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J Thorac Cardiovasc Surg 2007;133:1382-1383
© 2007 The American Association for Thoracic Surgery

Brief Communication

Giant mediastinal teratoma—bull in a china shop: Management strategies

Lakhvinder S. Vohra, MSa, Rajnish Talwar, MSa, Mala Mathur, MSa, Chadalavada Venkata R. Mohan, MDc, Naveen Chawla, MDa, Ramanathan Saranga Bharathi, MBBSb,*

a Malignant Diseases Treatment Centre, Command Hospital (Southern Command), Pune, Maharashtra, India
b Department of Surgery, Armed Forces Medical College, Pune, Maharashtra, India
c Department of Anesthesiology and Critical Care, Armed Forces Medical College, Pune, Maharashtra, India.

Received for publication November 25, 2006; accepted for publication December 12, 2006.

* Address for reprints: Maj. Ramanathan Saranga Bharathi, Assistant Professor, Department of Surgery, Armed Forces Medical College, Pune, Maharashtra, India 411040. (Email: sarangabharathi@rediffmail.com; rsarangabharathi@yahoo.co.in).

The first 20% of the full text of this article appears below.

Large thoracic tumors behave in a similar manner to an enraged bull in a china shop when they grow, despite treatment with neoadjuvant chemotherapy (NACT). Management strategies should be tailored to meet the challenges posed by the rapidity of growth and enormity of size of these giants. We report a case of a patient with large and heavy malignant mediastinal teratoma, in which the intensity of compressive features caused by spiraling growth, despite NACT, necessitated urgent surgery using a combination of incisions that were individually inadequate and perilous for safe tumor removal.

Clinical Summary

A mediastinal mass was radiologically detected in a 24-year-old man who presented with chest pain and a dry cough of 2 months’ duration. Serial x-ray films showed the rapid increase in mass size, mediastinal shift to the right with onset of dyspnea, and prominent veins in the superior vena cava (SVC) territory. Computed tomography (CT) revealed a large, heterogenous, anterior mediastinal mass abutting the pericardium and left hilar vessels, displacing the heart to the extreme right and collapsing the left lung (Figure 1). CT-guided biopsy . . . [Full Text of this Article]






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