Mature thoracoabdominal teratoma in a teenager: a case report

Teratomas are neoplasms composed of cellular elements derived from the three germ layers: endoderm, mesoderm, and ectoderm. The most common sites of teratomas are the sacrococcygeal region and ovaries (51%–60%). However, other locations are also possible: testes, the retroperitoneal space, the stomach, the neck, and the floor of the oral cavity. Teratomas in two different body cavities are extremely rare. A 15-year-old girl presented with a mass in the chest that was an incidental finding on routine chest X-ray. Subsequent inpatient workup (multislice CT and aortoarteriography) showed that the lesion had a thoracoabdominal location with a large feeding artery arising from the upper abdominal aorta. Surgery involved a right posterolateral thoracotomy through the 7th intercostal space. During the procedure, dense adhesion of the cystic mass to the right lower lobe was found. After mobilization of the tumor from the lung and ligation of its vascular pedicle, it was found that the tumor extended into the abdominal cavity through the esophageal hiatus. The diaphragmatic crura were divided, and the cyst was completely mobilized bluntly from the esophagus and stomach. The tumor was removed from the pleural cavity, and damaged tissues were repaired. Operating time was 155 minutes. There were no intraoperative complications such as bleeding or esophageal or gastric perforation. The chest tube was removed on day 2, and ultrasound showed no hydrothorax. Histopathology revealed a mature cystic teratoma. Follow-up multislice CT of the chest and abdomen showed no residual tumor. The relevance of this report lies in the extreme rarity of thoracoabdominal mature teratomas in children and the lack of standardized surgical guidelines. This description of successful radical resection of a large tumor via a single thoracotomy approach broadens the clinical understanding of the topographic anatomy of such tumors and demonstrates the feasibility of minimizing surgical trauma when the tumor involves two body cavities.