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Case Report Open Access

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

  • Authors:
    • Fahmi H. Kakamad
    • Marwan N. Hassan
    • Rebaz M. Ali
    • Hawkar A. Nasralla
    • Suhaib H. Kakamad
    • Fakher Abdullah
    • Govand Nawzad Abubaker
    • Muhammed Sherzad Ezzat
    • Sozy Amanj Kareem
    • Berun A. Abdalla
  • View Affiliations / Copyright

    Affiliations: Department of Scientific Affairs, Smart Health Tower, Sulaymaniyah 46001, Iraq, Kscien Organization for Scientific Research (Middle East office), Sulaymaniyah 46001, Iraq
    Copyright: © Kakamad et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY 4.0].
  • Article Number: 63
    |
    Published online on: August 19, 2025
       https://doi.org/10.3892/mi.2025.262
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Abstract

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.
View Figures

Figure 1

Chest X-ray illustrating an enlarged
mediastinum.

Figure 2

A contrast-enhanced chest computed
tomography scan illustrating the following: (A) A large,
thin-walled cystic lesion in the anterior mediastinum. (B) The cyst
extending into both the right and left sides of the mediastinum,
with a greater extension towards the right. (C) On the right side,
the cyst extends further down to the level of the diaphragm.

Figure 3

Bilateral thoracic access with the
excised cyst wall: (A) Right side view, (B) left side view.

Figure 4

Multiple hematoxylin and eosin-stained
sections, demonstrating two types of epithelial cell lining,
stratified squamous epithelial cells (red arrows) and ciliated
columnar epithelial cells (green arrows), with the presence of
glial tissue (black stars) and sebaceous glands (black arrows),
with unremarkable thymic tissue (green stars) surrounded by adipose
tissue.
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Copy and paste a formatted citation
Spandidos Publications style
Kakamad FH, Hassan MN, Ali RM, Nasralla HA, Kakamad SH, Abdullah F, Abubaker GN, Ezzat MS, Kareem SA, Abdalla BA, Abdalla BA, et al: Giant mediastinal teratoma mimicking pericardial cyst: A case report with brief review of the literature. Med Int 5: 63, 2025.
APA
Kakamad, F.H., Hassan, M.N., Ali, R.M., Nasralla, H.A., Kakamad, S.H., Abdullah, F. ... Abdalla, B.A. (2025). Giant mediastinal teratoma mimicking pericardial cyst: A case report with brief review of the literature. Medicine International, 5, 63. https://doi.org/10.3892/mi.2025.262
MLA
Kakamad, F. H., Hassan, M. N., Ali, R. M., Nasralla, H. A., Kakamad, S. H., Abdullah, F., Abubaker, G. N., Ezzat, M. S., Kareem, S. A., Abdalla, B. A."Giant mediastinal teratoma mimicking pericardial cyst: A case report with brief review of the literature". Medicine International 5.6 (2025): 63.
Chicago
Kakamad, F. H., Hassan, M. N., Ali, R. M., Nasralla, H. A., Kakamad, S. H., Abdullah, F., Abubaker, G. N., Ezzat, M. S., Kareem, S. A., Abdalla, B. A."Giant mediastinal teratoma mimicking pericardial cyst: A case report with brief review of the literature". Medicine International 5, no. 6 (2025): 63. https://doi.org/10.3892/mi.2025.262
Copy and paste a formatted citation
x
Spandidos Publications style
Kakamad FH, Hassan MN, Ali RM, Nasralla HA, Kakamad SH, Abdullah F, Abubaker GN, Ezzat MS, Kareem SA, Abdalla BA, Abdalla BA, et al: Giant mediastinal teratoma mimicking pericardial cyst: A case report with brief review of the literature. Med Int 5: 63, 2025.
APA
Kakamad, F.H., Hassan, M.N., Ali, R.M., Nasralla, H.A., Kakamad, S.H., Abdullah, F. ... Abdalla, B.A. (2025). Giant mediastinal teratoma mimicking pericardial cyst: A case report with brief review of the literature. Medicine International, 5, 63. https://doi.org/10.3892/mi.2025.262
MLA
Kakamad, F. H., Hassan, M. N., Ali, R. M., Nasralla, H. A., Kakamad, S. H., Abdullah, F., Abubaker, G. N., Ezzat, M. S., Kareem, S. A., Abdalla, B. A."Giant mediastinal teratoma mimicking pericardial cyst: A case report with brief review of the literature". Medicine International 5.6 (2025): 63.
Chicago
Kakamad, F. H., Hassan, M. N., Ali, R. M., Nasralla, H. A., Kakamad, S. H., Abdullah, F., Abubaker, G. N., Ezzat, M. S., Kareem, S. A., Abdalla, B. A."Giant mediastinal teratoma mimicking pericardial cyst: A case report with brief review of the literature". Medicine International 5, no. 6 (2025): 63. https://doi.org/10.3892/mi.2025.262
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