|LETTER TO EDITOR
|Year : 2016 | Volume
| Issue : 4 | Page : 279-280
EUS-FNA diagnosis of a rare case of esophageal teratoma
Benedetto Mangiavillano1, Antonella De Ceglie1, Paolo Quilici2, Corrado Ruggeri2
1 Department of Gastroenterology and Gastrointestinal Endoscopy, General Hospital, Sanremo, Italy
2 Department of Pathological Anatomy, General Hospital, Sanremo, Italy
|Date of Web Publication||5-Aug-2016|
Gastroenterology and Gastrointestinal Endoscopy, General Hospital, Sanremo
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mangiavillano B, De Ceglie A, Quilici P, Ruggeri C. EUS-FNA diagnosis of a rare case of esophageal teratoma. Endosc Ultrasound 2016;5:279-80
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  and is known as well for its high accuracy and low complication rate.  Moreover, EUS-FNA has proven to be helpful in obtaining tissue samples from mediastinal lesions. , Different tricks to improve the diagnostic yield of EUS-FNA have been proposed. 
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. 
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.
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[Figure 1], [Figure 2], [Figure 3]