Physiological activity in mediastinal teratomata

The clinical details of two patients with benign mediastinal teratomata are presented. Both patients developed inflammation of the root of the neck, the first after a small dose of radiotherapy and the second after a larger dose of radiotherapy and exploration of the thoracic inlet. In both cases, exploration of the inflamed area was followed by persistent discharge of fluid which was sterile on culture. In the first case, this was found to have a high cholesterol, lipid, and amylase content. In both cases, a benign mixed teratoma, with contents including intestinal epithelium and pancreatic tissue, was removed at thoracotomy. The suggestion is made that leakage of digestive enzymes from pancreatic, intestinal or salivary tissue may be a cause of inflammation in and around teratomata, especially after surgical exploration. Early thoracotomy is advised when the condition is recognized.