Case 3

This is a CT study of the chest, showing a large anterior mediastinal mass which is oriented to the right side. The mass is well defined and shows extensive calcification on a background of solid soft tissue; the calcifications vary in form from amorphous to punctate, with a few of them resembling teeth. I note that there is no fat component in the mass.

It exerts mass pressure posteriorly and laterally on the right lung, compressing the right middle lobe bronchus and segmental bronchi of the right lower lobe, causing sub-segmental atelectasis.

There is no local invasion of adjacent structures.

The features of the mass, along with the young age of the patient, favour a diagnosis of mature teratoma.

The differential diagnosis includes malignant germ cell tumour; however, these are far less likely to contain extensive calcification and are typically found in young male adults.

I would raise this case for discussion at thoracic surgery MDT. The mainstay of treatment is surgical resection.