Intrapulmonary mature teratoma: an unusual finding

Area of Science:

• Oncology
• Thoracic Surgery
• Pathology

Background:

• Teratomas are germ cell tumors originating from multiple germ layers.
• Intrapulmonary teratomas, particularly those without mediastinal involvement, are exceptionally uncommon.
• Usual teratoma locations include the sacrococcygeal region, intracranial space, mediastinum, and gonads.

Observation:

• A 37-year-old male presented with a persistent, progressive intermittent cough.
• Computed tomography (CT) revealed an irregular, cystic lesion in the left upper lung lobe, initially suspected as an aspergilloma.
• Surgical exploration discovered a hypoplastic left lung almost entirely replaced by an irregular mass.

Findings:

• Pathological review confirmed the mass as an entirely intrapulmonary mature teratoma.
• The teratoma had no discernible mediastinal component.
• Trichoptysis, or expectoration of hair, is a rare but specific clinical sign for intrapulmonary teratomas.

Implications:

• This case underscores the rarity of intrapulmonary teratomas and the importance of considering them in the differential diagnosis of lung masses.
• Accurate preoperative diagnosis is crucial for appropriate surgical planning and management.
• Distinguishing intrapulmonary from mediastinal teratomas is clinically significant, with trichoptysis being a potential diagnostic clue.