INTRAPULMONARY TERATOMA: A RARE PRESENTATION OF BRONCHIECTASIS

TOPIC: Lung Pathology TYPE: Medical Student/Resident Case Reports INTRODUCTION: Intrapulmonary teratomas (IPT) are a rare extra-gonadal manifestation of and challenging diagnosis to make. We present patient with IPT presenting hemoptysis. CASE PRESENTATION: A 49-year-old man presented intermittent non-massive hemoptysis throughout the previous year. Labs were normal exception normocytic anemia hemoglobin 12.1 g/dL. CT chest contrast revealed necrotic mass in central left upper lobe invading bronchus obliterating pulmonary artery severe bronchiectatic changes. Multiple mediastinal lymph nodes enlarged. Flexible bronchoscopy was performed demonstrated occlusion dense, white mass, hair-like material within bronchus. Attempts at biopsy cryoprobe friable mucosa that easily bled. No intervention necessary as spontaneous hemostasis occurred. forceps unsuccessful because calcified material. As result, used. Cryoprobe biopsies inflammatory cells without evidence malignancy. Cultures including bacterial, fungal, AFB negative. Lack diagnosis, bronchiectasis, recurrent prompted recommendation for resection, he underwent thoracotomy interpleural pneumolysis. Due involvement artery, lung sparing surgery could not be safely achieved ultimately required pneumonectomy. Final pathology consistent teratoma. DISCUSSION: Teratomas germ cell tumors commonly located sacrococcygeal region, anterior mediastinum, retroperitoneum, cranium, ovary, or gonads. Rarely they intrapulmonary location (1). Less than 100 cases have been reported date, usually lobe. (2,7). Patients pain, cough, fever, dyspnea, pneumonia (5). may expectorate hair (trichoptysis), which is considered pathognomonic (3). Untreated, patients risk malignant transformation, tumor rupture, hemoptysis, airway obstruction from compression. shows well-defined round lobulated masses smooth contour areas peripheral translucency contain fat, calcium, fluid (5,6). Irregular ill-defined margins can suggest transformation (4).The only definitive treatment complete surgical resection often made concomitantly gross pathology. Early crucial order prevent complications (6). CONCLUSIONS: cause endobronchial highlights need early bronchoscopic evaluation critical provide treatment. REFERENCE #1: Khan J, Aslam F, Fatimi S, Ahmed R. Cough, fever cavitary lesion-an J Postgrad Med. 2005;51(4):330-1. #2: Faria RA, Bizon JA, Junior RS, Neto VD, Botter M, Saieg MA. Bras Pneumol 2007; 33: 612– 615. #3: Siddiqui, F.A., Jain, A., Maheshwari, V. Beg, M.H. (2010), FNA teratoma lung: case report. Diagn. Cytopathol., 38: 758-760. https://doi.org/10.1002/dc.21318Webb, W., Brant, W. E., & Helms, C. A. (1991). Fundamentals Body (1st ed.). Philadelphia, PA: B. Saunders Company.Sasaka, K., Kurihara, Y., Nakajima, Seto, Endo, I., Ishikawa, T., Takagi, M. (1998). Spontaneous rupture: complication benign mature mediastinum. American Journal Roentgenology, 170(2), 323-328. doi:10.2214/ajr.170.2.9456938 Mardani P, Naseri R, Amirian A, et al. cystic report entity. BMC Surgery. 2020;20:1-6. Ditah C, Templin T, Mandal Pinchot JW, Macke RA. Isolated Thorac Cardiovasc Surg. 2016 Dec;152(6):e129-e131. doi: 10.1016/j.jtcvs.2016.07.056. Epub Aug 5. PMID: 27576374. DISCLOSURES: relevant relationships by Beren Chandler, source=Web Response Garret Duron, Lindsey Goldberg, Joanna Kosko, Jason McClune, Lourens Willekes,