A Rare Presentation of Infantile Mediastinal Mature Cystic Teratoma Leading to Progressive Respiratory Failure - A Case Series

Purpose: Teratoma is a congenital tumour arising from one or more of the three germ cell layers in the embryo, with an incidence of 1.2-14.2 cases per 100,000 people per year. Mature cystic teratomas contain bone, cartilage, hair, nails, and cystic fluid filled spaces. Extragonadal teratomas are uncommon, and are usually detected incidentally in adults. Here, we report three cases of infantile mediastinal mature cystic teratomas presenting with impending acute respiratory failure.<br/>Methods: Three previously healthy infants (two were boys) aged 5-6 months presented with worsening respiratory tract infection and impending respiratory failure despite medical management. A chest radiograph revealed a large anterior mediastinal mass. CECT chest demonstrated the mediasti- nal tumour suggestive of Teratoma with a mediastinal shift, cardiac and tracheal compression. None of them had features of local infiltration. It was decided to proceed with surgical excision after multidisciplinary discussions. Mediastinum was approached with muscle sparing posterolateral thoracotomy in two patients. And the other child underwent right anterolat- eral thoracotomy. Excision of the tumour relieved the airway obstruction and mediastinal shift.<br/>Results: The symptoms improved rapidly following the tumour excision, and they were gradually weaned off from respiratory support. They received ITU care and recovered un- eventfully with no surgical complications. The histology of the excised tumours confirmed mature cystic teratoma.<br/>Conclusion: Mature cystic teratoma may rarely present in infancy with progressive respiratory failure, hence clinicians should have a high degree of suspicion. Complete excision is possible in most cases where there is a clear plane of dissection with the lesion and the surrounding structures with excellent clinical outcomes. Both anterolateral and posterolateral thora- cotomy approaches could be used to access the mediastinum.<br/>