Introduction and importance: Mature mediastinal teratomas can rarely become symptomatic after a compression of surrounding organs and a rupture and are often treated with an emergency open approach such as median sternotomy. Clinical significance of thoracoscopic approach as elective setting is unknown.
Case presentation: A previously healthy 21-year-old man presented with worsening left-sided chest pain for one week. Chest computed tomography revealed a multilocular cystic mass with no evidence of great vessel invasion. A histopathological examination of the biopsy specimen revealed that the pancreatic glands and ductal elements were without any immature embryonic tissue, consistent with a mature teratoma. After the symptoms improved, he successfully underwent an elective video-assisted thoracic surgery as a substitute for an emergency median sternotomy.
Clinical discussion: The ectopic pancreatic tissue itself may not imply an emergency surgery and a comprehensive workup is essential for an optimal treatment strategy. Elective surgery is worthy of consideration as a therapeutic option.
Conclusion: Elective video-assisted thoracic surgery could be a feasible option even for a ruptured mature mediastinal teratoma in selected patients. Besides its maximum size, a large proportion of the cystic component and the absence of great vessel invasion may indicate the feasibility of a video-assisted thoracic surgery.
Keywords: Germinoma; Teratoma; Video-assisted thoracic surgery.
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