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Year : 2003  |  Volume : 13  |  Issue : 1  |  Page : 31-32
Mature intrapulmonary teratoma - a case report


Department of Radiodiagnosis, Medical College, Calicut, India

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Keywords: Pulmonary, Teratoma

How to cite this article:
Sushama A, Gomathy S, Rajendran V R, Vasu C K. Mature intrapulmonary teratoma - a case report. Indian J Radiol Imaging 2003;13:31-2

How to cite this URL:
Sushama A, Gomathy S, Rajendran V R, Vasu C K. Mature intrapulmonary teratoma - a case report. Indian J Radiol Imaging [serial online] 2003 [cited 2019 Oct 20];13:31-2. Available from: http://www.ijri.org/text.asp?2003/13/1/31/28621
We would like to report a case of intrapulmonary teratoma presenting in a young female with chest pain and hemoptysis. The imaging features are discussed. A brief review of literature is presented.

An eighteen year old woman presented with left sided chest pain of 1 years duration and two episodes of massive hemoptysis. She had no history of fever or breathlessness, no cough, no history of pulmonary tuberculosis.

On examination the vital signs were stable. On inspection the chest cage appeared normal. A few inspiratory crackles were heard over the left infraclavicular, upper axillary and upper interscapular area.

Routine hematological investigations were within normal limits. Mantoux test was negative. Chest radiograph - pa view showed an ill defined homogenous opacity in the left midzone with a few areas of air bronchogram [Figure - 1]. Lateral view [Figure - 2] showed the lesion in the region of the anterior segment of the left upper lobe.

The patient was put on antibiotics and a repeat chest radiograph, after a fortnight, showed no changes in the opacity. Bronchoscopy was done subsequently which showed inflammatory changes in the bronchial wall. The left upper lobe bronchial lumen was erythematous with viscous whitish material coming out from it.

A CT study of the thorax was undertaken. Plain and contrast axial ct sections showed a sharply defined thick walled mixed density lesion involving the anterior and superior lingular segments of the left upper lobe [Figure - 3] Soft tissue and fluid attenuation values were noted within the lesion. A few specks of calcific density were also imaged in the wall of the lesion, which showed enhancement following contrast administration [Figure - 4]. The surrounding lung parenchyma showed areas of consolidation. Mediastinal structures were normal. No lymphnode enlargement was seen. No pleural effusion/ pleural thickening was noted. We made a diagnosis of chronic lung abscess. The patient was put on further medical management. Repeat chest x-ray and ct thorax after three months showed the same findings.

Left upper lobectomy and lingulectomy was done on 14/6/2001 which showed a thick walled abscess, 8 x 5 cm in size in the anterior and lingular segments of the left lung with a communication with the bronchus.

Microscopic examination showed a variety of cell lines - consisting of squamous epithelium, sebaceous glands, thymic and pancreatic tissue, bronchial and lymphoid elements, cartilage and areas of calcification [Figure - 6].


   Discussion Top


Mohr is credited with reporting the first case of teratoma of the lung in 1839[1]. Intrapulmonary teratomas are rare (only 33 published cases) [2]. These are believed to originate from the third pharyngeal pouch [1]. Slight female preponderance is reported. They are usually diagnosed in the third or fourth decade of life. Most are benign lesions [3].

Clinical features: chest pain (52%) hemoptysis (42%), cough (39%). The most specific symptom is trichoptysis or expectoration of hair (in 13%) [2]. Radiologically they present as lobulated upper lobe masses which show areas of calcification. Fat density is seen in 50% cases. Fat fluid levels have also been reported. Soft tissue elements may also be present. Two third of the cases occur in the upper lobes - usually in the left upper lobe [4]. Benign mature teratomas have a predominant cystic component. Solid components predominate in immature or malignant teratomas. Cysts often contain hair and calcification. Continuity with a bronchus may be seen in 42% cases. Bronchiectasis occur in 16% cases and may delay recognition of the pulmonary tumor [2].

 
   References Top

1.Collier FC, Dowling EA, Plot D, Schneider H. Teratoma of the lung. Archives of pathology 1959; 68: 138-142.  Back to cited text no. 1    
2.Colby TV, Koss MN, Travis W. Atlas of tumour pathology: Tumours of the lower respiratory tract, third series. Armed forces institute of pathology, 1994: 487-489.  Back to cited text no. 2    
3.Morgan DE, Sanders C, Mcelvein RB. Intrapulmonary teratoma - a case report and review of the literature. J thoracic imaging 1992; 7: 70-77.  Back to cited text no. 3    
4.Day DW, Taylor SA. An intrapulmonary teratoma associated with thymic tissue. Thorax 1975; 30: 582-587.  Back to cited text no. 4  [PUBMED]  

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Correspondence Address:
A Sushama
'Sushama', Thrikkandiyur (PO), Tirur, Malappuram (District), Kerala
India
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Source of Support: None, Conflict of Interest: None


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    Figures

[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6]



 

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