Intrapericardial teratoma presenting as recurrent pericardial tamponade: Report of a case

Intrapericardial teratomas are rare after infancy. An accurate diagnosis can only be made with a high index of suspicion. Most of the time, a mediastinal teratoma ruptures/perforates the pericardial cavity, thus causing either pericardial effusion or life-threatening tamponade. These factors emphasize the importance of an early surgical excision even for extrapericardial locations. This report presents the case of a 16-year-old girl with intrapericardial teratoma who presented with cardiac tamponade which is a rare complication of this rare tumor with only eight cases reported so far beyond infancy. This patient presented with recurrent tamponade, and underwent multiple procedures of pericardiocentesis and developed pyopericardium and polyserositis. This intrapericardial teratoma was not detected by imaging modalities.     

Intrapericardial teratoma in infancy: a rare disease

Intrapericardial teratoma is a rare, and generally benign, tumor originating from the 3 germinal layers. It occurs in 60% of the cases in the first two years of life. Severe cardio-respiratory distress due to mediastinal compression and pericardial effusion are the main clinical symptoms. Echo-cardiography and cine-angiography confirm the diagnosis and early surgical removal brings immediate and durable improvement.     

Intrapericardial teratoma: a continuing challenge

Intrapericardial teratoma is a rare entity that presents a diagnostic and therapeutic challenge. The authors describe the case of an 18-month-old boy with this condition who was successfully managed by resection of the mass. Computerized axial tomography, radionuclide scanning and angiography are important aids in the preoperative assessment of intrapericardial masses. However, all are nonspecific. Definitive diagnosis can only be established by thoracotomy, resection and microscopic examination of the specimen. The long-term prognosis is good.     

Benign mediastinal teratoma causing pericardial tamponade and pleural effusion

Mediastinal teratomas are known to adhere to and penetrate the pericardium, but perforation and tamponade are uncommon. We present a patient who developed a life-threatening pericardial tamponade and pleural effusion, whose life was saved by timely surgery. We believe this to be the third successfully treated patient and the first to be reported from Great Britain.     

Mature teratoma of the pancreas: A rare entity

Aim and Background

Pancreatic cystic lesions are being increasingly recognized and comprise different pathological entities. The management of these lesions is often challenging, because of inadequate preoperative diagnosis. Among this family of lesions, mature cystic teratomas are an extremely rare finding and are usually found in children.

Case Report

We present the rare case of a 60-year-old man being evaluated for melena. Preoperative investigation revealed a pancreatic mass. The patient underwent a Whipple pancreaticoduodenectomy. Surprisingly, histopathology revealed a mature teratoma of the pancreas.

Conclusion

This case highlights the difficulty in establishing a preoperative diagnosis of this benign pathological entity. Though unusual in older patients, mature teratomas can present in this subgroup of patients. Mimicking malignancy, they warrant a radical surgical resection.     

Intrapericardial teratoma in a newborn: a case report

Intrapericardial teratomas are unusual tumors that often cause respiratory distress and might be lethal in the newborn. The purpose of this article is to present the clinical and pathological findings in a 12-day-old male successfully treated for a big intrapericardial teratoma. Given that the diameter of this tumor is generally related to the age at the time of diagnosis, the rarity of our case is the presence of a huge intrapericardial teratoma in a newborn. The surgical resection was lifesaving.     

Giant cavernous sinus teratoma: a clinical example of a rare entity: case report

OBJECTIVE AND IMPORTANCE: Teratomas represent 0.5% of all intracranial tumors. These benign tumors have tissue representative of the three germinal layers: ectoderm, mesoderm, and endoderm. Most teratomas are midline tumors located predominantly in the sellar and pineal regions. Cavernous sinus location is very rare; only two purely intracavernous teratomas have been reported. CLINICAL PRESENTATION: A 14-year-old boy presented with a history of progressive right eye proptosis and visual acuity impairment, headaches, and a neuralgia-like facial pain in the right V1 distribution. A head computed tomographic scan and magnetic resonance imaging disclosed a large tumor filling the right cavernous sinus and extending into the ipsilateral middle fossa. These scans also demonstrated mixed signals derived from different tissues conforming to the tumor (fat, cartilage, muscle strands, bone, and a primordial tooth). Heterogeneous enhancement was seen after infusion of contrast medium. Significant bone erosion and remodeling was evident in the middle fossa floor and right orbit, with secondary proptosis. A presumptive diagnosis of mature teratoma was made. INTERVENTION: With the use of a right frontotemporal interfascial approach, a combined extra- and intradural dissection of the tumor was performed. The lesion entirely occupied the cavernous sinus, laterally displacing the Gasserian ganglion and trigeminal branches (predominantly V1 and V2). The internal carotid artery and Cranial Nerve VI were medially displaced by the tumor mass. The lesion was composed of different tissues, including hair, fat, cartilage, muscle, nerve-like tissue, bone, and a primordial tooth. The tumor was removed completely, and the pathological report confirmed the diagnosis of a mature teratoma. There was no evidence of recurrence at the 8-month follow-up examination. CONCLUSION: Because of the lesion's location in the lateral wall of the cavernous sinus, a total removal was achieved with the use of standard microsurgical techniques. Knowledge of the microanatomy is essential in treating intracavernous pathology. We present the third reported case of a giant mature teratoma of the cavernous sinus.     

Resection of mediastinal teratoma in a patient with cardiac tamponade due to pericardial perforation

Benign teratoma of the mediastinum causes a variety of complications if left untreated, but reports of pericardial perforation have been rare. We report a case of mediastinal teratoma that perforated the pericardium and induced clinical cardiac tamponade. The patient was a 46-year-old male, who was admitted due to sudden chest pain. Since chest CT and echocardiography suggested perforation of the pericardium by a mediastinal teratoma, pericardial drainage was carried out. However, heart failure could not be resolved, and the tumor was resected on the 5th hospital day. From the intraoperative and pathologic findings, mature type mediastinal teratoma was found to have perforated the pericardium, causing massive influx of yellowish fluid from the cyst of the tumor. There have been only 10 cases reported to date in Japan and abroad in which mediastinal teratoma was complicated by cardiac tamponade.     

Coexisting right nonrecurrent and right recurrent inferior laryngeal nerves: a rare and controversial entity

Variations in the course of the recurrent laryngeal nerve (RLN) can occur, including the development of a nonrecurrent inferior laryngeal nerve (NRILN). Rarely, both a right RLN and a right NRILN have been reported in the same patient, merging before they enter the larynx. A case is presented, including images, and the literature concerning this rare anatomical finding is reviewed, including studies suggesting alternative explanations for these cases. Fourteen previously reported cases of coexisting RLN and NRILN were identified, all involving the right side. Some cases were associated with an anomalous origin of the right subclavian artery and some were not. The alternative explanations that a communicating branch of the sympathetic nerve, which joins the RLN, is mistaken for an NRILN or that a collateral branch from an NRILN is mistaken for an RLN in these cases are also considered. Surgeons must be aware of these unusual variations to minimize nerve injury during neck surgery.     

Intrapericardial teratoma in a low birth weight preterm infant: a successful multidisciplinary approach

We report the case of an intrapericardial teratoma, a rare tumour in infants, prenatally diagnosed and successfully treated thanks to a multidisciplinary approach. An intrapericardial cystic mass (2.5?cm) with pericardial effusion was identified in a foetus at 32?weeks gestational age (GA). Intrauterine pericardiocentesis was performed immediately (40?ml) and repeated at 33 weeks (25?ml) and then at 34?weeks GA, just before birth (36?ml). Considering the rapid growth of the mass and the risk of hydrops, vaginal delivery was induced. A baby girl weighing 1.98?kg was born without cardiorespiratory compromise. Echocardiography and thoracic CT-scan located the 4.0×3.0?cm cystic mass between the left atrial appendage and the left superior pulmonary vein. At three days of life, the mass was completely removed without cardiobypass. It arose from the ascending aorta. Postoperative course was uneventful. Pathology diagnosed an immature intrapericardial teratoma. As long-term follow-up is required, alpha-fetoprotein can be a valid tool to monitor a possible recurrence. A multidisciplinary approach allows successful prenatal management and postnatal tumour surgery.     

Fourth ventricle meningiomas: a rare entity

Fourth ventricle meningiomas (FVMs) are rare, often misdiagnosed, lesions. To the best of our knowledge, 47 cases have been reported in the literature: we describe our series of three cases treated at our Institution, focusing on some diagnostic tips and intraoperative features of these tumours. Our three patients have a history of headache. Gait disturbances, vomiting and/or diplopia complicated the clinical picture before the referral at our Department. The operations were uneventful, and the patients fully recovered from neurological symptoms. They are free of recurrence at a median follow-up of 19 years. FVMs are rare lesions, which are difficult to differentiate preoperatively from the much more common ependymomas. A preoperative distinction would be extremely advantageous: indeed, although both tumours share similar radiological and clinical patterns, they clearly differ as to surgical difficulty and outcome. In fact, meningiomas are comparatively easier to remove, granting better clinical results.