Teratoma of the lung

Definition

A rare tumour consisting of tissue derived from more than one germ cell line. An extrapulmonary origin must be excluded.

Epidemiology

Most cases occur between the ages of 10 and 40 years³.

Clinical features

Patients may present with fever⁴, haemoptysis, cough or pyothorax. They may expectorate hair⁵. Bronchopleural fistulae may develop.

Radiology

The lesions occur most often in the upper lobes and are usually cystic and focally calcified³.

Macroscopic appearances

The lesions are usually cystic and multilocular: the cysts may communicate with the bronchi¹.

Histopathology

Two thirds of cases are mature and benign, one third malignant³. Mature teratomas consist of cysts lined by squamous epithelium, resembling ovarian dermoids. Thymic¹ and pancreatic tissue are common. Malignant elements consist of carcinoma or sarcoma, rarely other immature elements.

Immunohistochemistry

Ultrastructure

Differential diagnosis

Metastatic teratoma: after chemotherapy, metastases may be entirely mature².
Carcinosarcoma: lacks organoid structures.
Pleuropulmonary blastoma: lacks organoid structures.

Management

Surgical excision.

Prognosis

Mature teratomas are benign and are cured by complete resection. Most malignant teratomas cannot be resected and cause death within six months.

References

⁰ Tumours of the Lung, Pleura, Thymus and Heart. WHO Classification of Tumours. IARC Press 2004.

¹ Asano S, Hoshikawa Y, Yamane Y, et al. An intrapulmonary teratoma associated with bronchiectasia containing various kinds of primordium: a case report and review of the literature. Virchows Arch 2000; 436:384-8

² Cagini L, Nicholson AG, Horwich A, et al. Thoracic metastasectomy for germ cell tumours: long term survival and prognostic factors. Ann Oncol 1998; 9:1185-91

³ Morgan DE, Sanders C, McElvein RB, et al. Intrapulmonary teratoma: a case report and review of the literature. J Thorac Imaging 1992; 7:70-7

⁴ Suzuki Y, Saiga T, Ozeki Y, et al. [Two cases of intrapulmonary teratoma]. Nippon Kyobu Geka Gakkai Zasshi 1993; 41:498-502

⁵ Ustun MO, Demircan A, Paksoy N, et al. A case of intrapulmonary teratoma presenting with hair expectoration. Thorac Cardiovasc Surg 1996; 44:271-3

This page last revised 20.6.2005.