EUS-FNA diagnosis of a rare case of esophageal teratoma.

Dear Editor,

Endoscopic ultrasonography (EUS)-guided fine-needle aspiration (FNA) with tissue acquisition plays a pivotal role in the diagnosis of different diseases of the gastrointestinal tract and adjacent structures[1] and is known as well for its high accuracy and low complication rate.[2] Moreover, EUS-FNA has proven to be helpful in obtaining tissue samples from mediastinal lesions.[34] Different tricks to improve the diagnostic yield of EUS-FNA have been proposed.[5]

Germ cell tumor (GCT) differs in frequency in children when compared to adults. Only a smaller proportion of GCTs are present in adults, showing different pathogenesis and features from prepubertal age. Teratoma is almost uniformly benign in children but generally malignant in the older patients.[6]

A 52-year-old man was admitted to our unit for suspicion of a mediastinal mass. At the age of 13 years he underwent orchiectomy plus retroperitoneal lymphadenectomy for an embryonal carcinoma, and 7 years ago, thoracic and left sovraclavear lymphadenectomy for teratocarcinoma metastases, followed by chemotherapy.

In March 2015, a follow-up computed tomography (CT)-positron emission tomography (PET) diagnosed a nodular mass of about 3 cm, above the right atrium, closer to the esophageal wall, not confirmed by magnetic resonance imaging (MRI), which showed only an esophageal diverticulum with a partially solid tissue.

Mediastinal EUS evidenced, at the middle third of the esophagus inside the submucosal layers, a type-mixed, ovular-shaped lesion of 3 cm, with an anechoic area and a remnant solid ipoechoic tissue, close to the ascending aorta [Figure 1]. A 25-gauge FNA, with two passes, was performed with rapid on-site evaluation (ROSE) by a pathologist [Figure 2]. Cytology showed neoplastic cells [Figure 3]. The patient was then referred to surgery, and histology diagnosed a teratoma.

Figure 1

EUS radial findings of the esophageal teratoma

Figure 2

EUS-FNA of the esophageal teratoma

Figure 3

Neoplastic cells revealed at cytopathology examination

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Conflicts of interest

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