title: Adenocarcinoma with sarcomatous dedifferentiation arising from mature cystic teratoma of the anterior mediastinum.
abstract: Mediastinal teratoma with malignant transformation (TMT) is a very rare condition. A 44-year-old man presented with a large cystic mass of the anterior mediastinum. The tumor was surgically removed. The cystic mass was well demarcated, with an irregularly thickened wall. Histologically, the cystic wall was mainly lined by non-ciliated columnar epithelium and focally by squamous epithelium. A nodular part of the cystic wall revealed well-differentiated adenocarcinoma composed of tubulopapillary structures. Deep in the nodular tissue, neoplastic glands merged into undifferentiated sarcomatous cells. Immunohistochemically, CK7, CK19, and smad-4 were strongly and diffusely positive in adenocarcinoma. CD10 was focally positive on the luminal surface of the glands, and MUC5AC was also focally positive. TTF-1, cdx-2, and CK20 were negative in the adenocarinoma. Sarcomatous area showed diffuse strong positivity for vimentin, but was negative for the aforementioned epithelial markers. About 10 months postoperatively, a left pleural effusion had developed with multiple pleural nodules on computed tomography scan of the chest. The cytologic diagnosis from pleural fluid was metastatic adenocarcinoma. To our knowledge, in the English literature, this is the first case of adenocarcinoma with sarcomatous transformation that has developed in a mature cystic teratoma of the mediastinum and shows pleural metastasis.
authors.affiliation: Department of Pathology and Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
authors.forename: Jee-Yeon
authors.initials: JY
authors.lastname: Kim
authors.forename: Chang-Hun
authors.initials: CH
authors.lastname: Lee
authors.forename: Won-Young
authors.initials: WY
authors.lastname: Park
authors.forename: Ju-Yeon
authors.initials: JY
authors.lastname: Kim
authors.forename: Ah-Rong
authors.initials: AR
authors.lastname: Kim
authors.forename: Nari
authors.initials: N
authors.lastname: Shin
authors.forename: Do-Youn
authors.initials: DY
authors.lastname: Park
authors.forename: Gi-Yeong
authors.initials: GY
authors.lastname: Huh
mesh_terms: D000230:Adenocarcinoma / Q000378:metabolism / Q000473:pathology*; D000328:Adult; D014408:Biomarkers, Tumor / Q000378:metabolism; D054337:Cell Dedifferentiation; D002471:Cell Transformation, Neoplastic; D006801:Humans; D059012:Lost to Follow-Up; D008297:Male; D008479:Mediastinal Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D016066:Pleural Effusion, Malignant / Q000175:diagnosis; D010997:Pleural Neoplasms / Q000378:metabolism / Q000473:pathology*; D012509:Sarcoma / Q000378:metabolism / Q000473:pathology*; D013724:Teratoma / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D014057:Tomography, X-Ray Computed
chemical_list: D014408:Biomarkers, Tumor