Imaging findings of three cases of large mediastinal mature cystic teratoma

Figures

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  Fig. 1. (Case 1) Mediastinal mature cystic teratoma in a 37-year-old man. Frontal chest radiography and CT scan images: (a) The frontal chest X-ray shows a noncalcified mediastinal mass. This mass arose from the anterior mediastinum because the descending aortic border was not silhouetted (arrow); (b) the axial plain view, (c) the coronal plain view, and (d) the sagittal plain view of the CT image shows a large heterogeneous cystic mass in the superior anterior mediastinum. Areas of soft tissue (arrow in c) and fat attenuation (arrow in b) are depicted within the mass.

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  Fig. 2. (Case 1) Mediastinal mature cystic teratoma in a 37-year-old man. MRI findings: (a) In-phase and (b) opposed-phase MRI scans demonstrate a decrease in signal intensity on the opposed-phase images comparing with the in-phase images. The hypointensities on opposed-phase imaging reveals areas of microscopic intracellular lipid within the lesion. (c) Axial T2 haste and (d) axial T2 blade FS show the large left anterior mediastinal mass lesion causing an impression on the superior vena cava with internal heterogeneous areas of signal intensity abnormality. (e) Axial contrast-enhanced fat-suppressed T1-weighted MR image and (f) axial T1 FS subtraction, obtained after administration of intravenous gadolinium-based contrast material, show a lack of solid enhancement within the mass lesion.

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  Fig. 3. (Case 1) Hematoxylin and eosin-stained (original magnification, × 200) medium-power microscopic images showing the cartilage (blue star), smooth muscle (red star), and glandular epithelium (yellow star). (Color version of figure is available online.)

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  Fig. 4. (Case 2) Mediastinal mature cystic teratoma in a 35-year-old woman. The frontal chest -X-ray and CT scan images: (a) Frontal chest X-ray showing the mass on the left anterior mediastinum. The descending aorta remains visible implying the mass cannot be posterior. The left hilar vessels remain visible (hilum overlay sign) implying the mass cannot be at the hilum. The upper left heart border silhouette is absent indicating the mass must be anterior. (b) Axial plain view and (c) coronal view of chest CT scan with contrast demonstrating a left anterior mediastinal mass containing fat (orange arrow) and soft tissue components (blue arrow). (Color version of figure is available online.)

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  Fig. 5. (Case 2) Mediastinal mature cystic teratoma in a 35-year-old woman. MRI findings: (a) Coronal T2 HASTE and (b) Coronal T1 vibe FS postcontrast images confirming a left anterior mediastinal mass with heterogeneous intensity on T2W, peripheral and septal enhancement. (c) Axial T1 in-phase and (d) opposed-phase images showing hypointensity areas in opposed-phase image of microscopic intracellular lipid in the lesion. (e) Axial T1 vibe FS and (f) axial T1 vibe FS subtraction images showing unenhanced proteinaceous fluid and soft tissue enhancement (arrow) within the mass.

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  Fig. 6. (Case 2) Hematoxylin and eosin-stained (original magnification, × 200) medium-power microscopic images demonstrating the fibrous connective tissue (blue star), squamous epithelium (red star), and sebaceous gland (yellow star). (Color version of figure is available online.)

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  Fig. 7. (Case 3) Mediastinal mature cystic teratoma in a 54-year-old woman. Frontal chest radiograph and CT image: (a) Frontal chest X-ray demonstrating a large soft tissue density and calcification on the right side. The mass is located by default in the anterior mediastinum because it obliterates the normal silhouette of the SVC and right heart border. Hilar vessels can be seen through the mass (hilum overlay sign) (b) and (c) anterior hypodense well-defined right-sided mediastinal mass, with calcification (green arrow) and fat (orange arrow) within it, the appearance is highly suggestive of teratoma. (Color version of figure is available online.)

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  Fig. 8. (Case 3) Mediastinal mature cystic teratoma in a 54-year-old woman. MRI findings: (a): Coronal T2 HASTE image demonstrating a complex cystic anterior mediastinal mass. (b): Axial T2 HASTEIRM image demonstrating a regular, thin-walled cystic anterior mediastinal mass with both fluidlike (green arrow) and nodular components (orange arrow). (c) Axial T1 in-phase and (d) opposed-phase images demonstrating microscopic intracellular lipid in the lesion (blue arrow). (e) T1 vibe FS and (f) T1 vibe FS subtraction images after the administration of gadolinium demonstrating a proteinaceous cystic anterior mediastinal mass without enhancement. (Color version of figure is available online.)

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  Fig. 9. (Case 3) Hematoxylin and eosin-stained (original magnification, × 200) medium-power microscopic images showing the squamous epithelium (blue star) and pseudostratified columnar epithelium (red star). (Color version of figure is available online.)