the tumor cyst fluid. Fetal mediastinal teratomas are rare tumors that cause hydrops fetalis or fetal demise in the prenatal period and respiratory distress in the neonatal period. The patient presented with a large cystic mass in the thoracic cavity complicated by hydrops fetalis. The hydrops resolved after fetal aspiration of the tumor cyst fluid. The infant was born without respiratory distress, and tumor resection was performed at the age of 30 days. The postoperative course was uneventful, and the patient was in good health 6 months postoperatively.

Prenatal diagnosis of posterior mediastinal lymphangioma by two- and three-dimensional ultrasonography.

Lymphangioma is a rare benign tumor characterized by proliferating lymph vessels and composed of large cyst spaces with endothelium-lined channels of varying dimensions. The incidence of lymphangioma is approximately one in 6000 pregnancies. Less than 1% of lymphangiomas are purely mediastinal. The great majority of cases are of cystic lymphangioma, but very rarely there is a mixed lesion consisting of multiple cysts of dilated capillary and lymph vessels. We report a case of posterior mediastinal lymphangioma diagnosed at 28 weeks' gestation, in which three-dimensional ultrasonography was helpful in determining the precise location of the tumor. A Cesarean section was performed at 39 weeks and the tumor was resected on the 5(th) day postdelivery; histological examination revealed a mixed cystic lymphangioma.

[Mediastinal tumor as a cause of fetal hydrops]. / Guz sródpiersia przyczyna uogólnionego obrzeku plodu.

Unusual case of fetal hydrops was presented. In a stillborn infant an Rh incompatibility was suspected as a cause of hydrops, although prentally an immunologic source of the illness was excluded. Post-mortem a large polycystic mediastinal teratoma with cardiac and pulmonary hypoplasia was stated as a main cause of the hydrops. Additionally, histopathological examination proved this diagnosis. The mediastinal tissue contained immature epithelial, mesenchymal and blastemal elements. The congenital teratomas should be taken for account in problematic diagnosis of complicated cases.

Spectrum of germ cell tumors: from head to toe.

Germ cell tumors (GCTs) occur most frequently in the gonads and are relatively rare in other sites, such as the pineal gland, neurohypophysis, mediastinum, and retroperitoneum. GCTs are thought to originate from primordial germ cells, which migrate to the primitive gonadal glands in the urogenital ridge. Extragonadal GCTs might also originate from these cells when the cells are sequestered during their migration. Pathologic subtypes of GCTs vary, and the prevalence of mixed tumors is high. These factors produce a diversity of radiologic findings and make prospective radiologic diagnosis difficult in many cases. However, similar radiologic findings have been observed in pathologically equivalent tumors in varying sites. Seminomas appear as uniformly solid, lobulated masses with fibrovascular septa that enhance intensely. Nonseminomatous GCTs appear as heterogeneous masses with areas of necrosis, hemorrhage, or cystic degeneration. Fat and calcifications are hallmarks of teratomas, most of which are benign. In immature teratomas, scattered fat and calcification within larger solid components are occasionally seen. These imaging characteristics reflect the pathologic features of each tumor, and histologically similar GCTs at varying sites have similar radiologic features. Knowledge of the pathologic appearances of GCTs and their corresponding radiologic appearances will allow radiologists to diagnose these tumors correctly.

Embryology and surgical anatomy of the mediastinum with clinical implications.

This article discusses general mediastinal embryology, and provides anatomy and algorithms for the investigation of mediastinal masses. The superior, anterior, middle, and posterior mediastina also are detailed.

In utero development of a mediastinal teratoma: a second-trimester event.

Mediastinal teratomas have rarely been discovered during the prenatal period. When seen during the neonatal period, these tumours have caused respiratory distress or hydrops fetalis. We present the sonographic and pathological findings of a rapidly developing anterior mediastinal teratoma causing hydrops fetalis and in utero demise at 27 weeks' gestation.

Cervical, cervicomediastinal and intrathoracic lymphangioma.

Lymphangiomas result from abnormal development of the lymphatic system, with obstruction to lymph drainage from the affected area. The neck is the most common site (25%). In this study, we review the literature of lymphangioma in the neck and thorax and have undertaken detailed analysis of 52 children with cervical lymphangioma treated during the 20 years 1969-1988. Cervicomediastinal lymphangioma is uncommon (4%) and lesions confined to the thorax are rare, with none in our series. Neck lymphangiomas occur in early childhood with half being diagnosed at birth and almost 90% before school age. All have a mass. Two-thirds are asymptomatic; sudden enlargement, inflammation, infection, feeding difficulties and respiratory symptoms occur in the remainder. Pharyngeal and laryngeal involvement, usually associated with large infiltrating lesions, results in acute airways obstruction. The respiratory symptoms caused by mediastinal extensions are usually less dramatic. Lymphangiomas have a characteristic appearance on ultrasound examination and CT scan. These investigations are mandatory for an undiagnosed intrathoracic mass and when there is clinical suspicion of mediastinal extension of cervical lymphangioma but should be obtained for neck swellings only when the clinical diagnosis is in doubt. The recommended treatment is surgical excision which can be achieved with no mortality and little morbidity. An initial period of observation is justified for asymptomatic cervical lesions because there is a small incidence (6%) of spontaneous regression. Cervicomediastinal lymphangiomas can be removed at one operation using a neck incision combined with median sternotomy. The surgeon must preserve vital structures (especially vagus, recurrent laryngeal and phrenic nerves) and should not necessarily attempt total removal of all lymphangiomatous tissue. Massive infiltrating cervical lesions pose a particular challenge and may require multiple operations over many years before a satisfactory result with good-quality survival is attained.

The association of congenital neuroblastoma and congenital heart disease. Is there a common embryologic basis?

Several authors have reported an association between neuroblastoma and congenital heart disease; others contend that, unlike specific well-known associations between malignancy and congenital defects (Wilm's tumor and aniridia, leukemia and Down's syndrome), no real relationship exists. We present three cases of cyanotic congenital heart disease in which subclinical neuroblastoma was found. We speculate that abnormal neural crest cell migration and development may be a common link between cardiac malformations and congenital neuroblastoma.

[A case of mediastinal parathyroid adenoma visible on standard pulmonary radiography (author's transl)]. / Adénome parathyroïdien médiastinal, à propos d'un cas, visible sur les radiographies pulmonaires standards.

Mediastinal adenomas form about 10 % of all parathyroid adenomas, and are only very rarely visualized in standard pulmonary radiograms. This was the case however in a 54-year-old woman with hyperparathyroidism, chronic renal insufficiency, and an anterosuperior mediastinal tumor. After surgical excision by sternotomy the mass was found to be a large parathyroid adenoma weighing 105 g and measuring 8 cm in diameter. The authors discuss the problems raised by mediastinal adenomas and review the cases reported in the published literature.

Mediastinal rhabdomyoma.

An 80-year-old black male with gastric adenocarcinoma, liver metastases, and parathyroid adenomas also had a rhabdomyoma of the anterior-superior mediastinum. This appears to be the first reported case of mediastinal rhabdomyoma in the literature. The ultrastructural demonstration of haphazardly arranged myofilaments with prominent Z bands and the absence of demosomes indicates that it is of extra-cardiac type. The probable origin of this tumor from the myoid cells of the thymus is discussed.