Giant mediastinal teratoma mimicking pericardial cyst: A case report with brief review of the literature

Giant teratomas with bilateral mediastinal extension are rare. The present case report highlights the challenging resection of a giant anterior mediastinal cystic teratoma extending bilaterally using video-assisted thoracoscopic surgery (VATS), rendering it one of the largest mediastinal teratomas managed with VATS in the current literature. A 47-year-old woman presented with a 1-year history of central chest pain. The physical examination did not reveal any notable findings. A computed tomography coronary angiogram revealed a thin-walled cyst in the anterior mediastinum, measuring ~12x10x9 cm, consistent with a pericardial cyst. The cyst was completely resected using a bilateral thoracoscopic approach, and the patient was transferred to recovery in stable condition. A histopathological examination confirmed a mature cystic teratoma. In addition, a brief literature review conducted using the PubMed and Google Scholar databases identified 11 case reports of mediastinal teratomas resected using VATS. The mass sizes ranged from 4x4 to 17x10 cm. The majority of patients in these case reports were female (81.81%), with an average age of 21.45±12.69 years, ranging from 4 to 53 years. Notably, 63.63% of these patients were asymptomatic. On the whole, the present study demonstrates that large mediastinal cysts can be resected using VATS, which can provide a safe and effective alternative to conventional open thoracotomy or sternotomy. This approach may reduce surgical trauma and support faster post-operative recovery.