Enomoto Yuri, Nakano Yoshio, Fukuda Hiroyuki, Yamamoto Yoko, Ikeda Naoki, Yasuhara Yumiko, Gohma Iwao
Department of Respiratory Medicine Sakai City Medical Center Sakai Japan.
Department of Thoracic Surgery Sakai City Medical Center Sakai Japan.
Respirol Case Rep. 2025 Sep 18;13(9):e70345. doi: 10.1002/rcr2.70345. eCollection 2025 Sep.
Mediastinal teratomas demonstrating unidirectional pancreatic differentiation are exceedingly rare. We describe a 36-year-old woman with progressively worsening anterior chest pain. Computed tomography demonstrated a 5.9 cm multilocular cystic mass in the anterior mediastinum, accompanied by pleural and pericardial effusions. Given the lesion's size and presumed inflammatory reaction, we performed radical excision via a hemiclamshell incision. Histopathology revealed predominantly pancreatic acinar tissue with scattered non-pancreatic epithelial elements, prompting reclassification as a mediastinal teratoma rather than ectopic pancreas. Focal epithelial disruption was regarded as the nidus of the surrounding inflammation. The patient's postoperative course was uneventful. This report underscores the need to include teratoma in the differential diagnosis of anterior mediastinal lesions initially interpreted as ectopic pancreas and illustrates the value of the hemiclamshell approach for achieving complete, atraumatic resection when extensive local adhesions are present.
表现为单向胰腺分化的纵隔畸胎瘤极为罕见。我们描述了一名36岁女性，其前胸疼痛逐渐加重。计算机断层扫描显示前纵隔有一个5.9厘米的多房囊性肿块，并伴有胸腔和心包积液。鉴于病变大小及推测的炎症反应，我们通过半蛤壳式切口进行了根治性切除。组织病理学显示主要为胰腺腺泡组织，伴有散在的非胰腺上皮成分，促使重新分类为纵隔畸胎瘤而非异位胰腺。局灶性上皮破坏被认为是周围炎症的病灶。患者术后恢复顺利。本报告强调在鉴别诊断最初被解释为异位胰腺的前纵隔病变时需要考虑畸胎瘤，并说明了当存在广泛局部粘连时，半蛤壳式手术入路对于实现完整、无创伤切除的价值。
